II 

109TH CONGRESS 

2D SESSION S. 2465 

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

for the prevention, treatment, and control of tuberculosis, and for other 

purposes. 

IN THE SENATE OF THE UNITED STATES 

MARCH 28, 2006 

Mrs. BOXER (for herself, Mr. SMITH, and Mr. DURBIN) introduced the following bill; which was read twice and referred to the Committee on Foreign Relations 

A BILL 

To amend the Foreign Assistance Act of 1961 to provide 

increased assistance for the prevention, treatment, and 

control of tuberculosis, 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 of 2006’’. 

6 SEC. 2. FINDINGS. 

7 Congress finds the following: 

8 (1) Tuberculosis is one of the greatest infec9 tious causes of death of adults worldwide, killing 


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

2 15 seconds. 

3 (2) One-third of the world’s population is in4 fected with the tuberculosis bacterium and an esti5 mated 9,000,000 individuals develop active tuber6 culosis each year. 

7 (3) Tuberculosis is the leading killer among in8 dividuals who are HIV-positive due to their weak9 ened immune systems, and it is estimated that one10 third of people with HIV infection have tuberculosis. 

11 (4) Today, tuberculosis is a leading killer of 

12 women of reproductive age. 

13 (5) There are 22 countries that account for 80 

14 percent of the world’s burden of tuberculosis. The 

15 People’s Republic of China and India account for 35 

16 percent of all estimated new tuberculosis cases each 

17 year. 

18 (6) Driven by the HIV/AIDS pandemic, inci19 dence rates of tuberculosis in Africa have more than 

20 doubled on average since 1990, making it the only 

21 region in the world in which tuberculosis rates are 

22 not currently stabilized or declining. The problem is 

23 so pervasive that in August 2005, African Health 

24 Ministers and the World Health Organization 


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1 (WHO) declared tuberculosis to be an emergency in 

2 Africa. 

3 (7) The wide extent of drug resistance, includ4 ing multi-drug resistant tuberculosis (MDR–TB), in 

5 Eastern Europe and other parts of the world rep6 resents a critical challenge to the global control of 

7 tuberculosis. Drug resistance surveillance reports 

8 have confirmed the serious scale and spread of tu9 berculosis in Eastern Europe with tuberculosis 

10 strains often resistant to all first line drugs and also 

11 to some second line drugs. 

12 (8) With more than 50 percent of tuberculosis 

13 cases in the United States attributable to foreign14 born individuals and with the increase in inter15 national travel, commerce, and migration, elimi16 nation of tuberculosis in the United States depends 

17 on efforts to control the disease in developing coun18 tries. Recent research has shown that to invest in 

19 tuberculosis control abroad, where treatment and 

20 program costs are significantly cheaper than in the 

21 United States, would be a cost-effective strategy to 

22 reduce tuberculosis-related morbidity and mortality 

23 domestically. 

24 (9) The threat that tuberculosis poses for 

25 Americans derives from the global spread of tuberVerDate Aug 31 2005 00:22 Mar 29, 2006 Jkt 049196 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S2465.IS S2465

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1 culosis and the emergence and spread of strains of 

2 multi-drug resistant tuberculosis, which is far more 

3 deadly, and more difficult and costly to treat. 

4 (10) DOTS (Directly Observed Treatment 

5 Short-course) is one of the most cost-effective health 

6 interventions available today and is a core compo7 nent of the new Stop TB Strategy. 

8 (11) The Stop TB Strategy, developed by the 

9 World Health Organization, builds on the success of 

10 DOTS and ongoing challenges so as to serve all 

11 those in need and reach targets for prevalence, mor12 tality, and incidence reduction. The Stop TB Strat13 egy includes six components: 

14 (A) Pursuing high-quality expansion and 

15 enhancement of DOTS coverage. 

16 (B) Implementing tuberculosis and HIV 

17 collaborative activities, preventing, and control18 ling multi-drug resistant tuberculosis, and ad19 dressing other special challenges. 

20 (C) Contributing to the strengthening of 

21 health systems. 

22 (D) Engaging all health care providers, in23 cluding promotion of the International Stand24 ards for Tuberculosis Care. 


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1 (E) Empowering individuals with tuber2 culosis and communities. 

3 (F) Enabling and promoting research to 

4 develop new diagnostics, drugs, vaccines, and 

5 program-based operational research relating to 

6 tuberculosis. 

7 (12) The Global Plan to Stop TB 2006–2015: 

8 Actions for Life is a comprehensive plan developed 

9 by the Stop TB Partnership that sets out the ac10 tions necessary to achieve the millennium develop11 ment goal of cutting tuberculosis deaths and disease 

12 burden in half by 2015 and thus eliminate tuber13 culosis as a global health problem by 2050. 

