II

107TH CONGRESS

1ST SESSION S. 1032

To expanded assistance to countries seriously affected by HIV/AIDS, malaria,

and tuberculosis.

IN THE SENATE OF THE UNITED STATES

JUNE 13, 2001

Mr. FRIST (for himself, Mr. KERRY, Mr. HELMS, Mr. LEAHY, Mr. DURBIN,

and Mr. CHAFEE) introduced the following bill; which was read twice and

referred to the Committee on Foreign Relations

A BILL

To expanded assistance to countries seriously affected by

HIV/AIDS, malaria, and tuberculosis.

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 ‘‘International Infec5 tious Diseases Control Act of 2001’’.

6 SEC. 2. DEFINITIONS.

7 In this Act:

8 (1) AIDS.—The term ‘‘AIDS’’ means the ac9 quired immune deficiency syndrome.
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1 (2) EXECUTIVE AGENCY.—The term ‘‘Executive

2 agency’’ has the meaning given the term in section

3 105 of title 5, United States Code.

4 (3) GLOBAL FUND.—The term ‘‘global fund’’

5 means the global fund to fight HIV/AIDS, malaria,

6 and tuberculosis established consistent with section

7 4.

8 (4) HIV.—The term ‘‘HIV’’ means the human

9 immunodeficiency virus, the pathogen that causes

10 AIDS.

11 (5) HIV/AIDS.—The term ‘‘HIV/AIDS’’

12 means, with respect to an individual, an individual

13 who is infected with HIV or living with AIDS.

14 (6) SECRETARY GENERAL.—The term ‘‘Sec15 retary General’’ means the Secretary General of the

16 United Nations.

17 (7) WORLD BANK.—The term ‘‘World Bank’’

18 means the International Bank for Reconstruction

19 and Development.

20 SEC. ll03. FINDINGS.

21 Congress makes the following findings:

22 (1) HIV/AIDS, tuberculosis, and malaria dis23 proportionately affect the world’s poorest countries

24 and together will cost the lives of 6,000,000 people

25 this year alone.
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1 (2) According to the Joint United Nations Pro2 gramme on HIV/AIDS (UNAIDS), more than

3 58,000,000 people worldwide have already been in4 fected with HIV/AIDS, a fatal disease that is dev5 astating the health, economies, and social structures

6 in dozens of countries in Africa, and increasingly in

7 Asia, the Caribbean, and Eastern Europe.

8 (3) AIDS has wiped out decades of progress in

9 improving the lives of families in the developing

10 world. As the leading cause of death in Africa, AIDS

11 has killed 17,000,000 and will claim the lives of one

12 quarter of the population, mostly productive adults,

13 in the next decade. In addition, 13,000,000 children

14 have been orphaned by AIDS—a number that will

15 rise to 40,000,000 by 2010.

16 (4) The World Health Organization (WHO) es17 timates that 8,000,000 people each year become sick

18 with tuberculosis, one of the most dangerous con19 tagious diseases, easily transmitted through the air

20 from those infected. Globally, tuberculosis kills at

21 least 2,000,000 each year, is the leading killer of

22 women between 15 and 44 years old, and is the most

23 common cause of death in Africa in those with HIV/

24 AIDS.
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1 (5) More than 40 percent of tuberculosis cases

2 in the United States result from importation of tu3 berculosis from foreign-borne persons. Multidrug-re4 sistant tuberculosis spreads because of inadequate

5 control programs and inappropriate use of anti-tu6 berculosis drugs—mostly in the developing world.

7 Without a concerted international effort to increase

8 the implementation of WHO-approved control strate9 gies, the United States risks importation of this par10 ticularly dangerous form of tuberculosis.

11 (6) Malaria is a third disease that saps the so12 cial and economic strength tropical developing coun13 tries. Malaria affects more than 500,000,000 people

14 each year and undermines not only the health and

15 productivity of the world’s poorest countries; malaria

16 kills at least 1,000,000 each year, about 3,000 each

17 day. In Africa, malaria kills a child every 40 sec18 onds.

