I 

109TH CONGRESS 

2D SESSION H. R. 5022 

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 HOUSE OF REPRESENTATIVES 

MARCH 28, 2006 

Mr. BROWN of Ohio (for himself, Mr. LEACH, Mrs. WILSON of New Mexico, 

Mr. UDALL of New Mexico, Ms. LEE, Ms. MCCOLLUM of Minnesota, Mr. 

BERMAN, Mr. HONDA, Mr. MCNULTY, Mr. CROWLEY, Mr. MCDERMOTT, 

Ms. SCHAKOWSKY, Mr. WAXMAN, Mr. GEORGE MILLER of California, Mr. 

INSLEE, Mr. GRIJALVA, Mr. ANDREWS, and Mr. HOLT) introduced the 

following bill; which was referred to the Committee on International Relations, and in addition to the Committee on Energy and Commerce, for 

a period to be subsequently determined by the Speaker, in each case for 

consideration of such provisions as fall within the jurisdiction of the committee concerned 

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 2006’’. 


HMOORE on PROD1PC68 with HMBILLS
2 

•HR 5022 IH 

1 SEC. 2. FINDINGS. 

2 Congress finds the following: 

3 (1) Tuberculosis is one of the greatest infec4 tious causes of death of adults worldwide, killing 

5 nearly 2,000,000 people per year—one person every 

6 15 seconds. 

7 (2) One-third of the world’s population is in8 fected with the tuberculosis bacterium and an esti9 mated 9,000,000 individuals develop active tuber10 culosis each year. 

11 (3) Tuberculosis is the leading killer among in12 dividuals who are HIV-positive due to their weak13 ened immune systems, and it is estimated that one14 third of people with HIV infection have tuberculosis. 

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

16 women of reproductive age. 

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

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

19 People’s Republic of China and India account for 35 

20 percent of all estimated new tuberculosis cases each 

21 year. 

22 (6) Driven by the HIV/AIDS pandemic, inci23 dence rates of tuberculosis in Africa have more than 

24 doubled on average since 1990, making it the only 

25 region in the world in which tuberculosis rates are 

26 not currently stabilized or declining. The problem is 


HMOORE on PROD1PC68 with HMBILLS
3 

•HR 5022 IH 

1 so pervasive that in August 2005, African Health 

2 Ministers and the World Health Organization 

3 (WHO) declared tuberculosis to be an emergency in 

4 Africa. 

5 (7) The wide extent of drug resistance, includ6 ing multi-drug resistant tuberculosis (MDR–TB), in 

7 Eastern Europe and other parts of the world rep8 resents a critical challenge to the global control of 

9 tuberculosis. Drug resistance surveillance reports 

10 have confirmed the serious scale and spread of tu11 berculosis in Eastern Europe with tuberculosis 

12 strains often resistant to all first line drugs and also 

13 to some second line drugs. 

14 (8) With more than 50 percent of tuberculosis 

15 cases in the United States attributable to foreign16 born individuals and with the increase in inter17 national travel, commerce, and migration, elimi18 nation of tuberculosis in the United States depends 

19 on efforts to control the disease in developing coun20 tries. Recent research has shown that to invest in 

21 tuberculosis control abroad, where treatment and 

22 program costs are significantly cheaper than in the 

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

24 reduce tuberculosis-related morbidity and mortality 

25 domestically. 


HMOORE on PROD1PC68 with HMBILLS
4 

•HR 5022 IH 

1 (9) The threat that tuberculosis poses for 

2 Americans derives from the global spread of tuber3 culosis and the emergence and spread of strains of 

4 multi-drug resistant tuberculosis, which is far more 

5 deadly, and more difficult and costly to treat. 

6 (10) DOTS (Directly Observed Treatment 

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

8 interventions available today and is a core compo9 nent of the new Stop TB Strategy. 

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

11 World Health Organization, builds on the success of 

12 DOTS and ongoing challenges so as to serve all 

13 those in need and reach targets for prevalence, mor14 tality, and incidence reduction. The Stop TB Strat15 egy includes six components: 

16 (A) Pursuing high-quality expansion and 

17 enhancement of DOTS coverage. 

18 (B) Implementing tuberculosis and HIV 

19 collaborative activities, preventing and control20 ling multi-drug resistant tuberculosis, and ad21 dressing other special challenges. 

22 (C) Contributing to the strengthening of 

23 health systems. 


HMOORE on PROD1PC68 with HMBILLS
5 

•HR 5022 IH 

1 (D) Engaging all health care providers, in2 cluding promotion of the International Stand3 ards for Tuberculosis Care. 

4 (E) Empowering individuals with tuber5 culosis and communities. 

