I 

108TH CONGRESS 

1ST SESSION H. R. 2069

To amend the Foreign Assistance Act of 1961 to provide increased foreign 

assistance for tuberculosis prevention, treatment, and control, and for 

other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 13, 2003

Mr. BROWN of Ohio (for himself and Mrs. WILSON of New Mexico) introduced 

the following bill; which was referred to the Committee on International 

Relations, and in addition to the Committee on Energy and Commerce, 

for a period to be subsequently determined by the Speaker, in each case 

for consideration of such provisions as fall within the jurisdiction of the 

committee concerned 

A BILL

To amend the Foreign Assistance Act of 1961 to provide 

increased foreign assistance for tuberculosis prevention, 

treatment, and control, and for other purposes.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Stop Tuberculosis 

5 (TB) Now Act’’. 

6 SEC. 2. FINDINGS. 

7 Congress finds the following: 
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1 (1)(A) Tuberculosis is a great health and eco2 nomic burden to impoverished nations and a health 

3 and security threat to the United States and other 

4 industrialized countries. 

5 (B) Tuberculosis is one of the greatest infec6 tious causes of death of adults worldwide, killing 

7 nearly 2,000,000 people per year—one person every 

8 15 seconds. 

9 (2) An estimated 8,000,000 individuals develop 

10 active tuberculosis each year. 

11 (3) Today, tuberculosis is the leading killer of 

12 women of reproductive age and of people who are 

13 HIV-positive. 

14 (4) Tuberculosis is spreading as a result of in15 adequate treatment and is a disease that knows no 

16 national borders. 

17 (5) With over 50 percent of tuberculosis cases 

18 in the United States attributable to foreign-born in19 dividuals and with the increase in international trav20 el, commerce, and migration, elimination of tuber21 culosis in the United States depends on efforts to 

22 control the disease in developing countries. 

23 (6) The threat that tuberculosis poses for 

24 Americans derives from the global spread of tuber-
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1 culosis and the emergence and spread of strains of 

2 multi-drug resistant tuberculosis (MDR–TB). 

3 (7) Up to 50,000,000 individuals may be in4 fected with multi-drug resistant tuberculosis. 

5 (8) In the United States, tuberculosis treat6 ment, normally about $2,000 per patient, increases 

7 to as much as $1,000,000 per patient to treat multi8 drug resistant tuberculosis, and treatment may not 

9 even be successful. 

10 (9) Without access to treatment, multi-drug re11 sistant tuberculosis is a virtual death sentence. 

12 (10) There is a highly effective and inexpensive 

13 treatment for standard tuberculosis. Recommended 

14 by the World Health Organization (WHO) as the 

15 best curative method for tuberculosis, this strategy, 

16 known as DOTS (Directly Observed Treatment 

17 Short-course), includes low-cost effective diagnosis, 

18 treatment, monitoring, and record keeping, as well 

19 as a reliable drug supply. A centerpiece of DOTS is 

20 observing patients to ensure that they take their 

21 medication and complete treatment. 

22 (11) DOTS is one of the most cost-effective 

23 health interventions available today. A full course of 

24 DOTS drugs costs as little as $10 in low-income 

25 countries. 
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1 (12) Proper DOTS treatment is imperative to 

2 prevent the development of dangerous multi-drug re3 sistant tuberculosis that arises through improper or 

4 incomplete tuberculosis treatment. 

5 (13) Building upon the DOTS strategy, DOTS6 Plus is a comprehensive tuberculosis management 

7 strategy that works as a supplement to the standard 

8 DOTS strategy to address areas where there is high 

9 prevalence of multi-drug resistant tuberculosis. 

