```

[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 2481 Introduced in Senate (IS)]

<DOC>

116th CONGRESS
  1st Session
                                S. 2481

To facilitate effective research on and treatment of neglected tropical 
    diseases through coordinated domestic and international efforts.

_______________________________________________________________________

                   IN THE SENATE OF THE UNITED STATES

                           September 17, 2019

 Mr. Brown (for himself and Mr. Wicker) introduced the following bill; 
     which was read twice and referred to the Committee on Health, 
                     Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL

 
To facilitate effective research on and treatment of neglected tropical 
    diseases through coordinated domestic and international efforts.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``End Neglected Tropical Diseases 
Act''.

SEC. 2. TABLE OF CONTENTS.

    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. Definitions.
Sec. 6. Rule of construction.
                        TITLE I--FOREIGN AFFAIRS

Sec. 101. United States Agency for International Development Neglected 
                            Tropical Diseases Program.
Sec. 102. Actions by Department of State.
Sec. 103. Multilateral development and health institutions.
           TITLE II--DEPARTMENT OF HEALTH AND HUMAN SERVICES

Sec. 201. Promoting efforts through interagency working groups and 
                            international forums.
Sec. 202. Report on neglected tropical diseases in the United States.
Sec. 203. Centers of excellence.
Sec. 204. Panel on worm infection solutions.

SEC. 3. STATEMENT OF POLICY.

    It is the policy of the United States to support a broad range of 
implementation and research and development activities that work toward 
the achievement of cost-effective and sustainable treatment, control 
and, where possible, elimination of neglected tropical diseases for the 
economic and social well-being of all people.

SEC. 4. FINDINGS.

    Congress finds the following:
            (1) The Centers for Disease Control and Prevention have 
        identified 17 neglected tropical diseases (referred to in this 
        section as ``NTDs''). Approximately 2,000,000,000 people are at 
        risk of contracting an NTD, and more than 1,040,000,000 people 
        are currently afflicted with 1 or more NTDs.
            (2) In 2012, the London Declaration on Neglected Tropical 
        Diseases identified 10 NTDs with the potential to be 
        controlled, eliminated, or eradicated by 2020.
            (3) In 2013, the World Health Organization (referred to in 
        this section as ``WHO'') adopted a comprehensive resolution on 
        NTDs, recognizing that increased national and international 
        investments in prevention and control of these diseases have 
        succeeded in improving health and social well-being in many 
        countries. WHO's World Health Assembly maintains and updates a 
        list of the diverse NTDs across the world.
            (4) In its fourth Update Report, published in 2017, WHO 
        reported significant progress in expanding NTD interventions 
        worldwide, but challenges continue in--
                    (A) developing improved evaluation and surveillance 
                tools; and
                    (B) maintaining sufficient funding to ensure that 
                progress is sustained.
            (5) NTDs have an enormous impact in terms of disease burden 
        and quality of life. NTDs cause the loss of up to 185,000 lives 
        and up to 2,500,000,000 disability-adjusted life years each 
        year. NTDs surpass both malaria and tuberculosis in causing 
        greater loss of life-years to disability and premature death. 
        Many NTDs cause disfigurement and disability, in addition to 
        significant morbidity and mortality, leading to stigma, social 
        discrimination, and societal marginalization.
            (6) NTDs create an economic burden of billions of dollars 
        through the loss of productivity and high costs of health care 
        required for treatment. People afflicted by NTDs are less 
        productive than their healthy counterparts. NTDs jeopardize the 
        ability of people to attend work and school, or to produce at 
        full capacity. For example, controlling 1 NTD (hookworm) in 
        children can result in a 43 percent increase in future wage 
        earnings.
            (7) The social, economic, and health burden of NTDs falls 
        primarily on low- and middle-income countries, where access to 
        safe water, sanitation, and health care is limited. At least 
        100 countries face 2 endemic NTD burdens, and 30 countries 
        carry six or more endemic NTDs. All low-income countries are 
        affected by at least 5 NTDs, and 149 countries and territories 
        are affected by at least 1 NTD.