19 (7) Beyond the human toll, the economic im20 pact of AIDS, malaria, and tuberculosis on regional

21 economies is severe. According to UNAIDS, HIV/

22 AIDS alone will reduce gross domestic product

23 (GDP) of South Africa by 17 percent, or

24 $22,000,000,000 over the next 10 years, and WHO

25 estimates that sub-Saharan Africa’s GDP would be
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1 32 percent, or $100,000,000,000 higher now if ma2 laria had been conquered 35 years ago. The current

3 short term economic loss and direct cost of malaria

4 is estimated to be up to $12,000,000,000 each year.

5 (8) The UNAIDS program estimates it will cost

6 $3,000,000,000 for basic AIDS prevention and care

7 services in sub-Saharan Africa alone, and at least

8 $2,000,000,000 more if anti-retroviral drugs are

9 provided widely. But in Africa, only $500,000,000 is

10 currently available from all donors, lending agencies,

11 and African governments themselves.

12 (9) For tuberculosis control, WHO estimates

13 that a total of $1,000,000,000 per year will be nec14 essary to effectively fight the tuberculosis epidemic,

15 which will be spent to identify at least 70 percent of

16 the cases and curing 85 percent of them. WHO indi17 cates that an increase of $400,000,000 per year

18 could make this goal a reality.

19 (10) The Secretary General of the United Na20 tions, Kofi Annan, has called for a global fund to

21 halt and reverse the spread of HIV/AIDS, malaria,

22 and tuberculosis. The Secretary General proposed a

23 multibillion dollar ‘‘war chest’’ financed jointly by

24 donor governments and private contributors and,

25 equally important, called on leaders from developing
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1 nations to give a much higher priority in their budg2 ets to development of comprehensive health systems.

3 (11) The Secretary General has outlined the

4 following five objectives for the fight against AIDS:

5 (A) To ensure that people everywhere

6 know what to do to prevent infection.

7 (B) To prevent the transmission from

8 mother to child.

9 (C) To provide care and treatment to those

10 infected.

11 (D) To provide care to those affected by

12 AIDS, especially orphans.

13 (E) To deliver scientific breakthroughs, es14 pecially vaccines.

15 (12) Prevention of new infections is key, al16 though treatment and care for those infected by

17 HIV/AIDS is an increasingly critical component of

18 the global response. Improving health systems, pro19 viding home-based care, treating AIDS-associated

20 diseases like tuberculosis, providing for family sup21 port and orphan care, and making anti-retroviral

22 drugs against HIV available will reduce social and

23 economic damage to families and communities.

24 (13) Responding to the call from the Secretary

25 General, the African heads of state meeting at the
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1 African Summit on HIV/AIDS, tuberculosis, and

2 other infectious diseases in Abuja, Nigeria, April

3 25–27, committed to increasing to at least 15 per4 cent the proportion of their budgets allocated to the

5 health sector.

6 (14) Expanded United States financial support

7 for new broad based international partnerships to

8 control HIV/AIDS, malaria, and tuberculosis can

9 help leverage substantial increases in global commit10 ments to narrow the gap between need and currently

11 available resources.

12 (15) The World Bank and WHO have dem13 onstrated that investment in global public health ac14 tivities to reduce HIV/AIDS, malaria, and tuber15 culosis not only is a humanitarian imperative, it also

16 helps bolster the economic and social development

17 necessary to build political and trade alliances. Fur18 ther, containment of international disease threats

19 has beneficial ramifications for Americans who are

20 increasingly susceptible to global infectious disease

21 threats.

22 SEC. 4. PURPOSES.

23 The purposes of this Act are to provide for United

24 States participation in a global effort to—
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1 (1) mitigate the effects, and control the spread,

2 of HIV/AIDS, malaria, and tuberculosis by sup3 porting programs for the prevention of new infec4 tions and for the care and treatment of individuals

5 infected with those diseases in countries seriously af6 fected, especially programs that provide care for

7 children orphaned by the HIV/AIDS epidemic; and

8 (2) provide the resources and leadership to con9 trol AIDS, malaria, and tuberculosis through sup10 port of programs that emphasize—

11 (A) a science-based integrated approach

12 that includes prevention of new infections and

13 the treatment and care of infected individuals;

14 (B) public-private partnerships; and

15 (C) good governance.

