I 

116TH CONGRESS 

1ST SESSION H. R. 3460 

To facilitate effective research on and treatment of neglected tropical diseases 

through coordinated international efforts. 

IN THE HOUSE OF REPRESENTATIVES 

JUNE 25, 2019 

Mr. SMITH of New Jersey (for himself, Mr. MCCAUL, Ms. BASS, Mr. SHERMAN, Mr. MEEKS, and Mr. CICILLINE) introduced the following bill; 

which was referred to the Committee on Foreign Affairs 

A BILL 

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, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘End Neglected Trop5 ical Diseases Act’’. 

6 SEC. 2. TABLE OF CONTENTS. 

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. 


pamtmann on DSKBFK8HB2PROD with BILLS
2 

•HR 3460 IH

Sec. 8. Actions by Department of State. 

Sec. 9. Multilateral development and health institutions. 

1 SEC. 3. STATEMENT OF POLICY. 

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

3 broad range of implementation and research and develop4 ment activities that work toward the achievement of cost5 effective and sustainable treatment, control, and, where 

6 possible, elimination of neglected tropical diseases for the 

7 economic and social well-being of all people. 

8 SEC. 4. FINDINGS. 

9 Congress finds the following: 

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

11 identified 17 neglected tropical diseases (NTDs). 

12 Approximately 2 billion people, almost one-third of 

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

14 NTD, and more than 1.4 billion people are currently 

15 afflicted with 1 or more NTDs. 

16 (2) In 2013, WHO adopted a comprehensive 

17 resolution on NTDs recognizing that increased na18 tional and international investments in prevention 

19 and control of neglected tropical diseases have suc20 ceeded in improving health and social well-being in 

21 many countries. 

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

23 disease burden and quality of life. NTDs cause the 

24 loss of up to 534,000 lives and 57 million disabilityVerDate Sep 11 2014 01:36 Jun 26, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H3460.IH H3460

pamtmann on DSKBFK8HB2PROD with BILLS
3 

•HR 3460 IH

1 adjusted life-years each year. NTDs surpass both 

2 malaria and tuberculosis in causing greater loss of 

3 life-years to disability and premature death. Many 

4 NTDs cause disfigurement and disability, leading to 

5 stigma, social discrimination, and societal 

6 marginalization. 

7 (4) NTDs create an economic burden of billions 

8 of dollars through the loss of productivity and high 

9 costs of health care required for treatment. People 

10 afflicted by NTDs are less productive than their 

11 healthy counterparts. NTDs jeopardize the ability of 

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

13 full capacity. For example, controlling one NTD, 

14 hookworm, in children can result in a 43-percent in15 crease in future wage earnings. 

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

17 NTDs falls primarily on low- and middle-income 

18 countries, where access to safe water, sanitation, 

19 and health care is limited. At least 100 countries 

20 face 2 endemic NTD burdens, and 30 countries 

21 carry 6 or more endemic NTDs. 

22 (6) NTDs are not confined to the developing 

23 world, however. Several NTD outbreaks have been 

24 reported in the United States and other developed 

25 countries, especially among the poor. In the United 


pamtmann on DSKBFK8HB2PROD with BILLS
4 

•HR 3460 IH

1 States, NTDs disproportionately affect people living 

2 in poverty, and especially minorities, including up to 

3 2.8 million African Americans with toxocariasis and 

4 300,000 or more people, mostly Hispanic Americans, 

5 with Chagas disease. 

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

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

8 feasible solutions. Understanding the economic bur9 den of NTDs on productivity and health care costs 

10 can help to assure governments and donors that the 

11 resources directed toward NTDs represent a good 

12 investment. 

13 (8) Research and development efforts are imme14 diately needed for all NTDs, especially those for 

15 which limited or no treatment currently exists. 

16 (9) Critical to developing robust NTD control 

17 strategies are epidemiological data that identify at18 risk populations, ensure appropriate treatment fre19 quency, and inform decisions about when treatment 

20 can be reduced or stopped. 

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

22 80 percent of infections are caused by soil-trans23 mitted helminths (STH) and schistosomiasis. STH 

24 are a group of 3 parasitic worms (roundworms, 

25 whipworms, and hookworms) that afflict more than 


pamtmann on DSKBFK8HB2PROD with BILLS
5 

•HR 3460 IH

1 1 billion people worldwide, including 600 million 

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

3 suffer from severe morbidity. Schistosomiasis is an4 other helminth infection affecting at least 200 mil5 lion people in developing countries, but some esti6 mates indicate that the true number of people af7 fected may be double or even triple that number. 

8 (11) The benefits of deworming are immediate 

9 and enduring. A rigorous randomized controlled trial 

10 has shown school-based deworming treatment to re11 duce school absenteeism by 25 percent. School-based 

12 deworming also benefits young siblings and other 

13 children who live nearby but are too young to be 

14 treated, leading to large cognitive improvements 

15 equivalent to half a year of schooling. 

