IIB 

116TH CONGRESS 

1ST SESSION H. R. 3460 

IN THE SENATE OF THE UNITED STATES 

DECEMBER 4, 2019 

Received; read twice and referred to the Committee on Foreign Relations 

AN ACT 

To facilitate effective research on and treatment of neglected 

tropical diseases through coordinated international efforts. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘End Neglected Trop3 ical Diseases Act’’. 

4 SEC. 2. TABLE OF CONTENTS. 

5 The table of contents for this Act is as follows: 

Sec. 1. Short title. 

Sec. 2. Table of contents. 

Sec. 3. Statement of policy. 

Sec. 4. Findings. 

Sec. 5. Definition. 

Sec. 6. Rule of construction. 

Sec. 7. Expansion of United States Agency for International Development Neglected Tropical Diseases Program. 

Sec. 8. Actions by Department of State. 

Sec. 9. Multilateral development and health institutions. 

6 SEC. 3. STATEMENT OF POLICY. 

7 It is the policy of the United States to support a 

8 broad range of implementation and research and develop9 ment activities that work toward the achievement of cost10 effective and sustainable treatment, control, and, where 

11 possible, elimination of neglected tropical diseases for the 

12 economic and social well-being of all people. 

13 SEC. 4. FINDINGS. 

14 Congress finds the following: 

15 (1) The World Health Organization (WHO) has 

16 identified 17 neglected tropical diseases (NTDs). 

17 Approximately 2 billion people, almost one-third of 

18 the world’s population, are at risk of contracting an 

19 NTD, and more than 1.4 billion people are currently 

20 afflicted with 1 or more NTDs. 


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1 (2) In 2013, WHO adopted a comprehensive 

2 resolution on NTDs recognizing that increased na3 tional and international investments in prevention 

4 and control of neglected tropical diseases have suc5 ceeded in improving health and social well-being in 

6 many countries. 

7 (3) NTDs have an enormous impact in terms of 

8 disease burden and quality of life. NTDs cause the 

9 loss of up to 534,000 lives and 57 million disability10 adjusted life-years each year. NTDs surpass both 

11 malaria and tuberculosis in causing greater loss of 

12 life-years to disability and premature death. Many 

13 NTDs cause disfigurement and disability, leading to 

14 stigma, social discrimination, and societal 

15 marginalization. 

16 (4) NTDs create an economic burden of billions 

17 of dollars through the loss of productivity and high 

18 costs of health care required for treatment. People 

19 afflicted by NTDs are less productive than their 

20 healthy counterparts. NTDs jeopardize the ability of 

21 people to attend work and school, or to produce at 

22 full capacity. For example, controlling one NTD, 

23 hookworm, in children can result in a 43-percent in24 crease in future wage earnings. 


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1 (5) The social, economic, and health burden of 

2 NTDs falls primarily on low- and middle-income 

3 countries, where access to safe water, sanitation, 

4 and health care is limited. At least 100 countries 

5 face 2 endemic NTD burdens, and 30 countries 

6 carry 6 or more endemic NTDs. 

7 (6) NTDs are not confined to the developing 

8 world, however. Several NTD outbreaks have been 

9 reported in the United States and other developed 

10 countries, especially among the poor. In the United 

11 States, NTDs disproportionately affect people living 

12 in poverty, and especially minorities, including up to 

13 2.8 million African Americans with toxocariasis and 

14 300,000 or more people, mostly Hispanic Americans, 

15 with Chagas disease. 

16 (7) Many NTDs can be controlled, prevented, 

17 and even eliminated using low-cost, effective, and 

18 feasible solutions. Understanding the economic bur19 den of NTDs on productivity and health care costs 

20 can help to assure governments and donors that the 

21 resources directed toward NTDs represent a good 

22 investment. 

23 (8) Research and development efforts are imme24 diately needed for all NTDs, especially those for 

25 which limited or no treatment currently exists. 


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1 (9) Critical to developing robust NTD control 

2 strategies are epidemiological data that identify at3 risk populations, ensure appropriate treatment fre4 quency, and inform decisions about when treatment 

5 can be reduced or stopped. 

6 (10) Of the 14 most common NTDs, roughly 

7 80 percent of infections are caused by soil-trans8 mitted helminths (STH) and schistosomiasis. STH 

9 are a group of 3 parasitic worms (roundworms, 

10 whipworms, and hookworms) that afflict more than 

11 1 billion people worldwide, including 600 million 

12 school-age children, of whom more than 300 million 

13 suffer from severe morbidity. Schistosomiasis is an14 other helminth infection affecting at least 200 mil15 lion people in developing countries, but some esti16 mates indicate that the true number of people af17 fected may be double or even triple that number. 

18 (11) The benefits of deworming are immediate 

19 and enduring. A rigorous randomized controlled trial 

20 has shown school-based deworming treatment to re21 duce school absenteeism by 25 percent. School-based 

22 deworming also benefits young siblings and other 

23 children who live nearby but are too young to be 

24 treated, leading to large cognitive improvements 

25 equivalent to half a year of schooling. 


