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[House Report 110-381]
[From the U.S. Government Publishing Office]

110th Congress                                            Rept. 110-381
                        HOUSE OF REPRESENTATIVES
 1st Session                                                     Part 1

======================================================================

 
                 STOP TUBERCULOSIS (TB) NOW ACT OF 2007

                                _______
                                

                October 15, 2007.--Ordered to be printed

                                _______
                                

   Mr. Lantos, from the Committee on Foreign Affairs, submitted the 
                               following

                              R E P O R T

                        [To accompany H.R. 1567]

      [Including cost estimate of the Congressional Budget Office]

  The Committee on Foreign Affairs, to whom was referred the 
bill (H.R. 1567) to amend the Foreign Assistance Act of 1961 to 
provide increased assistance for the prevention, treatment, and 
control of tuberculosis, and for other purposes, having 
considered the same, reports favorably thereon with an 
amendment and recommends that the bill as amended do pass.

                           TABLE OF CONTENTS

                                                                   Page
The Amendment....................................................     2
Summary..........................................................     5
Background and Purpose for the Legislation.......................     5
Hearings.........................................................     6
Committee Consideration..........................................     6
Votes of the Committee...........................................     6
Committee Oversight Findings.....................................     6
New Budget Authority and Tax Expenditures........................     7
Congressional Budget Office Cost Estimate........................     7
Intergovernmental and Private Sector Impact......................     8
Performance Goals and Objectives.................................     8
Constitutional Authority Statement...............................     8
New Advisory Committees..........................................     8
Congressional Accountability Act.................................     8
Earmark Identification...........................................     8
Section-by-Section Analysis and Discussion.......................     8
Changes in Existing Law Made by the Bill, as Reported............     9

                               Amendment

  The amendment is as follows:
  Strike all after the enacting clause and insert the 
following:

SECTION 1. SHORT TITLE.

  This Act may be cited as the ``Stop Tuberculosis (TB) Now Act of 
2007''.

SEC. 2. FINDINGS.

