II 

110TH CONGRESS 

1ST SESSION S. 968 

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 22, 2007 

Mrs. BOXER (for herself, Mr. SMITH, Mr. DURBIN, and Mr. BROWN) 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 2007’’. 

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 1.6 


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1 million people per year—one person every 15 sec2 onds. 

3 (2) One-third of the world’s population is in4 fected with the tuberculosis bacterium and an esti5 mated 8.8 million individuals develop active tuber6 culosis each year. 

7 (3) Tuberculosis is the leading infectious killer 

8 among individuals who are HIV-positive due to their 

9 weakened immune systems, and it is estimated that 

10 one-third of people with HIV infection have tuber11 culosis. 

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

13 women of reproductive age. 

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

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

16 People’s Republic of China and India account for 36 

17 percent of all estimated new tuberculosis cases each 

18 year. 

19 (6) Driven by the HIV/AIDS pandemic, inci20 dence rates of tuberculosis in Africa have more than 

21 doubled on average since 1990, making it the only 

22 region in the world in which tuberculosis rates are 

23 not currently stabilized or declining. The problem is 

24 so pervasive that in August 2005, African Health 

25 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 both multi-drug resistant tuberculosis (MDR– 

5 TB) and extensively drug resistant tuberculosis 

6 (XDR–TB), represents both a critical challenge to 

7 the global control of tuberculosis and a serious 

8 worldwide public health threat. XDR–TB, which is 

9 characterized as being MDR–TB with additional re10 sistance to multiple second-line anti-tuberculosis 

11 drugs, is associated with worst treatment outcomes 

12 of any form of tuberculosis. XDR–TB is converging 

13 with the HIV epidemic, undermining gains in HIV 

14 prevention and treatment programs and requires ur15 gent interventions. Drug resistance surveillance re16 ports have confirmed the serious scale and spread of 

17 tuberculosis with XDR–TB strains confirmed on six 

18 continents. Demonstrating the lethality of XDR–TB, 

19 an initial outbreak in Tugela Ferry, South Africa 

20 killed 52 of 53 patients with hundreds more cases 

21 reported since. Of the world’s regions, sub-Saharan 

22 Africa faces the greatest gap in capacity to prevent, 

23 find, and treat XDR–TB. 

24 (8) With more than 50 percent of tuberculosis 

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1 born individuals and with the increase in inter2 national travel, commerce, and migration, elimi3 nation of tuberculosis in the United States depends 

4 on efforts to control the disease in developing coun5 tries. Recent research has shown that to invest in 

6 tuberculosis control abroad, where treatment and 

7 program costs are significantly cheaper than in the 

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

9 reduce tuberculosis-related morbidity and mortality 

10 domestically. 

11 (9) The threat that tuberculosis poses for 

12 Americans derives from the global spread of tuber13 culosis and the emergence and spread of strains of 

14 multi-drug resistant tuberculosis and extensively 

15 drug resistant tuberculosis, which are far more 

16 deadly, and more difficult and costly to treat. 

17 (10) DOTS (Directly Observed Treatment 

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

19 interventions available today and is a core compo20 nent of the new Stop TB Strategy. 

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

22 World Health Organization, builds on the success of 

23 DOTS and ongoing challenges so as to serve all 

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1 tality, and incidence reduction. The Stop TB Strat2 egy includes six components: 

3 (A) Pursuing high-quality expansion and 

4 enhancement of DOTS coverage. 

5 (B) Implementing tuberculosis and HIV 

6 collaborative activities, preventing and control7 ling multi-drug resistant tuberculosis, and ad8 dressing other special challenges. 

9 (C) Contributing to the strengthening of 

10 health systems. 

11 (D) Engaging all health care providers, in12 cluding promotion of the International Stand13 ards for Tuberculosis Care. 

14 (E) Empowering individuals with tuber15 culosis and communities. 

16 (F) Enabling and promoting research to 

17 develop new diagnostics, drugs, vaccines, and 

18 program-based operational research relating to 

19 tuberculosis. 