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1 SEC. 5. DEFINITION. 

2 In this Act, the term ‘‘neglected tropical diseases’’ or 

3 ‘‘NTDs’’— 

4 (1) means infections caused by pathogens, in5 cluding viruses, bacteria, protozoa, and helminths 

6 that disproportionately impact individuals living in 

7 extreme poverty, especially in developing countries; 

8 and 

9 (2) includes— 

10 (A) Buruli ulcer (Mycobacterium Ulcerans 

11 infection); 

12 (B) Chagas disease; 

13 (C) dengue or severe dengue fever; 

14 (D) dracunculiasis (Guinea worm disease); 

15 (E) echinococcosis; 

16 (F) foodborne trematodiases; 

17 (G) human African trypanosomiasis (sleep18 ing sickness); 

19 (H) leishmaniasis; 

20 (I) leprosy; 

21 (J) lymphatic filariasis (elephantiasis); 

22 (K) onchocerciasis (river blindness); 

23 (L) scabies; 

24 (M) schistosomiasis; 

25 (N) soil-transmitted helminthiases (STH) 

26 (roundworm, whipworm, and hookworm); 


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1 (O) taeniasis/cysticercosis; 

2 (P) trachoma; and 

3 (Q) yaws (endemic treponematoses). 

4 SEC. 6. RULE OF CONSTRUCTION. 

5 Nothing in this Act shall be construed to increase au6 thorizations of appropriations for the United States Agen7 cy for International Development. 

8 SEC. 7. EXPANSION OF UNITED STATES AGENCY FOR 

9 INTERNATIONAL DEVELOPMENT NEGLECTED 

10 TROPICAL DISEASES PROGRAM. 

11 (a) FINDINGS.—Congress finds the following: 

12 (1) Since fiscal year 2006, the United States 

13 Government has been an essential leader in global 

14 efforts to control seven targeted neglected tropical 

15 diseases: lymphatic filariasis (elephantiasis), 

16 onchocerciasis (river blindness), schistosomiasis, soil17 transmitted helminthiases (roundworm, whipworm, 

18 and hookworm), and trachoma. Additional informa19 tion suggests that such efforts could also produce 

20 collateral benefits for at least three other neglected 

21 tropical diseases: foodborne trematodiases, scabies, 

22 and yaws (endemic treponematoses). 

23 (2) The United States Government is a partner 

24 in the London Declaration on Neglected Tropical 

25 Diseases (2012), which represents a new, coordiVerDate Sep 11 2014 21:50 Dec 04, 2019 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H3460.RFS H3460

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1 nated international push to accelerate progress to2 ward eliminating or controlling 10 NTDs by 2020. 

3 (3) While many of the most common NTDs 

4 have safe, easy to use, and effective treatments, 

5 treatment options for the NTDs with the highest 

6 death rates, including human African 

7 trypanosomiasis (sleeping sickness), visceral leishma8 niasis, and Chagas disease, are extremely limited. 

9 (4) The United States Agency for International 

10 Development (USAID) Neglected Tropical Diseases 

11 Program has made important and substantial con12 tributions to the global fight to control and eliminate 

13 5 of the most common NTDs. Leveraging more than 

14 $15,700,000,000 in donated medicines, USAID has 

15 supported the distribution of more than 1 billion 

16 treatments in 31 countries across Africa, Asia, and 

17 Latin America and the Caribbean. 

18 (5) Since 2014, the USAID Neglected Tropical 

19 Diseases Program has been investing in research 

20 and development for the treatment of certain NTDs 

21 to ensure that promising new breakthrough medi22 cines can be rapidly evaluated, registered, and made 

23 available to patients. 

24 (6) The USAID Neglected Tropical Diseases 

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1 private partnership between the Government and the 

2 private sector and should be judiciously expanded, as 

3 practicable and appropriate. 

4 (b) SENSE OF CONGRESS.—It is the sense of Con5 gress that the USAID Neglected Tropical Diseases Pro6 gram, as in effect on the date of the enactment of this 

7 Act, should— 

8 (1) provide integrated drug treatment packages 

9 to as many individuals suffering from NTDs or at 

10 risk of acquiring NTDs, including individuals dis11 placed by manmade and natural disasters, as 

12 logistically feasible; 

13 (2) better integrate NTD control and treatment 

14 tools and approaches into complementary develop15 ment and global health programs by coordinating, to 

16 the extent practicable and appropriate, across mul17 tiple sectors, including those relating to HIV/AIDS, 

18 malaria, tuberculosis, education, nutrition, other in19 fectious diseases, maternal and child health, and 

20 water, sanitation, and hygiene; 

21 (3) establish low-cost, high-impact community22 and school-based NTD programs to reach large at23 risk populations, including school-age children, with 

24 integrated drug treatment packages, as feasible; 


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1 (4) as opportunities emerge and resources 

2 allow, engage in research and development of new 

3 tools and approaches to reach the goals relating to 

4 the elimination of NTDs as set forth by the 2012 

5 World Health Organization publication ‘‘Accel6 erating Work to Overcome the Global Impact of Ne7 glected Tropical Diseases: A Roadmap for Imple8 mentation’’, including for Chagas disease, Guinea 

9 worm, human African trypanosomiasis (sleeping 

10 sickness), leprosy, and visceral leishmaniasis; and 

11 (5) monitor research on and developments in 

12 the prevention and treatment of other NTDs so 

13 breakthroughs can be incorporated into the USAID 

14 Neglected Tropical Diseases Program, as practicable 

15 and appropriate. 