  Congress finds the following:
          (1) Tuberculosis is one of the greatest infectious causes of 
        death of adults worldwide, killing 1.6 million people per 
        year--one person every 20 seconds.
          (2) One-third of the world's population is infected with the 
        tuberculosis bacterium and an estimated 8.8 million individuals 
        develop active tuberculosis each year.
          (3) Tuberculosis is the leading infectious killer among 
        individuals who are HIV-positive due to their weakened immune 
        systems, and it is estimated that one-third of people with HIV 
        infection have tuberculosis.
          (4) Today, tuberculosis is a leading killer of women of 
        reproductive age.
          (5) There are 22 countries that account for 80 percent of the 
        world's burden of tuberculosis. The People's Republic of China 
        and India account for 36 percent of all estimated new 
        tuberculosis cases each year.
          (6) Driven by the HIV/AIDS pandemic, incidence rates of 
        tuberculosis in Africa have more than doubled on average since 
        1990. The problem is so pervasive that in August 2005, African 
        Health Ministers and the World Health Organization (WHO) 
        declared tuberculosis to be an emergency in Africa.
          (7) The wide extent of drug resistance, including both multi-
        drug resistant tuberculosis (MDR-TB) and extensively drug 
        resistant tuberculosis (XDR-TB), represents both a critical 
        challenge to the global control of tuberculosis and a serious 
        worldwide public health threat. XDR-TB, which is characterized 
        as being MDR-TB with additional resistance to multiple second-
        line anti-tuberculosis drugs, is associated with worst 
        treatment outcomes of any form of tuberculosis. XDR-TB is 
        converging with the HIV epidemic, undermining gains in HIV 
        prevention and treatment programs and requires urgent 
        interventions. Drug resistance surveillance reports have 
        confirmed the serious scale and spread of tuberculosis with 
        XDR-TB strains confirmed on six continents. Demonstrating the 
        lethality of XDR-TB, an initial outbreak in Tugela Ferry, South 
        Africa, in 2006 killed 52 of 53 patients with hundreds more 
        cases reported since that time. Of the world's regions, sub-
        Saharan Africa, faces the greatest gap in capacity to prevent, 
        find, and treat XDR-TB.
          (8) With more than 50 percent of tuberculosis cases in the 
        United States attributable to foreign-born individuals and with 
        the increase in international travel, commerce, and migration, 
        elimination of tuberculosis in the United States depends on 
        efforts to control the disease in developing countries. Recent 
        research has shown that to invest in tuberculosis control 
        abroad, where treatment and program costs are significantly 
        cheaper than in the United States, would be a cost-effective 
        strategy to reduce tuberculosis-related morbidity and mortality 
        domestically.
          (9) The threat that tuberculosis poses for Americans derives 
        from the global spread of tuberculosis and the emergence and 
        spread of strains of multi-drug resistant tuberculosis and 
        extensively drug resistant tuberculosis, which are far more 
        deadly, and more difficult and costly to treat.
          (10) DOTS (Directly Observed Treatment Short-course) is one 
        of the most cost-effective health interventions available today 
        and is a core component of the new Stop TB Strategy.
          (11) The Stop TB Strategy, developed by the World Health 
        Organization, builds on the success of DOTS and ongoing 
        challenges so as to serve all those in need and reach targets 
        for prevalence, mortality, and incidence reduction. The Stop TB 
        Strategy includes six components:
                  (A) Pursuing high-quality expansion and enhancement 
                of DOTS coverage.
                  (B) Implementing tuberculosis and HIV collaborative 
                activities, preventing and controlling multi-drug 
                resistant tuberculosis, and addressing other special 
                challenges.
                  (C) Contributing to the strengthening of health 
                systems.
                  (D) Engaging all health care providers, including 
                promotion of the International Standards for 
                Tuberculosis Care.
                  (E) Empowering individuals with tuberculosis and 
                communities.
                  (F) Enabling and promoting research to develop new 
                diagnostics, drugs, vaccines, and program-based 
                operational research relating to tuberculosis.
          (12) The Global Plan to Stop TB 2006-2015: Actions for Life 
        is a comprehensive plan developed by the Stop TB Partnership 
        that sets out the actions necessary to achieve the millennium 
        development goal of cutting tuberculosis deaths and disease 
        burden in half by 2015 and thus eliminate tuberculosis as a 
        global health problem by 2050.
          (13) While innovations such as the Global Tuberculosis Drug 
        Facility have enabled low-income countries to treat a standard 
        case of tuberculosis with drugs that cost as little as $16 for 
        a full course of treatment, there are still millions of 
        individuals with no access to effective treatment.
          (14) As the global resource investment in fighting 
        tuberculosis increases, partner nations and international 
        institutions must commit to a corresponding increase in the 
        technical and program assistance necessary to ensure that the 
        most effective and efficient tuberculosis treatments are 
        provided.
          (15) The Global Fund to Fight AIDS, Tuberculosis and Malaria 
        is an important global partnership established to combat these 
        three infectious diseases that together kill millions of people 
        a year. Expansion of effective tuberculosis treatment programs 
        constitutes a major component of Global Fund investment, along 
        with integrated efforts to address HIV and tuberculosis in 
        areas of high prevalence.
          (16) The United States Agency for International Development 
        and the Centers for Disease Control and Prevention are actively 
        involved with global tuberculosis control efforts. Because the 
        global tuberculosis epidemic directly impacts tuberculosis in 
        the United States, Congress has urged the Centers for Disease 
        Control and Prevention each year to increase its involvement 
        with international tuberculosis control efforts.
          (17) The United States Agency for International Development 
        is the lead United States Government agency for international 
        tuberculosis efforts, working in close partnership with the 
        Centers for Disease Control and Prevention and with the 
        President's Emergency Plan for HIV/AIDS Relief. The goal of the 
        United States Agency for International Development is to 
        contribute to the global reduction of morbidity and mortality 
        associated with tuberculosis by building country capacity to 
        prevent and cure tuberculosis and achieve global targets of 70 
        percent case detection and 85 percent treatment success rates. 
        The United States Agency for International Development provides 
        support for tuberculosis programs in countries that have a high 
        burden of tuberculosis, a high prevalence of tuberculosis and 
        HIV, and a high risk of MDR-TB.

SEC. 3. ASSISTANCE TO COMBAT TUBERCULOSIS.