6 (F) Enabling and promoting research to 

7 develop new diagnostics, drugs, vaccines, and 

8 program-based operational research relating to 

9 tuberculosis. 

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

11 Actions for Life is a comprehensive plan developed 

12 by the Stop TB Partnership that sets out the ac13 tions necessary to achieve the millennium develop14 ment goal of cutting tuberculosis deaths and disease 

15 burden in half by 2015 and thus eliminate tuber16 culosis as a global health problem by 2050. 

17 (13) While innovations such as the Global Tu18 berculosis Drug Facility have enabled low-income 

19 countries to treat a standard case of tuberculosis 

20 with drugs that cost as little as $16 for a full six21 month course of treatment, there are still millions of 

22 individuals with no access to effective treatment. 

23 (14) As the global resource investment in fight24 ing tuberculosis increases, partner nations and inter25 national institutions must commit to a corVerDate Aug 31 2005 23:56 Mar 29, 2006 Jkt 049200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H5022.IH H5022

HMOORE on PROD1PC68 with HMBILLS
6 

•HR 5022 IH 

1 responding increase in the technical and program as2 sistance necessary to ensure that the most effective 

3 and efficient tuberculosis treatments are provided. 

4 (15) The Global Fund to Fight AIDS, Tuber5 culosis and Malaria is an important global partner6 ship established to combat these three infectious dis7 eases that together kill millions of people a year. Ex8 pansion of effective tuberculosis treatment programs 

9 constitutes a major component of Global Fund in10 vestment, along with integrated efforts to address 

11 HIV and tuberculosis in areas of high prevalence. 

12 (16) The Centers for Disease Control and Pre13 vention (CDC) is actively involved with global tuber14 culosis control efforts since the global tuberculosis 

15 epidemic directly impacts tuberculosis in the United 

16 States, and because Congress has strongly urged the 

17 CDC each year to increase its involvement with 

18 international tuberculosis control efforts. 

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

20 burden of tuberculosis to— 

21 (A) implement the World Health Organiza22 tion-recommended control strategies by improv23 ing the capacity to diagnose and cure individ24 uals with tuberculosis; 


HMOORE on PROD1PC68 with HMBILLS
7 

•HR 5022 IH 

1 (B) improve the capacity to diagnose, 

2 treat, and prevent tuberculosis in HIV-infected 

3 individuals and individuals with multi-drug re4 sistant tuberculosis; and 

5 (C) conduct programmatically-relevant 

6 operational research to identify and evaluate 

7 new diagnostics, treatment regimes, and inter8 ventions to control tuberculosis. 

9 SEC. 3. ASSISTANCE TO COMBAT TUBERCULOSIS. 

10 (a) POLICY.—Section 104B(b) of the Foreign Assist11 ance Act of 1961 (22 U.S.C. 2151b–3(b)) is amended to 

12 read as follows: 

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

14 assistance program of the United States to control tuber15 culosis. In all countries in which the United States Agency 

16 for International Development has established develop17 ment programs, the following goals in the battle against 

18 tuberculosis should be achieved by not later than Decem19 ber 31, 2015: 

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

21 disease burden from the 1990 baseline. 

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

23 70 percent of cases of tuberculosis infection and the 

24 cure of at least 85 percent of those cases detected.’’. 


HMOORE on PROD1PC68 with HMBILLS
8 

•HR 5022 IH 

1 (b) AUTHORIZATION.—Section 104B(c) of the For2 eign Assistance Act of 1961 (22 U.S.C. 2151b–3(c)) is 

3 amended by striking ‘‘is authorized to’’ and inserting 

4 ‘‘shall’’. 

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

6 104B(e) of the Foreign Assistance Act of 1961 (22 U.S.C. 

7 2151b–3(e)) is amended— 

8 (1) in the heading, to read as follows: ‘‘PRI9 ORITY TO STOP TB STRATEGY.—’’; 

10 (2) in the first sentence, by striking ‘‘In fur11 nishing’’ and all that follows through ‘‘, including 

12 funding’’ and inserting the following: 

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

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

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

16 Strategy, including expansion and enhancement 

17 of DOTS coverage, treatment for individuals in18 fected with both tuberculosis and HIV and 

19 treatment for individuals with multi-drug resist20 ant tuberculosis (MDR–TB), strengthening of 

21 health systems, use of the International Stand22 ards for Tuberculosis Care by all providers, em23 powering individuals with tuberculosis, and ena24 bling and promoting research to develop new 

25 diagnostics, drugs, and vaccines, and programVerDate Aug 31 2005 23:56 Mar 29, 2006 Jkt 049200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H5022.IH H5022

