69–010 

Calendar No. 415 

110TH CONGRESS REPORT " ! SENATE 1st Session 110–193 

STOP TUBERCULOSIS (TB) NOW ACT OF 2007 

OCTOBER 9, 2007.—Ordered to be printed 

Filed under the authority of the order of the Senate of October 4, 2007 

Mr. BIDEN, from the Committee on Foreign Relations, 

submitted the following 

R E P O R T 

[To accompany S. 968] 

The Committee on Foreign Relations, having had under consideration S. 968, 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, reports favorably 

thereon and recommends that the bill do pass. 

CONTENTS 

Page 

I. Purpose ........................................................................................................... 1 

II. Committee Action .......................................................................................... 1 

III. Discussion ....................................................................................................... 2 

IV. Cost Estimate ................................................................................................. 3 

V. Evaluation of Regulatory Impact .................................................................. 4 

VI. Changes in Existing Law .............................................................................. 4 

I. PURPOSE

The purpose of S. 968 is to improve the detection of tuberculosis 

(TB), to reduce the global number of TB-related deaths, and to support multilateral efforts 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). 

II. COMMITTEE ACTION

S. 968 was introduced by Senators Boxer, Smith, Durbin, and 

Brown on March 22, 2007. An additional 10 members cosponsored 


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the legislation. On September 11, 2007, the committee ordered the 

bill, with an amendment in the nature of a substitute, reported favorably by voice vote. 

III. DISCUSSION

Tuberculosis is one of the deadliest infectious diseases in the 

world, killing an estimated 1.6 million people per year. One third 

of the world’s population is infected with the tuberculosis bacterium, and an estimated 8.8 million people develop active TB each 

year. Resistance to standard drug treatments for TB is increasing 

in number and severity: the emergence of extensively drug-resistant tuberculosis (XDR–TB) poses a significant global public health 

threat. Persons with HIV/AIDS are particularly vulnerable to TB 

and the convergence of these epidemics undermines gains in HIV/ 

AIDS prevention, care, and treatment. 

S. 968 seeks to support the Global Plan to Stop TB, a ten-year 

strategy launched last year at the World Economic Forum by an 

international coalition of 500 governments, non-governmental organizations, private sector organizations, and others to cut the number of TB deaths in half by 2015. The bill identifies the control of 

TB as a major United States foreign assistance objective and calls 

for U.S. development programs in high prevalence areas to 

prioritize the halving of the TB death and disease burden in part 

through improvements in the TB detection and cure rates in those 

countries. 

In order to advance this strategy, the bill authorizes support for 

a variety of activities, including: implementing the Directly Observed Therapy Short-course (DOTS) approach; treating persons 

who are co-infected with TB and HIV; treating persons with multidrug resistant tuberculosis (MDR–TB); strengthening health systems; encouraging adherence to the International Standards for 

Tuberculosis Care; and expanding research to improve diagnostics, 

drugs, and vaccines to combat TB. The bill states that the President should ensure that $15 million of the funds authorized in the 

legislation are used to make a contribution to the Global Tuberculosis Facility. The bill also authorizes the President 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 TB to combat the epidemic and address the 

issue of drug resistance. 

The bill amends section 104A(e)(2)(C)(iii) of the Foreign Assistance Act of 1961 (22 U.S.C. 2151b–2(e)(2)(C)(iii)) to require inclusion of annual reporting on the percentage of 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. 

S. 968 authorizes the appropriation of up to $400 million for fiscal year 2008 and up to $550 million for fiscal year 2009 to carry 

out the objectives of this Act. Of the amounts subsequently appropriated for this purpose, the bill states that up to $70 million may 

be available for fiscal year 2008 and up to $100 million may be 

available for fiscal year 2009 for the Centers for Disease Control 

and Prevention for the purpose of carrying out global tuberculosis 

activities. Funds appropriated pursuant to the authorization provided in this bill are to remain available until expended. 


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V. COST ESTIMATE

In accordance with Rule XXVI, paragraph 11(a) of the Standing 

Rules of the Senate, the committee provides this estimate of the 

costs of this legislation prepared by the Congressional Budget Office. 

UNITED STATES CONGRESS, CONGRESSIONAL BUDGET OFFICE, Washington, DC, September 18, 2007. 

Hon. JOSEPH R. BIDEN, JR., Chairman, Committee on Foreign Relations, 

U.S. Senate, Washington, DC. 

DEAR MR. CHAIRMAN: The Congressional Budget Office has prepared the enclosed cost estimate for S. 968, 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. 

Sincerely, 

PETER R. ORSZAG. 

CONGRESSIONAL BUDGET OFFICE COST ESTIMATE

September 18, 2007. 

S. 968 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 S. 968 is shown in the following table. The costs of this legislation fall within budget functions 150 (international affairs) and 550 (health). 