  (a) Policy.--Subsection (b) of section 104B of the Foreign Assistance 
Act of 1961 (22 U.S.C. 2151b-3) is amended to read as follows:
  ``(b) Policy.--It is a major objective of the foreign assistance 
program of the United States to control tuberculosis. In all countries 
in which the Government of the United States has established 
development programs, particularly in countries with the highest burden 
of tuberculosis and other countries with high rates of tuberculosis, 
the United States Government should prioritize the achievement of the 
following goals by not later than December 31, 2015:
          ``(1) Reduce by half the tuberculosis death and disease 
        burden from the 1990 baseline.
          ``(2) Sustain or exceed the detection of at least 70 percent 
        of sputum smear-positive cases of tuberculosis and the cure of 
        at least 85 percent of those cases detected.''.
  (b) Authorization.--Subsection (c) of such section is amended--
          (1) in the heading, by striking ``Authorization'' and 
        inserting ``Assistance Required''; and
          (2) by striking ``is authorized to'' and inserting ``shall''.
  (c) Priority To Stop TB Strategy.--Subsection (e) of such section is 
amended--
          (1) in the heading, to read as follows: ``Priority To Stop TB 
        Strategy.--'';
          (2) in the first sentence, by striking ``In furnishing'' and 
        all that follows through ``, including funding'' and inserting 
        the following:
          ``(1) Priority.--In furnishing assistance under subsection 
        (c), the President shall give priority to--
                  ``(A) activities described in the Stop TB Strategy, 
                including expansion and enhancement of DOTS coverage, 
                treatment for individuals infected with both 
                tuberculosis and HIV and treatment for individuals with 
                multi-drug resistant tuberculosis (MDR-TB), 
                strengthening of health systems, use of the 
                International Standards for Tuberculosis Care by all 
                providers, empowering individuals with tuberculosis, 
                and enabling and promoting research to develop new 
                diagnostics, drugs, and vaccines, and program-based 
                operational research relating to tuberculosis; and
                  ``(B) funding''; and
          (3) in the second sentence--
                  (A) by striking ``In order to'' and all that follows 
                through ``not less than'' and inserting the following:
          ``(2) Availability of amounts.--In order to meet the 
        requirements of paragraph (1), the President--
                  ``(A) shall ensure that not less than'';
                  (B) by striking ``for Directly Observed Treatment 
                Short-course (DOTS) coverage and treatment of multi-
                drug resistant tuberculosis using DOTS-Plus,'' and 
                inserting ``to implement the Stop TB Strategy; and''; 
                and
                  (C) by striking ``including'' and all that follows 
                and inserting the following:
                  ``(B) should ensure that not less than $15,000,000 of 
                the amount made available to carry out this section for 
                a fiscal year is used to make a contribution to the 
                Global Tuberculosis Drug Facility.''.
  (d) Assistance for WHO and the Stop Tuberculosis Partnership.--Such 
section is further amended--
          (1) by redesignating subsection (f) as subsection (g); and
          (2) by inserting after subsection (e) the following new 
        subsection:
  ``(f) Assistance for WHO and the Stop Tuberculosis Partnership.--In 
carrying out this section, the President, acting through the 
Administrator of the United States Agency for International 
Development, is authorized to provide increased resources to the World 
Health Organization (WHO) and the Stop Tuberculosis Partnership to 
improve the capacity of countries with high rates of tuberculosis and 
other affected countries to implement the Stop TB Strategy and specific 
strategies related to addressing extensively drug resistant 
tuberculosis (XDR-TB).''.
  (e) Definitions.--Subsection (g) of such section, as redesignated by 
subsection (d)(1), is amended--
          (1) in paragraph (1), by adding at the end before the period 
        the following: ``, including low cost and effective diagnosis 
        and evaluation of treatment regimes, vaccines, and monitoring 
        of tuberculosis, as well as a reliable drug supply, and a 
        management strategy for public health systems, with health 
        system strengthening, promotion of the use of the International 
        Standards for Tuberculosis Care by all care providers, 
        bacteriology under an external quality assessment framework, 
        short-course chemotherapy, and sound reporting and recording 
        systems''; and
          (2) by adding after paragraph (5) the following new 
        paragraph:
          ``(6) Stop tb strategy.--The term `Stop TB Strategy' means 
        the six-point strategy to reduce tuberculosis developed by the 
        World Health Organization. The strategy is described in the 
        Global Plan to Stop TB 2007-2016: Actions for Life, a 
        comprehensive plan developed by the Stop Tuberculosis 
        Partnership that sets out the actions necessary to achieve the 
        millennium development goal of cutting tuberculosis deaths and 
        disease burden in half by 2016.''.
  (f) Annual Report.--Clause (iii) of section 104A(e)(2)(C) of the 
Foreign Assistance Act of 1961 (22 U.S.C. 2151b-2(e)(2)(C)) is amended 
by adding at the end before the semicolon the following: ``, including 
the percentage of such United States foreign assistance provided for 
diagnosis and treatment of individuals with tuberculosis in countries 
with the highest burden of tuberculosis, as determined by the World 
Health Organization (WHO)''.
  (g) Authorization of Appropriations.--
          (1) In general.--There are authorized to be appropriated to 
        the President not more than $400,000,000 for fiscal year 2008 
        and not more than $550,000,000 for fiscal year 2009 to carry 
        out section 104B of the Foreign Assistance Act of 1961 (22 
        U.S.C. 2151b-3), as amended by subsections (a) through (e) of 
        this section.
          (2) Funding for cdc.--Of the amounts appropriated pursuant to 
        the authorization of appropriations under paragraph (1), not 
        more than $70,000,000 for fiscal year 2008 and not more than 
        $100,000,000 for fiscal year 2009 shall be made available for 
        the purpose of carrying out global tuberculosis activities 
        through the Centers for Disease Control and Prevention.
          (3) Additional provisions.--Amounts appropriated pursuant to 
        the authorization of appropriations under paragraph (1) and 
        amounts made available pursuant to paragraph (2)--
                  (A) are in addition amounts otherwise made available 
                for such purposes; and
                  (B) are authorized to remain available until 
                expended.