16 SEC. 5. DEFINITION. 

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

18 ‘‘NTDs’’— 

19 (1) means infections caused by pathogens, in20 cluding viruses, bacteria, protozoa, and helminths 

21 that disproportionately impact individuals living in 

22 extreme poverty, especially in developing countries; 

23 and 

24 (2) includes— 


pamtmann on DSKBFK8HB2PROD with BILLS
6 

•HR 3460 IH

1 (A) Buruli ulcer (Mycobacterium Ulcerans 

2 infection); 

3 (B) Chagas disease; 

4 (C) dengue or severe dengue fever; 

5 (D) dracunculiasis (Guinea worm disease); 

6 (E) echinococcosis; 

7 (F) foodborne trematodiases; 

8 (G) human African trypanosomiasis (sleep9 ing sickness); 

10 (H) leishmaniasis; 

11 (I) leprosy; 

12 (J) lymphatic filariasis (elephantiasis); 

13 (K) onchocerciasis (river blindness); 

14 (L) scabies; 

15 (M) schistosomiasis; 

16 (N) soil-transmitted helminthiases (STH) 

17 (roundworm, whipworm, and hookworm); 

18 (O) taeniasis/cysticercosis; 

19 (P) trachoma; and 

20 (Q) yaws (endemic treponematoses). 

21 SEC. 6. RULE OF CONSTRUCTION. 

22 Nothing in this Act shall be construed to increase au23 thorizations of appropriations for the United States Agen24 cy for International Development. 


pamtmann on DSKBFK8HB2PROD with BILLS
7 

•HR 3460 IH

1 SEC. 7. EXPANSION OF UNITED STATES AGENCY FOR 

2 INTERNATIONAL DEVELOPMENT NEGLECTED 

3 TROPICAL DISEASES PROGRAM. 

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

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

6 Government has been an essential leader in global 

7 efforts to control seven targeted neglected tropical 

8 diseases: lymphatic filariasis (elephantiasis), 

9 onchocerciasis (river blindness), schistosomiasis, soil10 transmitted helminthiases (roundworm, whipworm, 

11 and hookworm), and trachoma. Additional informa12 tion suggests that such efforts could also produce 

13 collateral benefits for at least three other neglected 

14 tropical diseases: foodborne trematodiases, scabies, 

15 and yaws (endemic treponematoses). 

16 (2) The United States Government is a partner 

17 in the London Declaration on Neglected Tropical 

18 Diseases (2012), which represents a new, coordi19 nated international push to accelerate progress to20 ward eliminating or controlling 10 NTDs by 2020. 

21 (3) While many of the most common NTDs 

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

23 treatment options for the NTDs with the highest 

24 death rates, including human African 

25 trypanosomiasis (sleeping sickness), visceral leishma26 niasis, and Chagas disease, are extremely limited. 


pamtmann on DSKBFK8HB2PROD with BILLS
8 

•HR 3460 IH

1 (4) The United States Agency for International 

2 Development (USAID) Neglected Tropical Diseases 

3 Program has made important and substantial con4 tributions to the global fight to control and eliminate 

5 5 of the most common NTDs. Leveraging more than 

6 $15,700,000,000 in donated medicines, USAID has 

7 supported the distribution of more than 1 billion 

8 treatments in 31 countries across Africa, Asia, and 

9 Latin America and the Caribbean. 

10 (5) Since 2014, the USAID Neglected Tropical 

11 Diseases Program has been investing in research 

12 and development for the treatment of certain NTDs 

13 to ensure that promising new breakthrough medi14 cines can be rapidly evaluated, registered, and made 

15 available to patients. 

16 (6) The USAID Neglected Tropical Diseases 

17 Program is a clear example of a successful public18 private partnership between the Government and the 

19 private sector and should be judiciously expanded, as 

20 practicable and appropriate. 

21 (b) SENSE OF CONGRESS.—It is the sense of Con22 gress that the USAID Neglected Tropical Diseases Pro23 gram, as in effect on the date of the enactment of this 

24 Act, should— 


pamtmann on DSKBFK8HB2PROD with BILLS
9 

•HR 3460 IH

1 (1) provide integrated drug treatment packages 

2 to as many individuals suffering from NTDs or at 

3 risk of acquiring NTDs, including individuals dis4 placed by manmade and natural disasters, as 

5 logistically feasible; 

6 (2) better integrate NTD control and treatment 

7 tools and approaches into complementary develop8 ment and global health programs by coordinating, to 

9 the extent practicable and appropriate, across mul10 tiple sectors, including those relating to HIV/AIDS, 

11 malaria, tuberculosis, education, nutrition, other in12 fectious diseases, maternal and child health, and 

13 water, sanitation, and hygiene; 

14 (3) establish low-cost, high-impact community15 and school-based NTD programs to reach large at16 risk populations, including school-age children, with 

17 integrated drug treatment packages, as feasible; 

18 (4) as opportunities emerge and resources 

19 allow, engage in research and development of new 

20 tools and approaches to reach the goals relating to 

21 the elimination of NTDs as set forth by the 2012 

22 World Health Organization publication ‘‘Accel23 erating Work to Overcome the Global Impact of Ne24 glected Tropical Diseases: A Roadmap for Imple25 mentation’’, including for Chagas disease, Guinea 


pamtmann on DSKBFK8HB2PROD with BILLS
10 

•HR 3460 IH

1 worm, human African trypanosomiasis (sleeping 

2 sickness), leprosy, and visceral leishmaniasis; and 

3 (5) monitor research on and developments in 

4 the prevention and treatment of other NTDs so 

5 breakthroughs can be incorporated into the USAID 

6 Neglected Tropical Diseases Program, as practicable 

7 and appropriate. 