10 (14) The Global Fund to Fight AIDS, Tuber11 culosis and Malaria is an important new global part12 nership established to combat these 3 infectious dis13 eases that together kill 6,000,000 people a year. Ex14 pansion of effective tuberculosis treatment programs 

15 constitutes a major component of Global Fund in16 vestment, along with integrated efforts to address 

17 HIV and tuberculosis in areas of high prevalence. 

18 (15) The Centers for Disease Control and Pre19 vention (CDC) is actively involved with global tuber20 culosis control efforts since the global tuberculosis 

21 epidemic directly impacts tuberculosis in the United 

22 States, and because Congress has strongly urged the 

23 CDC each year to increase its involvement with 

24 international tuberculosis control efforts. 
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1 (16) The CDC is assisting countries with a high 

2 burden of tuberculosis—

3 (A) to implement the World Health Orga4 nization-recommended control strategies, DOTS 

5 and DOTS-Plus; 

6 (B) to identify and treat persons with 

7 multi-drug resistant tuberculosis; and 

8 (C) to conduct research to identify new 

9 diagnostics, treatments, and interventions to 

10 control tuberculosis. 

11 SEC. 3. FOREIGN ASSISTANCE FOR TUBERCULOSIS PRE12 VENTION, TREATMENT, AND CONTROL. 

13 (a) AMENDMENT TO FOREIGN ASSISTANCE ACT OF

14 1961.—Chapter 1 of part I of the Foreign Assistance Act 

15 of 1961 (22 U.S.C. 2151 et seq.) is amended by inserting 

16 after section 104 the following new section: 

17 ‘‘SEC. 104A. ASSISTANCE FOR TUBERCULOSIS PREVENTION, 

18 TREATMENT, AND CONTROL. 

19 ‘‘(a) STATEMENT OF POLICY.—Congress recognizes 

20 the growing international problem of tuberculosis and the 

21 impact its continued existence has on those nations that 

22 had previously largely controlled the disease. Congress fur23 ther recognizes that the means exist to control and treat 

24 tuberculosis, and that it is therefore a major objective of 

25 the foreign assistance program to control the disease.
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1 ‘‘(b) ASSISTANCE.—

2 ‘‘(1) IN GENERAL.—In meeting the objective 

3 described in subsection (a), the President shall pro4 vide assistance for the prevention, treatment, and 

5 control of tuberculosis. 

6 ‘‘(2) ADDITIONAL REQUIREMENTS.—In car7 rying out paragraph (1), the President shall—

8 ‘‘(A) coordinate with the World Health Or9 ganization (WHO), the Global Fund to Fight 

10 AIDS, Tuberculosis and Malaria, the Depart11 ment of Health and Human Services (including 

12 Centers for Disease Control and Prevention and 

13 the National Institutes of Health), and other 

14 organizations with respect to the development 

15 and implementation of a comprehensive tuber16 culosis control program; 

17 ‘‘(B) set as a goal the detection of at least 

18 70 percent of the cases of infectious tuber19 culosis, the cure of at least 85 percent of the 

20 cases detected by focusing efforts on the use of 

21 the Directly Observed Treatment Short-course 

22 (DOTS) strategy or other internationally ac23 cepted primary tuberculosis control strategies, 

24 in those countries in which the United States 

25 Agency for International Development has es-
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1 tablished development programs, by December 

2 31, 2010, and the reduction of tuberculosis-re3 lated deaths by 50 percent, by December 31, 

4 2010; and 

5 ‘‘(C) give priority to activities that increase 

6 Directly Observed Treatment Short-course 

7 (DOTS) coverage and treatment of multi-drug 

8 resistant tuberculosis where needed using 

9 DOTS-Plus, including funding for the Global 

10 Tuberculosis Drug Facility, the Stop Tuber11 culosis Partnership, and the Global Alliance for 

12 TB Drug Development. 

13 ‘‘(c) ALLOCATION OF FUNDS.—In carrying out sub14 section (b), the President shall ensure that—

15 ‘‘(1) not less than 75 percent of the amount 

16 made available to carry out this section for a fiscal 

17 year shall be expended for antituberculosis drugs, 

18 supplies, direct patient services, and training in di19 agnosis and treatment for Directly Observed Treat20 ment Short-course (DOTS) coverage and treatment 

21 of multi-drug resistant tuberculosis using DOTS22 Plus; and 

23 ‘‘(2) not less than 10 percent of the amount 

24 made available to carry out this section for a fiscal 

25 year shall be expended to provide a United States 
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1 contribution to the Global Tuberculosis Drug Facil2 ity. 