                                Summary

    The Stop Tuberculosis (TB) Now Act of 2007 amends the 
Foreign Assistance Act of 1961 to require the President to 
furnish assistance for tuberculosis (TB) prevention, treatment, 
and elimination. The Act gives priority to activities described 
in the Stop TB Strategy of the World Health Organization (WHO), 
and revises related fund use provisions. The Act authorizes the 
President, through the United States Agency for International 
Development (USAID), to provide increased resources to the 
World Health Organization (WHO) and the Stop Tuberculosis 
Partnership to improve the capacity of countries with high TB 
rates and other affected countries to implement the Stop TB 
Strategy and specific strategies related to addressing 
extensively drug resistant tuberculosis (XDR-TB). It also 
authorizes appropriations for Centers for Disease Control and 
Prevention (CDC) TB activities.

               Background and Purpose for the Legislation

    The Stop TB Act responds to the global tuberculosis crisis 
that has the potential to kill millions of individuals 
worldwide and introduce new strains of resistant tuberculosis 
in the United States. Worldwide, tuberculosis has one of the 
highest death rates for adults who contract an infectious 
disease, killing 1.6 million people per year--one person every 
15 seconds. One-third of the world's population is infected 
with the tuberculosis bacterium and an estimated 8.8 million 
individuals develop active tuberculosis each year.
    The emergence of both multi-drug resistant tuberculosis 
(MDR-TB) and extensively drug resistant tuberculosis (XDR-TB), 
represents both a critical challenge to the global control of 
tuberculosis and a serious worldwide public health threat. 
Demonstrating the lethality of XDR-TB, an initial outbreak in 
Tugela Ferry, South Africa killed 52 of 53 patients, with 
hundreds more cases reported since. Between October 2006 and 
May 2007, KwaZulu-Natal province in South Africa had at least 
1,000 diagnosed XDR-TB patients with the death rate of 100 
percent. Now, MDR-TB has been reported in all regions of the 
world and, according to the WHO, over 400,000 cases are 
emerging every year due to under investment in basic TB 
control, poor management of anti-TB drugs and to transmission 
of drug-resistant strains.
    One of the Committee's greatest concerns is the coinfection 
of tuberculosis and HIV/AIDS. Studies worldwide have shown that 
tuberculosis is the leading infectious killer among individuals 
who are HIV-positive. According to the Joint United Nations 
Programme on HIV/AIDS (UNAIDS), about 42 million people are 
HIV-infected and almost one-third are also infected with TB. In 
many African countries, more than 50 percent of patients with 
active TB disease are also HIV-positive. Persons infected with 
both HIV and TB are 30 times more likely to progress to active 
TB disease. Also, recent studies have shown that infection with 
TB enhances replication of HIV and may accelerate the 
progression of HIV infection to AIDS.
    The U.S. Government has invested heavily through the 
President's Emergency Plan for AIDS Relief (PEPFAR) in 
prevention, treatment, and care programs to address the HIV/
AIDS pandemic. In FY2006, Congress provided almost $3.4 billion 
for the PEPFAR programs targeting the 15 most heavily HIV/AIDS 
impacted countries in the world, primarily in Africa. While the 
PEPFAR program includes some funding to identify and treat HIV/
AIDS patients with TB, its resources are not intended for broad 
tuberculosis testing and treatment. However, if the 1.1 million 
men, women, and children on antiretrovirals through PEPFAR live 
in households and communities that do not have access to 
tuberculosis services, their chances of contracting the disease 