            (8) NTDs are not confined to the developing world. Several 
        NTDs have been reported in the United States and other 
        developed countries. In the United States, NTDs 
        disproportionately affect communities of color and the poor, 
        with up to 2,850,000 African Americans suffering from 
        toxocariasis and at least 300,000 people, who are mostly 
        Hispanic Americans, are afflicted with Chagas disease.
            (9) Many NTDs can be controlled, prevented, and even 
        eliminated using low-cost, effective, and feasible solutions. 
        Understanding the economic burden of NTDs on productivity and 
        health care costs can help to assure governments and donors 
        that the resources directed toward NTDs represent a good 
        investment.
            (10) Research and development efforts are immediately 
        needed for all NTDs, especially to advance next-generation 
        treatments, interventions, and diagnostics to ensure that 
        countries endemic for NTDs are able to implement and sustain 
        NTD control programs.
            (11) Epidemiological data that identify at-risk populations 
        and ensure that these populations receive consistent and 
        sufficient doses of treatment for their diseases are critical 
        to developing robust NTD control strategies.
            (12) The benefits of deworming are immediate. A rigorous, 
        randomized controlled trial has shown school-based deworming 
        treatment to reduce school absenteeism by 25 percent. School-
        based deworming also benefits young siblings and other children 
        who live nearby but are too young to be treated, leading to 
        large cognitive improvements equivalent to \1/2\ of a year of 
        schooling.
            (13) Improved access to water, sanitation, and hygiene can 
        also reduce the transmission of NTDs, particularly NTDs caused 
        by parasites.

SEC. 5. DEFINITIONS.

    In this Act:
            (1) Global fund.--The term ``Global Fund'' means the 
        public-private partnership known as the Global Fund to Fight 
        AIDS, Tuberculosis, and Malaria established pursuant to Article 
        80 of the Swiss Civil Code.
            (2) Neglected tropical diseases; ntds.--The terms 
        ``neglected tropical diseases'' and ``NTDs''--
                    (A) mean infections caused by pathogens, including 
                viruses, bacteria, protozoa, and helminths, that 
                disproportionately impact individuals living in extreme 
                poverty, especially in developing countries; and
                    (B) include--
                            (i) Buruli ulcer;
                            (ii) Chagas disease;
                            (iii) Cysticercosis;
                            (iv) Dengue fever;
                            (v) Dracunculiasis (Guinea worm disease);
                            (vi) Echinococcosis;
                            (vii) Fascioliasis;
                            (viii) Human African trypanosomiasis 
                        (sleeping sickness);
                            (ix) Leishmaniasis;
                            (x) Leprosy (Hansen's disease);
                            (xi) Lymphatic filariasis (elephantiasis);
                            (xii) Onchocerciasis (river blindness);
                            (xiii) Rabies;
                            (xiv) Schistosomiasis;
                            (xv) Soil-transmitted Helminthiases (STH), 
                        such as round worm, whip worm, and hook worm;
                            (xvi) Trachoma; and
                            (xvii) Yaws.

SEC. 6. RULE OF CONSTRUCTION.

    Nothing in this Act may be construed to increase the authorization 
of appropriations for--
            (1) the United States Agency for International Development; 
        or
            (2) the Department of Health and Human Services.

                        TITLE I--FOREIGN AFFAIRS

SEC. 101. UNITED STATES AGENCY FOR INTERNATIONAL DEVELOPMENT NEGLECTED 
              TROPICAL DISEASES PROGRAM.

    (a) Findings.--Congress finds the following:
            (1) Since fiscal year 2006, the United States Agency for 
        International Development (referred to in this title as 
        ``USAID'') has been an essential leading partner in advancing 
        control and elimination efforts for 5 targeted neglected 
        tropical diseases: lymphatic filariasis (elephantiasis), 
        onchocerciasis (river blindness), schistosomiasis, soil-
        transmitted helminthiases (round worm, whip worm, and hook 
        worm), and trachoma.