3 ‘‘(d) ANNUAL REPORT.—Not later than January 31 

4 of each year, the President shall transmit to the appro5 priate congressional committees a report that contains a 

6 summary of all programs, projects, and activities carried 

7 out under this section for the preceding fiscal year, includ8 ing a description of the increase in the number of individ9 uals treated and cured through each program, project, and 

10 activity. 

11 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—

12 ‘‘(1) IN GENERAL.—There are authorized to be 

13 appropriated to the President to carry out this sec14 tion $200,000,000 for each of the fiscal years 2004 

15 and 2005. 

16 ‘‘(2) AVAILABILITY.—Amounts appropriated 

17 pursuant to the authorization of appropriations 

18 under paragraph (1) are authorized to remain avail19 able until expended. 

20 ‘‘(f) DEFINITIONS.—In this section: 

21 ‘‘(1) APPROPRIATE CONGRESSIONAL COMMIT22 TEES.—The term ‘appropriate congressional com23 mittees’ means the Committee on International Re24 lations of the House of Representatives and the 

25 Committee on Foreign Relations of the Senate. 
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1 ‘‘(2) DOTS.—The term ‘DOTS’ or ‘Directly 

2 Observed Treatment Short-course’ means the World 

3 Health Organization-recommended strategy for 

4 treating tuberculosis. 

5 ‘‘(3) DOTS-PLUS.—The term ‘DOTS-Plus’ 

6 means a comprehensive tuberculosis management 

7 strategy that is built upon and works as a supple8 ment to the standard DOTS strategy, and which 

9 takes into account specific issues (such as use of sec10 ond line anti-tuberculosis drugs) that need to be ad11 dressed in areas where there is high prevalence of 

12 multi-drug resistant tuberculosis. 

13 ‘‘(4) GLOBAL ALLIANCE FOR TUBERCULOSIS

14 DRUG DEVELOPMENT.—The term ‘Global Alliance 

15 for Tuberculosis Drug Development’ means the pub16 lic-private partnership that brings together leaders 

17 in health, science, philanthropy, and private industry 

18 to ensure that new medications are available and af19 fordable in high tuberculosis burden countries and 

20 other affected countries. 

21 ‘‘(5) GLOBAL TUBERCULOSIS DRUG FACIL22 ITY.—The term ‘Global Tuberculosis Drug Facility 

23 (GDF)’ means the new initiative of the Stop Tuber24 culosis Partnership to increase access to high-quality 

25 tuberculosis drugs to facilitate DOTS expansion. 
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1 ‘‘(6) STOP TUBERCULOSIS PARTNERSHIP.—The 

2 term ‘Stop Tuberculosis Partnership’ means the 

3 partnership of the World Health Organization, do4 nors including the United States, high tuberculosis 

5 burden countries, multilateral agencies, and non6 governmental and technical agencies committed to 

7 short- and long-term measures required to control 

8 and eventually eliminate tuberculosis as a public 

9 health problem in the world.’’. 

10 (b) CONFORMING AMENDMENT.—Section 104(c) of 

11 the Foreign Assistance Act of 1961 (22 U.S.C. 2151b(c)) 

12 is amended by striking paragraph (7). 

13 (c) EFFECTIVE DATE.—The amendments made by 

14 this section shall take effect on October 1, 2003, or the 

15 date of the enactment of this Act, whichever occurs later. 

16 SEC. 4. AUTHORIZATION OF APPROPRIATIONS FOR GLOB17 AL TUBERCULOSIS ACTIVITIES OF THE CEN18 TERS FOR DISEASE CONTROL AND PREVEN19 TION. 

20 For the purpose of carrying out global tuberculosis 

21 activities through the Centers for Disease Control and 

22 Prevention, there are authorized to be appropriated 

23 $30,000,000 for fiscal year 2004, and such sums as may 

24 be necessary for fiscal year 2005. Such authorization is 

25 in addition to other authorizations of appropriations that 
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1 are available for such purpose. Amounts appropriated 

2 under this section shall remain available until expended.

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