and dying are greatly increased, thereby reversing the 
substantial efforts of the U.S. Government.
    The threat that the global tuberculosis crisis poses for 
Americans is very real. In May 2007, alarm spread across the 
United States as health investigators looked for an airline 
passenger who had traveled on an international commercial fight 
with a rare form of drug-resistant tuberculosis. With more than 
50 percent of tuberculosis cases in the United States 
attributable to foreign-born individuals and with the increase 
in international travel, commerce, and migration, elimination 
of tuberculosis in the United States depends heavily on efforts 
to control the disease abroad. Recent research has shown that 
to invest in tuberculosis control in developing countries, 
where treatment and program costs are significantly cheaper 
than in the United States, would be a cost-effective strategy 
to reduce tuberculosis-related morbidity and mortality 
domestically.
    Consideration of this legislation followed the adoption of 
an amendment to the Fiscal Year 2008 Foreign Operations bill in 
the House of Representatives which would increase funding for 
anti-TB programs by $50 million.

                                Hearings

    The Committee on Foreign Affairs held a Full Committee 
Hearing on ``PEPFAR: An Assessment of Progress and Challenges'' 
on April 24, 2007. Testimony was heard from Mark R. Dybul, U.S. 
Global AIDS Coordinator.

                        Committee Consideration

    The Committee marked up H.R. 1567 on July 31, 2007, and 
favorably reported the bill to the House, by voice vote, a 
quorum being present.

                         Votes of the Committee

    There were no recorded votes held on H.R. 1567.

                      Committee Oversight Findings

    In compliance with clause 3(c)(1) of rule XIII of the Rules 
of the House of Representatives, the Committee reports that the 
findings and recommendations of the Committee, based on 
oversight activities under clause 2(b)(1) of rule X of the 
Rules of the House of Representatives, are incorporated in the 
descriptive portions of this report.

               New Budget Authority and Tax Expenditures

    Clause 3(c) (2) of House Rule XIII is inapplicable because 
this legislation does not provide new budgetary authority or 
increased tax expenditures.

               Congressional Budget Office Cost Estimate

                                     U.S. Congress,
                               Congressional Budget Office,
                                 Washington, DC, September 7, 2007.
Hon. Tom Lantos, Chairman,
Committee on Foreign Affairs,
House of Representatives, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for H.R. 1567, the Stop 
Tuberculosis (TB) Now Act of 2007.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Sunita 
D'Monte, who can be reached at 226-2840.
            Sincerely,
                                           Peter R. Orszag.
Enclosure

cc:
        Honorable Ileana Ros-Lehtinen
        Ranking Member
H.R. 1567--Stop Tuberculosis (TB) Now Act of 2007
    H.R. 1567 would authorize the appropriation of $400 million 
in 2008 and $550 million in 2009 for programs working to 
control the global spread of tuberculosis. CBO estimates that 
implementing the bill would cost $93 million in 2008 and about 
$900 million over the 2008-2012 period, assuming that the 
authorized amounts are appropriated and that outlays will 
follow historical spending patterns for those programs. 
Enacting the bill would not affect direct spending or revenues.
    The estimated budgetary impact of H.R. 1567 is shown in the 
following table. The costs of this legislation fall within 
budget functions 150 (international affairs) and 550 (health).