16 SEC. 5. GLOBAL FUND TO FIGHT HIV/AIDS, MALARIA, AND

17 TUBERCULOSIS.

18 (a) EFFORTS TO REACH AGREEMENT FOR ESTAB19 LISHMENT OF GLOBAL FUND.—

20 (1) IN GENERAL.—The President, in consulta21 tion with the Secretary General and the heads of rel22 evant Executive agencies, shall work with foreign

23 governments, the United Nations and its relevant

24 specialized agencies, the World Bank, and the pri25 vate sector to reach an agreement for the establish-
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1 ment of a global fund to fight HIV/AIDS, malaria,

2 and tuberculosis, to carry out the purposes of sec3 tion 4 (1) and (2).

4 (2) DELEGATION OF AUTHORITY.—The Presi5 dent shall exercise the authority of this subsection

6 through the Secretary of State and the Secretary of

7 Health and Human Services, except that, with re8 spect to the World Bank, the President shall exer9 cise such authority through the Secretary of the

10 Treasury.

11 (b) DESCRIPTION OF GLOBAL FUND.—The global

12 fund should—

13 (1) be a public-private partnership that includes

14 participation of, and seeks contributions from, gov15 ernments, foundations, the private sector, civil soci16 ety, the United Nations system, nongovernmental or17 ganizations, and other parties;

18 (2) pursue an integrated approach that includes

19 the prevention of new infections and the treatment

20 and care of infected individuals;

21 (3) focus on promotion of ‘‘best practices’’ in

22 the prevention of new infections by funding a core

23 group of programs that have been proven effective

24 and then funding additional programs;
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1 (4) promote scientific and medical account2 ability by requiring proposals to be reviewed and ap3 proved by medical and public health experts; and

4 (5) respect intellectual property rights as an

5 important incentive in the development of new

6 drugs.

7 (c) COMPOSITION.—The global fund should be com8 posed as follows:

9 (1) BOARD OF TRUSTEES.—The global fund

10 should be governed by a board of trustees, which

11 should be composed of representatives of donors, re12 cipients of funding, multilateral agencies, and such

13 other parties as may be authorized by the agreement

14 establishing the global fund.

15 (2) TECHNICAL ADVISORY GROUP.—The board

16 of trustees of the global fund should establish a

17 technical advisory group, consisting of persons with

18 demonstrated knowledge and experience in the fields

19 of public health, epidemiology, health care delivery,

20 health economics, and biomedical research, to advise

21 the board of trustees with respect to funding pro22 posals and other matters.

23 (3) SECRETARIAT AND OTHER BODIES.—Other

24 bodies, such as a small secretariat, should be estab-
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1 lished to support the work of the board of trustees

2 of the global fund.

3 (d) PROGRAM OBJECTIVES.—

4 (1) GRANT AUTHORITY.—

5 (A) IN GENERAL.—In carrying out the

6 purposes of section 4 (1) and (2), the global

7 fund, acting through its board of trustees with

8 guidance from the technical advisory group,

9 should provide only grants, including grants for

10 technical assistance to support measures to

11 build local capacity in national and local gov12 ernment, civil society, and the private sector,

13 with respect to the prevention of new infections

14 and the care and treatment of individuals in15 fected with disease.

16 (B) ELIGIBILITY FOR GRANTS.—Govern17 ments and nongovernmental organizations shall

18 be eligible to receive grants from the global

19 fund. Emphasis should be given to facilitating

20 the funding of nongovernmental organizations,

21 including both faith-based and secular groups

22 working in communities, except that national

23 authorities should set the overall plan and agen24 da for dealing with public health and infectious

25 diseases in their countries.
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1 (2) ACTIVITIES SUPPORTED.—

2 (A) IN GENERAL.—Activities supported

3 under paragraph (1) should include efforts to

4 lead and implement effective and affordable

5 HIV/AIDS, malaria, and tuberculosis programs,

6 including programs focused on prevention and

7 health education and treatment and care serv8 ices, including access to affordable drugs.