16 (c) PROGRAM PRIORITIES.—The Administrator of 

17 USAID should incorporate the following priorities into the 

18 USAID Neglected Tropical Diseases Program (as in effect 

19 on the date of the enactment of this Act): 

20 (1) Planning for and conducting robust moni21 toring and evaluation of program investments in 

22 order to accurately measure impact, identify and 

23 share lessons learned, and inform future NTD con24 trol and elimination strategies. 


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1 (2) Coordinating program activities with com2 plementary USAID development and global health 

3 programs, including programs relating to water, 

4 sanitation, and hygiene, food and nutrition security, 

5 and education (both primary and secondary), in 

6 order to advance the goals of the London Declara7 tion on Neglected Tropical Diseases (2012). 

8 (3) Including morbidity management in treat9 ment plans for high-burden NTDs. 

10 (4) Incorporating NTDs included in the Global 

11 Burden of Disease Study 2010 into the program as 

12 opportunities emerge, to the extent practicable and 

13 appropriate. 

14 (5) Continuing investments in the research and 

15 development of new tools and approaches that com16 plement existing research investments and ensure 

17 that new discoveries make it through the pipeline 

18 and become available to individuals who need them 

19 most. 

20 SEC. 8. ACTIONS BY DEPARTMENT OF STATE. 

21 (a) OFFICE OF THE GLOBAL AIDS COORDINATOR.— 

22 It is the sense of Congress that the Coordinator of United 

23 States Government Activities to Combat HIV/AIDS Glob24 ally should fully consider evolving research on the impact 

25 of NTDs on efforts to control HIV/AIDS when making 


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1 future programming decisions, as necessary and appro2 priate. 

3 (b) GLOBAL PROGRAMMING.— 

4 (1) IN GENERAL.—The Secretary of State 

5 should encourage the Global Fund to take into con6 sideration evolving research on the impact of NTDs 

7 on efforts to control HIV/AIDS when making pro8 gramming decisions, particularly with regard to fe9 male genital schistosomiasis, which studies suggest 

10 may be one of the most significant cofactors in the 

11 AIDS epidemic in Africa, as necessary and appro12 priate. 

13 (2) GLOBAL FUND.—In this subsection, the 

14 term ‘‘Global Fund’’ means the public-private part15 nership known as the Global Fund to Fight AIDS, 

16 Tuberculosis and Malaria established pursuant to 

17 Article 80 of the Swiss Civil Code. 

18 (c) G–20 COUNTRIES.—The Secretary of State, act19 ing through the Office of Global Health Diplomacy, should 

20 encourage G–20 countries to significantly increase their 

21 role in the control and elimination of NTDs. 

22 SEC. 9. MULTILATERAL DEVELOPMENT AND HEALTH INSTI23 TUTIONS. 

24 (a) CONGRESSIONAL FINDING.—Congress finds that 

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1 based deworming programs, can be a highly cost-effective 

2 intervention, and schools can serve as an effective delivery 

3 mechanism for reaching large numbers of children with 

4 safe treatment for soil-transmitted helminthiases 

5 (roundworm, whipworm, and hookworm) in particular. 

6 (b) UNITED NATIONS.—The President should direct 

7 the United States permanent representative to the United 

8 Nations to use the voice, vote, and influence of the United 

9 States to urge the World Health Organization and the 

10 United Nations Development Programme to— 

11 (1) ensure the dissemination of best practices 

12 and programming on NTDs to governments and 

13 make data accessible to practitioners in an open and 

14 timely fashion; 

15 (2) highlight impacts of community- and school16 based deworming programs on children’s health and 

17 education, emphasizing the cost-effectiveness of such 

18 programs; 

19 (3) encourage governments to implement 

20 deworming campaigns at the national level; 

21 (4) consider the designation of a portion of 

22 grant funds of the institutions to deworming initia23 tives and cross-sectoral collaboration with water, 

24 sanitation, and hygiene efforts and nutrition or edu25 cation programming, as practicable and appropriate; 


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1 (5) encourage accurate monitoring and evalua2 tion of NTD programs, including deworming pro3 grams; and 

4 (6) engage governments in cross-border initia5 tives for the treatment, control, prevention, and 

6 elimination of NTDs, and assist in developing 

7 transnational agreements, when and where nec8 essary. 

Passed the House of Representatives December 3, 

2019. 

Attest: CHERYL L. JOHNSON, 

Clerk. 


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