                                     By Fiscal Year, in Millions of Dollars
----------------------------------------------------------------------------------------------------------------
                                                                       2008     2009     2010     2011     2012
----------------------------------------------------------------------------------------------------------------
CHANGES IN SPENDING SUBJECT TO APPROPRIATION
International Assistance                                                 330      450        0        0        0
  Authorization Level
  Estimated Outlays                                                       66      239      264      113       52

Centers for Disease Control and Prevention                                70      100        0        0        0
  Authorization Level
  Estimated Outlays                                                       27       68       52       16        5

Total Changes                                                            400      550        0        0        0
  Authorization Level
  Estimated Outlays                                                       93      307      316      129       57
----------------------------------------------------------------------------------------------------------------

    H.R. 1567 would authorize the appropriation of $400 million 
in 2008 and $550 million in 2009 for foreign assistance to 
improve the detection of tuberculosis, to reduce the number of 
tuberculosis-related deaths in other countries, and to provide 
funds for those purposes to international organizations. Of 
those amounts, $70 million in 2008 and $100 million in 2009 
would be earmarked for global antituberculosis programs of the 
Centers for Disease Control and Prevention.
    H.R. 1567 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act and 
would not affect the budgets of state, local, or tribal 
governments.
    The CBO staff contact for this estimate is Sunita D'Monte, 
who can be reached at 226-2840. This estimate was approved by 
Peter H. Fontaine, Assistant Director for Budget Analysis.

              Intergovernmental and Private Sector Impact

    H.R. 1567 contains no intergovernmental or private-sector 
mandates as defined in UMRA and would not affect the budgets of 
state, local, or tribal governments

                    Performance Goals and Objectives

    Pursuant to clause (3)(c) of House rule XIII, upon 
enactment of this legislation, assistance will be increased for 
the prevention, treatment and control of TB.

                   Constitutional Authority Statement

    Pursuant to clause 3(d) (1) of rule XIII of the Rules of 
the House of Representatives, the Committee finds the authority 
for this legislation in article I, section 8 of the 
Constitution.

                        New Advisory Committees

    H.R. 567 does not establish or authorize any new advisory 
committees.

                    Congressional Accountability Act

    H.R. 1567 does not apply to the Legislative Branch.

                         Earmark Identification

    H.R. 1567 does not contain any congressional earmarks, 
limited tax benefits, or limited tariff benefits as defined in 
clause 9(d), 9(e), or 9(f) of rule XXI.