8 (c) PROGRAM PRIORITIES.—The Administrator of 

9 USAID should incorporate the following priorities into the 

10 USAID Neglected Tropical Diseases Program (as in effect 

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

12 (1) Planning for and conducting robust moni13 toring and evaluation of program investments in 

14 order to accurately measure impact, identify and 

15 share lessons learned, and inform future NTD con16 trol and elimination strategies. 

17 (2) Coordinating program activities with com18 plementary USAID development and global health 

19 programs, including programs relating to water, 

20 sanitation, and hygiene, food and nutrition security, 

21 and education (both primary and secondary), in 

22 order to advance the goals of the London Declara23 tion on Neglected Tropical Diseases (2012). 

24 (3) Including morbidity management in treat25 ment plans for high-burden NTDs. 


pamtmann on DSKBFK8HB2PROD with BILLS
11 

•HR 3460 IH

1 (4) Incorporating NTDs included in the Global 

2 Burden of Disease Study 2010 into the program as 

3 opportunities emerge, to the extent practicable and 

4 appropriate. 

5 (5) Continuing investments in the research and 

6 development of new tools and approaches that com7 plement existing research investments and ensure 

8 that new discoveries make it through the pipeline 

9 and become available to individuals who need them 

10 most. 

11 SEC. 8. ACTIONS BY DEPARTMENT OF STATE. 

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

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

14 States Government Activities to Combat HIV/AIDS Glob15 ally should fully consider evolving research on the impact 

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

17 future programming decisions, as necessary and appro18 priate. 

19 (b) GLOBAL PROGRAMMING.— 

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

21 should encourage the Global Fund to take into con22 sideration evolving research on the impact of NTDs 

23 on efforts to control HIV/AIDS when making pro24 gramming decisions, particularly with regard to fe25 male genital schistosomiasis, which studies suggest 


pamtmann on DSKBFK8HB2PROD with BILLS
12 

•HR 3460 IH

1 may be one of the most significant cofactors in the 

2 AIDS epidemic in Africa, as necessary and appro3 priate. 

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

5 term ‘‘Global Fund’’ means the public-private part6 nership known as the Global Fund to Fight AIDS, 

7 Tuberculosis and Malaria established pursuant to 

8 Article 80 of the Swiss Civil Code. 

9 (c) G–20 COUNTRIES.—The Secretary of State, act10 ing through the Office of Global Health Diplomacy, should 

11 encourage G–20 countries to significantly increase their 

12 role in the control and elimination of NTDs. 

13 SEC. 9. MULTILATERAL DEVELOPMENT AND HEALTH INSTI14 TUTIONS. 

15 (a) CONGRESSIONAL FINDING.—Congress finds that 

16 the treatment of NTDs, including community- and school17 based deworming programs, can be a highly cost-effective 

18 intervention, and schools can serve as an effective delivery 

19 mechanism for reaching large numbers of children with 

20 safe treatment for soil-transmitted helminthiases 

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

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

23 the United States permanent representative to the United 

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


pamtmann on DSKBFK8HB2PROD with BILLS
13 

•HR 3460 IH

1 States to urge the World Health Organization and the 

2 United Nations Development Programme to— 

3 (1) ensure the dissemination of best practices 

4 and programming on NTDs to governments and 

5 make data accessible to practitioners in an open and 

6 timely fashion; 

7 (2) highlight impacts of community- and school8 based deworming programs on children’s health and 

9 education, emphasizing the cost-effectiveness of such 

10 programs; 

11 (3) encourage governments to implement 

12 deworming campaigns at the national level; 

13 (4) consider the designation of a portion of 

14 grant funds of the institutions to deworming initia15 tives and cross-sectoral collaboration with water, 

16 sanitation, and hygiene efforts and nutrition or edu17 cation programming, as practicable and appropriate; 

18 (5) encourage accurate monitoring and evalua19 tion of NTD programs, including deworming pro20 grams; and 

21 (6) engage governments in cross-border initia22 tives for the treatment, control, prevention, and 

23 elimination of NTDs, and assist in developing 


pamtmann on DSKBFK8HB2PROD with BILLS
14 

•HR 3460 IH

1 transnational agreements, when and where nec2 essary. 

Æ 


pamtmann on DSKBFK8HB2PROD with BILLS