ESTIMATED BUDGETARY IMPACT OF S. 968 

By Fiscal Year, in Millions of Dollars 

2008 2009 2010 2011 2012 

CHANGES IN SPENDING SUBJECT TO APPROPRIATION 

International Assistance 

Authorization Level ........................................................... 330 450 0 0 0 

Estimated Outlays ............................................................ 66 239 264 113 52 

Centers for Disease Control and Prevention 

Authorization Level ........................................................... 70 100 0 0 0 

Estimated Outlays ............................................................ 27 68 52 16 5 

Total Changes 

Authorization Level ........................................................... 400 550 0 0 0 

Estimated Outlays ............................................................ 93 307 316 129 57 

S. 968 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 


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2008 and $100 million in 2009 would be earmarked for global 

antituberculosis programs of the Centers for Disease Control and 

Prevention.S. 968 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. 

On September 7, 2007, CBO transmitted a cost estimate for H.R. 

1567, the Stop Tuberculosis (TB) Now Act of 2007, as ordered reported by the House Committee on Foreign Affairs on July 31, 

2007. The two bills are similar, and their estimated costs are identical. 

The CBO staff contact for this estimate is Sunita D’Monte. This 

estimate was approved by Peter H. Fontaine, Assistant Director for 

Budget Analysis. 

V. EVALUATION OF REGULATORY IMPACT

Pursuant to Rule XXVI, paragraph 11(b) of the Standing Rules 

of the Senate, the committee has determined that there is no regulatory impact as a result of this legislation. 

VI. CHANGES IN EXISTING LAW

In compliance with Rule XXVI, paragraph 12 of the Standing 

Rules of the Senate, 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 italic, existing law in which no change is proposed is shown in roman). 

The Foreign Assistance Act of 1961 

* * * * * * * 

PART I 

Chapter 1—Policy; Development Assistance Authorizations 

* * * * * * * 

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

(a) FINDING.—Congress recognizes that the alarming spread of 

HIV/AIDS in countries in sub-Saharan Africa, the Caribbean, and 

other developing countries is a major global health, national security, development, and humanitarian crisis. 

* * * * * * * 

(e) ANNUAL REPORT.—

(1) IN GENERAL.—Not later than January 31 of each year, the 

President shall submit to the Committee on Foreign Relations 

of the Senate and the Committee on International Relations of 

the House of Representatives a report on the implementation 

of this section for the prior fiscal year. 

(2) REPORT ELEMENTS.—Each report shall include— (A) * * * 

* * * * * * * 

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

(i)(I) the effectiveness of such programs in reducing 

the spread of the HIV infection, particularly in women 


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and girls, in reducing mother-to-child transmission of 

the HIV infection, and in reducing mortality rates 

from HIV/AIDS; and 

(II) the number of patients currently receiving treatment for AIDS in each country that receives assistance under this Act. 

(ii) the progress made toward improving health care 

delivery systems (including the training of adequate 

numbers of staff) and infrastructure to ensure increased access to care and treatment; 

(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 tuberculois in countries with the highest burden 

of tuberculosis, as determined by the World Health Organization (WHO); and 

* * * * * * * 

SEC. 104B. ASSISTANCE TO COMBAT TUBERCULOSIS. 

(a) FINDINGS.—Congress makes the following findings: 

* * * * * * * 

ø(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) øAuthorization.¿ ASSISTANCE REQUIRED.—To carry out this 

section and consistent with section 104(c), the President øis authorized to¿ shall furnish assistance, on such terms and conditions as 

the President may determine, for the prevention, treatment, control, and elimination of tuberculosis. 

(d) COORDINATION.—In carrying out this section, the President 

shall coordinate with the World Health Organization, the Global 

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zations with respect to the development and implementation of a 

comprehensive tuberculosis control program. 

ø(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 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 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.¿ 

(e) 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 fro 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. 

(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 anti-tuberculosis drugs, supplies, direct patient 

services, and training in diagnosis and treatment 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). 

ø(f)¿ (g) DEFINITIONS.—In this section: 


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(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, treatment, 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. 

(2) DOTS-PLUS.—The term ‘‘DOTS-Plus’’ means a comprehensive tuberculosis management strategy that is built 

upon and works as a supplement to the standard DOTS strategy, and which takes into account specific issues (such as use 

of second line anti-tuberculosis drugs) that need to be addressed in areas where there is high prevalence of multi-drug 

resistant tuberculosis. 

(3) GLOBAL ALLIANCE FOR TUBERCULOSIS DRUG DEVELOPMENT.—The term ‘‘Global Alliance for Tuberculosis Drug Development’’ means the public-private partnership that brings 

together leaders in health, science, philanthropy, and private 

industry to devise new approaches to tuberculosis and to ensure that new medications are available and affordable in high 

tuberculosis burden countries and other affected countries. 

(4) GLOBAL TUBERCULOSIS DRUG FACILITY.—The term ‘‘Global 

Tuberculosis Drug Facility (GDF)’’ means the new initiative of 

the Stop Tuberculosis Partnership to increase access to highquality tuberculosis drugs to facilitate DOTS expansion. 

(5) STOP TUBERCULOSIS PARTNERSHIP.—The term ‘‘Stop Tuberculosis Partnership’’ means the partnership of the World 

Health Organization, donors including the United States, high 

tuberculosis burden countries, multilateral agencies, and nongovernmental and technical agencies committed to short- and 

long-term measures required to control and eventually eliminate tuberculosis as a public health problem in the world. 

(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. 

* * * * * * * 

Æ 


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