HMOORE on PROD1PC68 with HMBILLS
9 

•HR 5022 IH 

1 based operational research relating to tuber2 culosis; and 

3 ‘‘(B) funding’’; and 

4 (3) in the second sentence— 

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

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

7 the following: 

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

9 meet the requirements of paragraph (1), the Presi10 dent— 

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

12 (B) by striking ‘‘for Directly Observed 

13 Treatment Short-course (DOTS) coverage and 

14 treatment of multi-drug resistant tuberculosis 

15 using DOTS-Plus,’’ and inserting ‘‘to imple16 ment the Stop TB Strategy; and’’; and 

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

18 follows and inserting the following: 

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

20 $15,000,000 of the amount made available to 

21 carry out this section for a fiscal year is used 

22 to make a contribution to the Global Tuber23 culosis Drug Facility.’’. 

24 (d) ASSISTANCE FOR WHO AND THE STOP TUBER25 CULOSIS PARTNERSHIP.—Section 104B of the Foreign 


HMOORE on PROD1PC68 with HMBILLS
10 

•HR 5022 IH 

1 Assistance Act of 1961 (22 U.S.C. 2151b–3) is amend2 ed— 

3 (1) by redesignating subsection (f) as sub4 section (g); and 

5 (2) by inserting after subsection (e) the fol6 lowing new subsection: 

7 ‘‘(f) ASSISTANCE FOR WHO AND THE STOP TUBER8 CULOSIS PARTNERSHIP.—In carrying out this section, the 

9 President, acting through the Administrator of the United 

10 States Agency for International Development, is author11 ized to provide increased resources to the World Health 

12 Organization (WHO) and the Stop Tuberculosis Partner13 ship to improve the capacity of countries with high rates 

14 of tuberculosis and other affected countries to implement 

15 the Stop TB Strategy.’’. 

16 (e) DEFINITIONS.—Section 104B(g) of the Foreign 

17 Assistance Act of 1961, as redesignated by subsection 

18 (d)(1), is amended— 

19 (1) in paragraph (1), by adding at the end be20 fore the period the following: ‘‘, including low cost 

21 and effective diagnosis, treatment, and monitoring of 

22 tuberculosis, as well as a reliable drug supply, and 

23 a management strategy for public health systems, 

24 with health system strengthening, promotion of the 

25 use of the International Standards for Tuberculosis 


HMOORE on PROD1PC68 with HMBILLS
11 

•HR 5022 IH 

1 Care by all care providers, bacteriology under an ex2 ternal quality assessment framework, short-course 

3 chemotherapy, and sound reporting and recording 

4 systems’’; and 

5 (2) by adding after paragraph (5) the following 

6 new paragraph: 

7 ‘‘(6) STOP TB STRATEGY.—The term ‘Stop TB 

8 Strategy’ means the strategy described in the Global 

9 Plan to Stop TB 2006–2015: Actions for Life, a 

10 comprehensive plan developed by the Stop Tuber11 culosis Partnership that sets out the actions nec12 essary to achieve the millennium development goal of 

13 cutting tuberculosis deaths and disease burden in 

14 half by 2015.’’. 

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

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

17 2(e)(2)(C)(iii)) is amended by adding at the end before 

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

19 of such United States foreign assistance provided for diag20 nosis and treatment of individuals with tuberculosis in 

21 countries with the highest rates of tuberculosis, as deter22 mined by the World Health Organization (WHO)’’. 

23 (g) AUTHORIZATION OF APPROPRIATIONS.—There 

24 are authorized to be appropriated to the President not less 

25 than $225,000,000 for fiscal year 2007 and not less than 


HMOORE on PROD1PC68 with HMBILLS
12 

•HR 5022 IH 

1 $260,000,000 for fiscal year 2008 to carry out section 

2 104B of the Foreign Assistance Act of 1961 (22 U.S.C. 

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

4 this section. 

5 SEC. 4. AUTHORIZATION OF APPROPRIATIONS FOR GLOB6 AL TUBERCULOSIS ACTIVITIES OF THE CEN7 TERS FOR DISEASE CONTROL AND PREVEN8 TION. 

9 For the purpose of carrying out global tuberculosis 

10 activities through the Centers for Disease Control and 

11 Prevention, there are authorized to be appropriated 

12 $30,000,000 for fiscal year 2007 and such sums as may 

13 be necessary for fiscal year 2008. Such authorization of 

14 appropriations is in addition to other authorizations of ap15 propriations that are available for such purposes. Amounts 

16 appropriated pursuant to the authorization of appropria17 tions under this section shall remain available until ex18 pended. 

Æ 


HMOORE on PROD1PC68 with HMBILLS