               Section-by-Section Analysis and Discussion

Section 1. Short Title.
    This section states that this Act may be cited as the 
``Stop Tuberculosis (TB) Now Act of 2007.''
Section 2. Findings.
    This section presents a number of findings that stress the 
urgency of new initiatives to combat the global spread of 
tuberculosis. The findings note that tuberculosis represents 
one of the greatest causes of deaths among adults worldwide and 
is a leading killer of women of reproductive age. The findings 
also note the virulent new form of XDR-TB that came to our 
attention when the disease began to surge throughout South 
Africa. The Committee is concerned that this strain of TB could 
undo all of the achievements gained to date in lives saved 
through treatment and care programs funded by the PEPFAR.
    This section also highlights the DOTS (Directly Observed 
Treatment Short-Course) program that has been determined to be 
one of the most cost-effective and patient-friendly ways to 
treat TB in poor countries. DOTS is part of the new Stop TB 
Strategy developed by the WHO.
Section 3. Assistance to Combat Tuberculosis.
    This section establishes as a U.S. policy objective the 
control of tuberculosis, particularly in countries where the 
United States has established development programs, and should 
achieve the following, no later than December 31, 2015--
         Lreduce by half the tuberculosis death and 
        disease burden from the 1990 baseline; and
         Lsustain or exceed the detection of at last 70 
        percent of sputum smear-positive cases of tuberculosis 
        and the cure of at least 85 percent of those cases 
        detected.
    This section also requires assistance to adhere to the Stop 
TB Strategy, including expansion of DOTS.
    In addition, this section authorizes not less than 
$15,000,000 to the Global Tuberculosis Drug Facility. It 
further authorizes through USAID up to $330,000,000 for Fiscal 
Year 2008 and up to $450,000,000 for fiscal year 2009 to 
support the WHO and the Stop Tuberculosis Partnership to 
improve the capacity of countries with high rates of 
tuberculosis to implement the Stop TB Strategy. This section 
also authorizes an appropriation of up to $70,000,000 for 
fiscal year 2008 and up to $100,000,000 for fiscal year 2009 to 
carry out global TB activities through the CDC. The 
appropriations shall remain available until expended.
    The Committee expects USAID and the CDC to ensure fully 
that all such TB funding increases authorized under this 
section or endorsed by the House in an amendment to the FY 2008 
Foreign Operations bill in June 2007 are expended in a 
transparent and efficient manner. All U.S. funded anti-TB 
programs should be results-driven and should expand upon or 
complement, but not duplicate, other international and 
indigenous efforts. The Committee further asserts that the Stop 
Tuberculosis Partnership, a multilateral effort which is to 
receive increased funding pursuant to this section, also must 
be held to the highest standard of transparency in terms of 
planning, procurement and implementation. The Committee intends 
to conduct rigorous oversight of these programs as they expand 
and develop over the next two years. This Section also requires 
an annual report that includes the percentage of U.S. foreign 
assistance provided for diagnosis and treatment of individuals 
with tuberculosis in countries with the highest burden of 
tuberculosis, as determined by WHO.

         Changes in Existing Law Made by the Bill, as Reported

  In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (existing law 
proposed to be omitted is enclosed in black brackets, new 
matter is printed in italics, existing law in which no change 
is proposed is shown in roman):

FOREIGN ASSISTANCE ACT OF 1961

           *       *       *       *       *       *       *

                                 PART I

Chapter 1--Policy; Development Assistance Authorizations

           *       *       *       *       *       *       *

SEC. 104A. ASSISTANCE TO COMBAT HIV/AIDS.

  (a) * * *

           *       *       *       *       *       *       *

  (e) Annual Report.--
          (1) * * *
          (2) Report elements.--Each report shall include--
                  (A) * * *

           *       *       *       *       *       *       *

                  (C) a detailed assessment of the impact of 
                programs established pursuant to such sections, 
                including--
                          (i) * * *

           *       *       *       *       *       *       *

                          (iii) with respect to tuberculosis, 
                        the increase in the number of people 
                        treated and the increase in number of 
                        tuberculosis patients cured through 
                        each program, project, or activity 
                        receiving United States foreign 
                        assistance for tuberculosis control 
                        purposes, including the percentage of 
                        such United States foreign assistance 
                        provided for diagnosis and treatment of 
                        individuals with tuberculosis in 
                        countries with the highest burden of 
                        tuberculosis, as determined by the 
                        World Health Organization (WHO); and

           *       *       *       *       *       *       *

SEC. 104B. ASSISTANCE TO COMBAT TUBERCULOSIS.

  (a) * * *
  [(b) Policy.--It is a major objective of the foreign 
assistance program of the United States to control 
tuberculosis, including the detection of at least 70 percent of 
the cases of infectious tuberculosis, and the cure of at least 
85 percent of the cases detected, not later than December 31, 
2005, in those countries classified by the World Health 
Organization as among the highest tuberculosis burden, and not 
later than December 31, 2010, in all countries in which the 
United States Agency for International Development has 
established development programs.]
  (b) Policy.--It is a major objective of the foreign 
assistance program of the United States to control 
tuberculosis. In all countries in which the Government of the 
United States has established development programs, 
particularly in countries with the highest burden of 
tuberculosis and other countries with high rates of 
tuberculosis, the United States Government should prioritize 
the achievement of the following goals by not later than 
December 31, 2015:
          (1) Reduce by half the tuberculosis death and disease 
        burden from the 1990 baseline.
          (2) Sustain or exceed the detection of at least 70 
        percent of sputum smear-positive cases of tuberculosis 
        and the cure of at least 85 percent of those cases 
        detected.
  (c) [Authorization] Assistance Required.--To carry out this 
section and consistent with section 104(c), the President [is 
authorized to] shall furnish assistance, on such terms and 
conditions as the President may determine, for the prevention, 
treatment, control, and elimination of tuberculosis.