            (2) USAID is an original endorser of the ``London 
        Declaration on Neglected Tropical Diseases'', signed in London 
        on January 30, 2012, which represents a new, coordinated 
        international push to accelerate progress toward eliminating or 
        controlling 10 NTDs by 2020.
            (3) The USAID Neglected Tropical Diseases Program has made 
        important and substantial contributions to the global fight to 
        control and eliminate the 5 targeted NTDs. Leveraging more than 
        $19,000,000,000 in donated medicines, USAID has supported the 
        distribution of more than 2,300,000,000 treatments in 31 
        countries across Africa, Asia, Latin America, and the 
        Caribbean.
            (4) Since 2014, the USAID Neglected Tropical Diseases 
        Program has been investing in gathering research and 
        development for the treatment of certain NTDs to ensure that 
        promising new breakthrough diagnostics and medicines can be 
        rapidly evaluated, registered, and made available to patients.
            (5) The USAID Neglected Tropical Diseases Program--
                    (A) is a clear example of a successful public-
                private partnership between the Government and the 
                private sector; and
                    (B) already has contributed to the elimination of 
                at least 1 NTD in 9 different countries.
    (b) Sense of Congress.--It is the sense of Congress that the USAID 
Neglected Tropical Diseases Program, as in effect on the date of the 
enactment of this Act--
            (1) should be continued and may be judiciously expanded, as 
        practicable and appropriate;
            (2) should continue to provide treatment to as many 
        individuals suffering from an NTD or at risk of acquiring an 
        NTD, including individuals displaced by manmade and natural 
        disasters, as logistically feasible;
            (3) should integrate NTD control, treatment tools, and 
        approaches into complementary development and global health 
        programs by coordinating, to the extent practicable and 
        appropriate, across multiple sectors, including sectors 
        relating to HIV/AIDS, malaria, tuberculosis, education, 
        nutrition, other infectious diseases, maternal and child 
        health, and water, sanitation, and hygiene;
            (4) should continue to conduct low-cost, high-impact 
        community and school-based NTD programs to reach large at-risk 
        populations, including school-age children, with integrated 
        drug treatment packages, as feasible;
            (5) should engage in research and development of new tools 
        and approaches, as opportunities emerge and resources allow, to 
        reach the goals relating to the elimination of NTDs set forth 
        by the World Health Organization; and
            (6) should monitor research on and developments in the 
        prevention and treatment of other NTDs so breakthroughs can be 
        incorporated into the USAID Neglected Tropical Diseases 
        Program, as practicable and appropriate.
    (c) Program Priorities.--The Administrator of USAID should 
incorporate the following priorities into USAID's Neglected Tropical 
Diseases Program (as in effect on the date of the enactment of this 
Act):
            (1) Planning for, and conducting robust monitoring and 
        evaluation of, program investments in order to accurately 
        measure impact, identify and share lessons learned, and inform 
        future NTD control and elimination strategies.
            (2) Coordinating program activities with complementary 
        USAID development and global health programs, including 
        programs relating to water, sanitation, and hygiene, food and 
        nutrition security, and primary and secondary education in 
        order to advance the goals of the London Declaration on 
        Neglected Tropical Diseases.
            (3) Including morbidity management in National NTD Master 
        Plans.
            (4) Incorporating NTDs included in the Global Burden of 
        Disease Study 2010 into the program as opportunities emerge, to 
        the extent practicable and appropriate.
            (5) Continuing investments in the research and development 
        of new tools and approaches that--
                    (A) complement existing research investments; and
                    (B) ensure that new discoveries make it through the 
                pipeline and become available to individuals who need 
                them.

SEC. 102. ACTIONS BY DEPARTMENT OF STATE.

    (a) Sense of Congress.--It is the sense of Congress that the 
Coordinator of United States Government Activities to Combat HIV/AIDS 
Globally should fully consider, as necessary and appropriate, evolving 
research on the impact of neglected tropical diseases on efforts to 
control HIV/AIDS when making future programming decisions.
    (b) Global Programming.--The Secretary of State should encourage 
the Global Fund to consider, as necessary and appropriate, evolving 
research on the impact of NTDs on efforts to control HIV/AIDS, 
tuberculosis, and malaria when making programming decisions, 
particularly with regard to female genital schistosomiasis, which 
studies suggest may be a significant co-factor in the AIDS epidemic in 
Africa.