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

21 Actions for Life is a comprehensive plan developed 

22 by the Stop TB Partnership that sets out the ac23 tions necessary to achieve the millennium develop24 ment goal of cutting tuberculosis deaths and disease 


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1 burden in half by 2015 and thus eliminate tuber2 culosis as a global health problem by 2050. 

3 (13) While innovations such as the Global Tu4 berculosis Drug Facility have enabled low-income 

5 countries to treat a standard case of tuberculosis 

6 with drugs that cost as little as $16 for a full course 

7 of treatment, there are still millions of individuals 

8 with no access to effective treatment. 

9 (14) As the global resource investment in fight10 ing tuberculosis increases, partner nations and inter11 national institutions must commit to a cor12 responding increase in the technical and program as13 sistance necessary to ensure that the most effective 

14 and efficient tuberculosis treatments are provided. 

15 (15) The Global Fund to Fight AIDS, Tuber16 culosis and Malaria is an important global partner17 ship established to combat these three infectious dis18 eases that together kill millions of people a year. Ex19 pansion of effective tuberculosis treatment programs 

20 constitutes a major component of Global Fund in21 vestment, along with integrated efforts to address 

22 HIV and tuberculosis in areas of high prevalence. 

23 (16) The Centers for Disease Control and Pre24 vention (CDC) is actively involved with global tuber25 culosis control efforts since the global tuberculosis 


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1 epidemic directly impacts tuberculosis in the United 

2 States, and because Congress has strongly urged the 

3 CDC each year to increase its involvement with 

4 international tuberculosis control efforts. 

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

6 burden of tuberculosis to— 

7 (A) implement the World Health Organiza8 tion-recommended control strategies by improv9 ing the capacity to diagnose and cure individ10 uals with tuberculosis; 

11 (B) improve the capacity to diagnose, 

12 treat, and prevent tuberculosis in HIV-infected 

13 individuals and individuals with multi-drug re14 sistant tuberculosis and extensively drug resist15 ant tuberculosis; and 

16 (C) conduct programmatically-relevant 

17 clinical and operational research to identify and 

18 evaluate new diagnostics, treatment regimes, 

19 and interventions to control tuberculosis. 

20 SEC. 3. ASSISTANCE TO COMBAT TUBERCULOSIS. 

21 (a) POLICY.—Section 104B(b) of the Foreign Assist22 ance Act of 1961 (22 U.S.C. 2151b–3(b)) is amended to 

23 read as follows: 

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

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1 culosis. In all countries in which the Government of the 

2 United States has established development programs, par3 ticularly in countries with the highest burden of tuber4 culosis and other countries with high rates of tuberculosis, 

5 the United States Government should prioritize the 

6 achievement of the following goals by not later than De7 cember 31, 2015: 

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

9 disease burden from the 1990 baseline. 

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

11 70 percent of sputum smear-positive cases of tuber12 culosis and the cure of at least 85 percent of those 

13 cases detected.’’. 

14 (b) AUTHORIZATION.—Section 104B(c) of the For15 eign Assistance Act of 1961 (22 U.S.C. 2151b–3(c)) is 

16 amended— 

17 (1) in the heading, by striking ‘‘AUTHORIZA18 TION’’ and inserting ‘‘ASSISTANCE REQUIRED’’; and 

19 (2) by striking ‘‘is authorized to’’ and inserting 

20 ‘‘shall’’. 