14 (13) While innovations such as the Global Tu15 berculosis Drug Facility have enabled low-income 

16 countries to treat a standard case of tuberculosis 

17 with drugs that cost as little as $16 for a full six18 month course of treatment, there are still millions of 

19 individuals with no access to effective treatment. 

20 (14) As the global resource investment in fight21 ing tuberculosis increases, partner nations and inter22 national institutions must commit to a cor23 responding increase in the technical and program as24 sistance necessary to ensure that the most effective 

25 and efficient tuberculosis treatments are provided. 


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1 (15) The Global Fund to Fight AIDS, Tuber2 culosis and Malaria is an important global partner3 ship established to combat these three infectious dis4 eases that together kill millions of people a year. Ex5 pansion of effective tuberculosis treatment programs 

6 constitutes a major component of Global Fund in7 vestment, along with integrated efforts to address 

8 HIV and tuberculosis in areas of high prevalence. 

9 (16) The Centers for Disease Control and Pre10 vention (CDC) is actively involved with global tuber11 culosis control efforts since the global tuberculosis 

12 epidemic directly impacts tuberculosis in the United 

13 States, and because Congress has strongly urged the 

14 CDC each year to increase its involvement with 

15 international tuberculosis control efforts. 

16 (17) The CDC is assisting countries with a high 

17 burden of tuberculosis to— 

18 (A) implement the World Health Organiza19 tion-recommended control strategies by improv20 ing the capacity to diagnose and cure individ21 uals with tuberculosis; 

22 (B) improve the capacity to diagnose, 

23 treat, and prevent tuberculosis in HIV-infected 

24 individuals and individuals with multi-drug re25 sistant tuberculosis; and 


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1 (C) conduct programmatically-relevant 

2 operational research to identify and evaluate 

3 new diagnostics, treatment regimes, and inter4 ventions to control tuberculosis. 

5 SEC. 3. ASSISTANCE TO COMBAT TUBERCULOSIS. 

6 (a) POLICY.—Section 104B(b) of the Foreign Assist7 ance Act of 1961 (22 U.S.C. 2151b–3(b)) is amended to 

8 read as follows: 

9 ‘‘(b) POLICY.—It is a major objective of the foreign 

10 assistance program of the United States to control tuber11 culosis. In all countries in which the United States Agency 

12 for International Development has established develop13 ment programs, the following goals in the battle against 

14 tuberculosis should be achieved by not later than Decem15 ber 31, 2015: 

16 ‘‘(1) Reduce by half the tuberculosis death and 

17 disease burden from the 1990 baseline. 

18 ‘‘(2) Sustain or exceed the detection of at least 

19 70 percent of cases of tuberculosis infection and the 

20 cure of at least 85 percent of those cases detected.’’. 

21 (b) AUTHORIZATION.—Section 104B(c) of the For22 eign Assistance Act of 1961 (22 U.S.C. 2151b–3(c)) is 

23 amended by striking ‘‘is authorized to’’ and inserting 

24 ‘‘shall’’. 


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1 (c) PRIORITY TO STOP TB STRATEGY.—Section 

2 104B(e) of the Foreign Assistance Act of 1961 (22 U.S.C. 

3 2151b–3(e)) is amended— 

4 (1) in the heading, to read as follows: ‘‘PRI5 ORITY TO STOP TB STRATEGY.—’’; 

6 (2) in the first sentence, by striking ‘‘In fur7 nishing’’ and all that follows through ‘‘, including 

8 funding’’ and inserting the following: 

9 ‘‘(1) PRIORITY.—In furnishing assistance under 

10 subsection (c), the President shall give priority to— 

11 ‘‘(A) activities described in the Stop TB 

12 Strategy, including expansion and enhancement 

13 of DOTS coverage, treatment for individuals in14 fected with both tuberculosis and HIV and 

15 treatment for individuals with multi-drug resist16 ant tuberculosis (MDR–TB), strengthening of 

17 health systems, use of the International Stand18 ards for Tuberculosis Care by all providers, em19 powering individuals with tuberculosis, and ena20 bling and promoting research to develop new 

21 diagnostics, drugs, and vaccines, and program22 based operational research relating to tuber23 culosis; and 

24 ‘‘(B) funding’’; and 

25 (3) in the second sentence— 


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1 (A) by striking ‘‘In order to’’ and all that 

2 follows through ‘‘not less than’’ and inserting 

3 the following: 