    (c) G-20 Countries.--The Secretary of State, acting through the 
Office of Global Health Diplomacy, should encourage G-20 countries to 
significantly increase their role in the control and elimination of 
NTDs.

SEC. 103. MULTILATERAL DEVELOPMENT AND HEALTH INSTITUTIONS.

    (a) Finding.--Congress finds that the treatment of NTDs, including 
community and school-based deworming programs, can be a highly cost-
effective education intervention and schools can serve as an effective 
delivery mechanism for reaching large numbers of children with safe 
treatment for soil-transmitted helminthiases (round worm, whip worm, 
and hook worm).
    (b) Sense of Congress.--The President should direct the United 
States Permanent Representative to the United Nations to use the voice, 
vote, and influence of the United States to urge the World Health 
Organization and the United Nations Development Programme--
            (1) to ensure the dissemination of best practices and 
        programming on NTDs to governments and make data accessible to 
        practitioners in an open and timely fashion;
            (2) to highlight impacts of community and school-based 
        deworming programs on children's health and education, 
        emphasizing the cost-effectiveness of such programs;
            (3) to encourage governments to establish and implement 
        national NTD programs;
            (4) to consider designating a portion of grant funds of the 
        institutions to deworming initiatives and cross-sectoral 
        collaboration with water, sanitation, and hygiene efforts and 
        nutrition or education programming, as practicable and 
        appropriate;
            (5) to encourage accurate monitoring and evaluation of NTD 
        programs, including deworming programs; and
            (6) to engage governments in cross-border initiatives for 
        the treatment, control, prevention, and elimination of NTDs, 
        and assist in developing transnational agreements, when and 
        where necessary.

           TITLE II--DEPARTMENT OF HEALTH AND HUMAN SERVICES

SEC. 201. PROMOTING EFFORTS THROUGH INTERAGENCY WORKING GROUPS AND 
              INTERNATIONAL FORUMS.

    The Secretary of Health and Human Services shall continue to 
promote the need for robust programs and activities to diagnose, 
prevent, control, and treat neglected tropical diseases--
            (1) through interagency working groups on health; and
            (2) through relevant international forums on behalf of the 
        United States, including the post-2015 United Nations 
        development agenda.

SEC. 202. REPORT ON NEGLECTED TROPICAL DISEASES IN THE UNITED STATES.

    (a) In General.--Not later than 1 year after the date of the 
enactment of this Act, the Secretary of Health and Human Services, 
acting through relevant agencies of the Department of Health and Human 
Services, shall submit a report to the Congress on neglected tropical 
diseases in the United States.
    (b) Contents.--The report required under this section shall--
            (1) assess the epidemiology of, impact of, and appropriate 
        funding required to address, neglected tropical diseases in the 
        United States; and
            (2) include information necessary--
                    (A) to guide future health policy with respect to 
                such diseases;
                    (B) to accurately evaluate the current state of 
                knowledge concerning such diseases; and
                    (C) to define gaps in such knowledge.

SEC. 203. CENTERS OF EXCELLENCE.

    Part P of title III of the Public Health Service Act is amended by 
inserting after section 399V-6 (42 U.S.C. 280g-17) the following:

``SEC. 399V-7. NEGLECTED TROPICAL DISEASE CENTERS OF EXCELLENCE.

    ``(a) Cooperative Agreements and Grants.--
            ``(1) In general.--The Secretary, acting through the 
        Director of the Centers for Disease Control and Prevention, may 
        enter into cooperative agreements with, and award grants to, 
        public or private nonprofit entities to pay all or part of the 
        cost of planning, establishing, or strengthening, and providing 
        basic operating support for, one or more centers of excellence 
        for research into, training in, and development of diagnosis, 
        prevention, control, and treatment methods for neglected 
        tropical diseases, including tools to support elimination by 
        building capacity for sustainable prevention efforts once 
        epidemiology has been characterized and initial control 
        achieved.