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

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

23 2151b–3(e)) is amended— 

24 (1) in the heading, to read as follows: ‘‘PRI25 ORITY TO STOP TB STRATEGY.—’’; 


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1 (2) in the first sentence, by striking ‘‘In fur2 nishing’’ and all that follows through ‘‘, including 

3 funding’’ and inserting the following: 

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

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

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

7 Strategy, including expansion and enhancement 

8 of DOTS coverage, treatment for individuals in9 fected with both tuberculosis and HIV and 

10 treatment for individuals with multi-drug resist11 ant tuberculosis (MDR–TB), strengthening of 

12 health systems, use of the International Stand13 ards for Tuberculosis Care by all providers, em14 powering individuals with tuberculosis, and ena15 bling and promoting research to develop new 

16 diagnostics, drugs, and vaccines, and program17 based operational research relating to tuber18 culosis; and 

19 ‘‘(B) funding’’; and 

20 (3) in the second sentence— 

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

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

23 the following: 


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

2 meet the requirements of paragraph (1), the Presi3 dent— 

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

5 (B) by striking ‘‘for Directly Observed 

6 Treatment Short-course (DOTS) coverage and 

7 treatment of multi-drug resistant tuberculosis 

8 using DOTS–Plus,’’ and inserting ‘‘to imple9 ment the Stop TB Strategy; and’’; and 

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

11 follows and inserting the following: 

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

13 $15,000,000 of the amount made available to 

14 carry out this section for a fiscal year is used 

15 to make a contribution to the Global Tuber16 culosis Drug Facility.’’. 

17 (d) ASSISTANCE FOR WHO AND THE STOP TUBER18 CULOSIS PARTNERSHIP.—Section 104B of the Foreign 

19 Assistance Act of 1961 (22 U.S.C. 2151b–3) is amend20 ed— 

21 (1) by redesignating subsection (f) as sub22 section (g); and 

23 (2) by inserting after subsection (e) the fol24 lowing new subsection: 


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1 ‘‘(f) ASSISTANCE FOR WHO AND THE STOP TUBER2 CULOSIS PARTNERSHIP.—In carrying out this section, the 

3 President, acting through the Administrator of the United 

4 States Agency for International Development, is author5 ized to provide increased resources to the World Health 

6 Organization (WHO) and the Stop Tuberculosis Partner7 ship to improve the capacity of countries with high rates 

8 of tuberculosis and other affected countries to implement 

9 the Stop TB Strategy and specific strategies related to 

10 addressing extensively drug resistant tuberculosis (XDR– 

11 TB).’’. 

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 six-point strategy to reduce tu5 berculosis developed by the World Health Organiza6 tion. The strategy is described in the Global Plan to 

7 Stop TB 2007–2016: Actions for Life, a comprehen8 sive plan developed by the Stop Tuberculosis Part9 nership that sets out the actions necessary to 

10 achieve the millennium development goal of cutting 

11 tuberculosis deaths and disease burden in half by 

12 2016.’’. 

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

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

15 2(e)(2)(C)(iii)) is amended by adding at the end before 

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

17 of such United States foreign assistance provided for diag18 nosis and treatment of individuals with tuberculosis in 

19 countries with the highest burden of tuberculosis, as deter20 mined by the World Health Organization (WHO)’’. 

21 (g) AUTHORIZATION OF APPROPRIATIONS.—There 

22 are authorized to be appropriated to the President not less 

23 than $330,000,000 for fiscal year 2008 and not less than 

24 $450,000,000 for fiscal year 2009 to carry out section 

25 104B of the Foreign Assistance Act of 1961 (22 U.S.C. 


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1 2151b–3), as amended by subsections (a) through (e) of 

2 this section. 

3 SEC. 4. AUTHORIZATION OF APPROPRIATIONS FOR GLOB4 AL TUBERCULOSIS ACTIVITIES OF THE CEN5 TERS FOR DISEASE CONTROL AND PREVEN6 TION. 

7 For the purpose of carrying out global tuberculosis 

8 activities through the Centers for Disease Control and 

9 Prevention, there are authorized to be appropriated 

10 $70,000,000 for fiscal year 2008 and $100,000,000 for 

11 fiscal year 2009. Such authorization of appropriations is 

12 in addition to other authorizations of appropriations that 

13 are available for such purposes. Amounts appropriated 

14 pursuant to the authorization of appropriations under this 

15 section shall remain available until expended. 

Æ 


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