9 (B) EMPHASIS ON STRONG POLITICAL

10 LEADERSHIP.—Emphasis should be given to en11 suring strong political leadership in recipient

12 countries, through the development and imple13 mentation of effective strategies against HIV/

14 AIDS, tuberculosis, and malaria; development

15 of well managed, transparently administered

16 health systems; and monitoring and evaluation

17 of programs supported by the global fund.

18 (C) INITIAL PRIORITY ON COMBATING HIV/

19 AIDS.—In view of the globalization of the AIDS

20 epidemic, initial priority should be given to pro21 grams to combat HIV/AIDS. Such programs

22 should include the promotion of ‘‘best prac23 tices’’ in the prevention of new infections, in24 cluding education that emphasizes risk avoid25 ance such as abstinence, measures to stop
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1 mother-to-child transmission, and efforts to

2 provide for the support and education of AIDS

3 orphans and the families, communities, and in4 stitutions most affected by HIV/AIDS.

5 (e) REPORTS TO CONGRESS.—

6 (1) ANNUAL REPORTS BY THE PRESIDENT.—

7 Not later than one year after the date of the enact8 ment of this Act, and annually thereafter for the du9 ration of the global fund, the President shall submit

10 to the appropriate committees of Congress a report

11 on the global fund, including its structure, objec12 tives, contributions, funded projects, and assessment

13 of its effectiveness.

14 (2) APPROPRIATE COMMITTEES DEFINED.—In

15 paragraph (1), the term ‘‘appropriate committees of

16 Congress’’ means the Committee on Foreign Rela17 tions and the Committee on Appropriations of the

18 Senate and the Committee on International Rela19 tions and the Committee on Appropriations of the

20 House of Representatives.

21 (f) UNITED STATES FINANCIAL PARTICIPATION.—

22 (1) AUTHORIZATION OF APPROPRIATIONS.—In

23 addition to any other funds authorized for multilat24 eral or bilateral programs related to HIV/AIDS, ma25 laria, tuberculosis, or economic development, there is
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1 authorized to be appropriated to the Department of

2 State $200,000,000 for fiscal year 2002 and

3 $500,000,000 for fiscal year 2003 for payment to

4 the global fund.

5 (2) REPROGRAMMING OF FISCAL YEAR 2001

6 FUNDS.—Funds made available for fiscal year 2001

7 under section 141 of the Global AIDS and Tuber8 culosis Relief Act of 2000 (as in effect immediately

9 before the date of enactment of this Act)—

10 (A) are authorized to remain available

11 until expended; and

12 (B) shall be transferred to, merged with,

13 and made available for the same purposes as,

14 funds made available for fiscal year 2002 under

15 paragraph (1).

16 (3) CERTIFICATION REQUIREMENT.—

17 (A) IN GENERAL.—Before the initial obli18 gation or expenditure of funds appropriated

19 under paragraph (1) or reprogrammed under

20 paragraph (2), the President shall certify that

21 adequate procedures and standards have been

22 established to ensure accountability for and

23 monitoring of the use of funds contributed to

24 the global fund, including the cost of admin25 istering the global fund.
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1 (B) TRANSMITTAL OF CERTIFICATION.—

2 The certification required by subparagraph (A),

3 and the bases for that certification, shall be

4 submitted by the President to Congress.

5 (4) STATUTORY CONSTRUCTION.—Nothing in

6 this Act may be construed to substitute for, or re7 duce resource levels otherwise appropriated by Con8 gress for, bilateral and multilateral HIV/AIDS, ma9 laria, and tuberculosis programs.

10 SEC. 6. REPEAL.

11 Subtitle B of title I of the Global AIDS and Tuber12 culosis Relief Act of 2000 (22 U.S.C. 6821 et seq.) is here13 by repealed.

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