4 ‘‘(2) AVAILABILITY OF AMOUNTS.—In order to 

5 meet the requirements of paragraph (1), the Presi6 dent— 

7 ‘‘(A) shall ensure that not less than’’; 

8 (B) by striking ‘‘for Directly Observed 

9 Treatment Short-course (DOTS) coverage and 

10 treatment of multi-drug resistant tuberculosis 

11 using DOTS-Plus,’’ and inserting ‘‘to imple12 ment the Stop TB Strategy; and’’; and 

13 (C) by striking ‘‘including’’ and all that 

14 follows and inserting the following: 

15 ‘‘(B) should ensure that not less than 

16 $15,000,000 of the amount made available to 

17 carry out this section for a fiscal year is used 

18 to make a contribution to the Global Tuber19 culosis Drug Facility.’’. 

20 (d) ASSISTANCE FOR WHO AND THE STOP TUBER21 CULOSIS PARTNERSHIP.—Section 104B of the Foreign 

22 Assistance Act of 1961 (22 U.S.C. 2151b–3) is amend23 ed— 

24 (1) by redesignating subsection (f) as sub25 section (g); and 


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1 (2) by inserting after subsection (e) the fol2 lowing new subsection: 

3 ‘‘(f) ASSISTANCE FOR WHO AND THE STOP TUBER4 CULOSIS PARTNERSHIP.—In carrying out this section, the 

5 President, acting through the Administrator of the United 

6 States Agency for International Development, is author7 ized to provide increased resources to the World Health 

8 Organization (WHO) and the Stop Tuberculosis Partner9 ship to improve the capacity of countries with high rates 

10 of tuberculosis and other affected countries to implement 

11 the Stop TB Strategy.’’. 

12 (e) DEFINITIONS.—Section 104B(g) of the Foreign 

13 Assistance Act of 1961, as redesignated by subsection 

14 (d)(1), is amended— 

15 (1) in paragraph (1), by adding at the end be16 fore the period the following: ‘‘, including low cost 

17 and effective diagnosis, treatment, and monitoring of 

18 tuberculosis, as well as a reliable drug supply, and 

19 a management strategy for public health systems, 

20 with health system strengthening, promotion of the 

21 use of the International Standards for Tuberculosis 

22 Care by all care providers, bacteriology under an ex23 ternal quality assessment framework, short-course 

24 chemotherapy, and sound reporting and recording 

25 systems’’; and 


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1 (2) by adding after paragraph (5) the following 

2 new paragraph: 

3 ‘‘(6) STOP TB STRATEGY.—The term ‘Stop TB 

4 Strategy’ means the strategy described in the Global 

5 Plan to Stop TB 2006–2015: Actions for Life, a 

6 comprehensive plan developed by the Stop Tuber7 culosis Partnership that sets out the actions nec8 essary to achieve the millennium development goal of 

9 cutting tuberculosis deaths and disease burden in 

10 half by 2015.’’. 

11 (f) ANNUAL REPORT.—Section 104A(e)(2)(C)(iii) of 

12 the Foreign Assistance Act of 1961 (22 U.S.C. 2151b– 

13 2(e)(2)(C)(iii)) is amended by adding at the end before 

14 the semicolon the following: ‘‘, including the percentage 

15 of such United States foreign assistance provided for diag16 nosis and treatment of individuals with tuberculosis in 

17 countries with the highest rates of tuberculosis, as deter18 mined by the World Health Organization (WHO)’’. 

19 (g) AUTHORIZATION OF APPROPRIATIONS.—There 

20 are authorized to be appropriated to the President not less 

21 than $225,000,000 for fiscal year 2007 and not less than 

22 $260,000,000 for fiscal year 2008 to carry out section 

23 104B of the Foreign Assistance Act of 1961 (22 U.S.C. 

24 2151b–3), as amended by subsections (a) through (e) of 

25 this section. 


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1 SEC. 4. AUTHORIZATION OF APPROPRIATIONS FOR GLOB2 AL TUBERCULOSIS ACTIVITIES OF THE CEN3 TERS FOR DISEASE CONTROL AND PREVEN4 TION. 

5 For the purpose of carrying out global tuberculosis 

6 activities through the Centers for Disease Control and 

7 Prevention, there are authorized to be appropriated 

8 $30,000,000 for fiscal year 2007 and such sums as may 

9 be necessary for fiscal year 2008. Such authorization of 

10 appropriations is in addition to other authorizations of ap11 propriations that are available for such purposes. Amounts 

12 appropriated pursuant to the authorization of appropria13 tions under this section shall remain available until ex14 pended. 

Æ 


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