            ``(2) Eligibility.--To be eligible for a cooperative 
        agreement or grant under this section, an entity must--
                    ``(A) have demonstrated expertise in research on, 
                or the epidemiology and surveillance of, major 
                neglected tropical diseases that are endemic to the 
                United States, such as Chagas disease, dengue, 
                leishmaniasis, West Nile virus, and helminth 
                infections; and
                    ``(B) participate in one or more not-for-profit 
                product development partnerships.
    ``(b) Policies.--A cooperative agreement or grant under subsection 
(a) shall be entered into or awarded in accordance with established 
policies.
    ``(c) Coordination.--The Secretary shall ensure that activities 
under this section are coordinated with similar activities of the 
Department of Health and Human Services relating to neglected tropical 
diseases.
    ``(d) Uses of Funds.--A cooperative agreement or grant under 
subsection (a) may be used for--
            ``(1) staffing, administrative, and other basic operating 
        costs, including patient care costs that are required for 
        research;
            ``(2) clinical training, including training for allied 
        health professionals, continuing education for health 
        professionals and allied health professions personnel, and 
        information programs for the public with respect to neglected 
        tropical diseases; and
            ``(3) research and development programs.
    ``(e) Period of Support; Additional Periods.--
            ``(1) In general.--Except as provided in paragraph (2), 
        support of a center of excellence under this section may be for 
        a period of not more than 5 years.
            ``(2) Extensions.--The period specified in paragraph (1) 
        may be extended by the Secretary for additional periods of not 
        more than 5 years each if--
                    ``(A) the operations of the center of excellence 
                involved have been reviewed by an appropriate technical 
                and scientific peer review group; and
                    ``(B) group referred to in subparagraph (A) has 
                recommended to the Secretary that such period should be 
                extended.
    ``(f) Definitions.--In this section:
            ``(1) The term `neglected tropical diseases' has the 
        meaning given that term in section 5 of the End Neglected 
        Tropical Diseases Act.
            ``(2) The term `product development partnership' means a 
        partnership to bring together public and private sector 
        researchers to develop new, or improve on current, global 
        health tools, such as drugs, diagnostics, insecticides, 
        vaccines, and vector management strategies--
                    ``(A) that are for neglected tropical diseases; and
                    ``(B) for which there is generally no profitable 
                market.''.

SEC. 204. PANEL ON WORM INFECTION SOLUTIONS.

    (a) Establishment.--The Secretary of Health and Human Services 
shall establish a panel to conduct an evaluation of issues relating to 
worm infections, including potential solutions such as deworming 
medicines.
    (b) Strategies.--The panel established pursuant to subsection (a) 
shall develop recommendations for strategies for solutions with respect 
to--
            (1) repeat infections;
            (2) vector control;
            (3) clean water solutions;
            (4) identifying incentives to encourage basic research for 
        less toxic, more effective medicines; and
            (5) improving the success and cost efficiency of current 
        programs in these areas, based on a thorough scan of 
        initiatives already underway in both the public and private 
        sectors.
    (c) Appointment of Members.--In addition to representatives from 
the Centers for Disease Control and Prevention and other relevant 
agencies working on neglected tropical diseases, the Secretary of 
Health and Human Services shall appoint, as members of the panel 
established pursuant to subsection (a), individuals from the public and 
private sectors who are knowledgeable about or affected by worm 
infections, including--
            (1) at least 2 representatives of nongovernmental 
        organizations;
            (2) at least 2 representatives of private industry involved 
        in the development of de-worming medications;
            (3) at least 2 representatives from academia; and
            (4) representatives of industries relating to sanitation, 
        clean water, and vector control.
    (d) Report.--Not later than 1 year after the date of the enactment 
of this Act, the panel shall submit a report to Congress and to the 
Secretary of Health and Human Services that includes--
            (1) the findings and recommended strategies of the panel; 
        and
            (2) recommendations for such administrative action and 
        legislation as the panel determines to be appropriate.
    (e) Termination.--The panel shall terminate not later than 6 months 
after the submission of the report required under subsection (d).
                                 <all>
```