           *       *       *       *       *       *       *

  (e) [Priority to DOTS Coverage.--In furnishing assistance 
under subsection (c), the President shall give priority to 
activities that increase Directly Observed Treatment Short-
course (DOTS) coverage and treatment of multi-drug resistant 
tuberculosis where needed using DOTS-Plus, including funding] 
Priority To Stop TB Strategy.--
          (1) Priority.--In furnishing assistance under 
        subsection (c), the President shall give priority to--
                  (A) activities described in the Stop TB 
                Strategy, including expansion and enhancement 
                of DOTS coverage, treatment for individuals 
                infected with both tuberculosis and HIV and 
                treatment for individuals with multi-drug 
                resistant tuberculosis (MDR-TB), strengthening 
                of health systems, use of the International 
                Standards for Tuberculosis Care by all 
                providers, empowering individuals with 
                tuberculosis, and enabling and promoting 
                research to develop new diagnostics, drugs, and 
                vaccines, and program-based operational 
                research relating to tuberculosis; and
                  (B) funding for the Global Tuberculosis Drug 
                Facility, the Stop Tuberculosis Partnership, 
                and the Global Alliance for TB Drug 
                Development. [In order to meet the requirement 
                of the preceding sentence, the President should 
                ensure that not less than]
          (2) Availability of amounts.--In order to meet the 
        requirements of paragraph (1), the President--
                  (A) shall ensure that not less than 75 
                percent of the amount made available to carry 
                out this section for a fiscal year should be 
                expended for antituberculosis drugs, supplies, 
                direct patient services, and training in 
                diagnosis and treatment [for Directly Observed 
                Treatment Short-course (DOTS) coverage and 
                treatment of multi-drug resistant tuberculosis 
                using DOTS-Plus, including substantially 
                increased funding for the Global Tuberculosis 
                Drug Facility.] to implement the Stop TB 
                Strategy; and
                  (B) should ensure that not less than 
                $15,000,000 of the amount made available to 
                carry out this section for a fiscal year is 
                used to make a contribution to the Global 
                Tuberculosis Drug Facility.
  (f) Assistance for WHO and the Stop Tuberculosis 
Partnership.--In carrying out this section, the President, 
acting through the Administrator of the United States Agency 
for International Development, is authorized to provide 
increased resources to the World Health Organization (WHO) and 
the Stop Tuberculosis Partnership to improve the capacity of 
countries with high rates of tuberculosis and other affected 
countries to implement the Stop TB Strategy and specific 
strategies related to addressing extensively drug resistant 
tuberculosis (XDR-TB).
  [(f)] (g) Definitions.--In this section:
          (1) DOTS.--The term ``DOTS'' or ``Directly Observed 
        Treatment Short-course'' means the World Health 
        Organization-recommended strategy for treating 
        tuberculosis, including low cost and effective 
        diagnosis and evaluation of treatment regimes, 
        vaccines, and monitoring of tuberculosis, as well as a 
        reliable drug supply, and a management strategy for 
        public health systems, with health system 
        strengthening, promotion of the use of the 
        International Standards for Tuberculosis Care by all 
        care providers, bacteriology under an external quality 
        assessment framework, short-course chemotherapy, and 
        sound reporting and recording systems.

           *       *       *       *       *       *       *

          (6) Stop tb strategy.--The term ``Stop TB Strategy'' 
        means the six-point strategy to reduce tuberculosis 
        developed by the World Health Organization. The 
        strategy is described in the Global Plan to Stop TB 
        2007-2016: Actions for Life, a comprehensive plan 
        developed by the Stop Tuberculosis Partnership that 
        sets out the actions necessary to achieve the 
        millennium development goal of cutting tuberculosis 
        deaths and disease burden in half by 2016.

           *       *       *       *       *       *       *

                                  
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