II 

116TH CONGRESS 

1ST SESSION S. 2438 

To prevent, treat, and cure tuberculosis globally. 

IN THE SENATE OF THE UNITED STATES 

AUGUST 1, 2019 

Mr. MENENDEZ (for himself and Mr. YOUNG) introduced the following bill; 

which was read twice and referred to the Committee on Foreign Relations 

A BILL 

To prevent, treat, and cure tuberculosis globally. 

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 Tuberculosis Now 

5 Act of 2019’’. 

6 SEC. 2. FINDINGS. 

7 Congress makes the following findings: 

8 (1) Tuberculosis is a preventable, treatable, and 

9 curable airborne infection; however more than 25 

10 years after the World Health Organization declared 

11 tuberculosis a public health emergency and called on 

12 countries to make scaling up tuberculosis control a 


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1 priority, tuberculosis still kills more people world2 wide than any other infectious disease, and is the 

3 leading killer of people living with HIV/AIDS. 

4 (2) In 2017, 10,000,000 people became ill with 

5 tuberculosis, 10 percent of whom were children, and 

6 1,600,000 people died from the disease. In order to 

7 achieve the goals of the World Health Organization 

8 End TB Strategy by 2035, new tools must be devel9 oped and made available. 

10 (3) Over one-third of people who become ill with 

11 tuberculosis may be undiagnosed, misdiagnosed, or 

12 treated but not reported, resulting in unnecessary 

13 illness, communicable infections, and increased mor14 tality. 

15 (4) Failure to properly treat tuberculosis can 

16 cause treatment failure and death, and exacerbates 

17 antimicrobial resistance, increasing multi-drug-re18 sistant tuberculosis (MDR–TB) and extensively 

19 drug-resistant tuberculosis (XDR–TB), which are 

20 significantly costlier and more difficult to treat than 

21 drug-sensitive tuberculosis and can also be trans22 mitted from person-to-person, increasing the likeli23 hood that drug-resistant tuberculosis will spread to 

24 new geographic areas. 


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1 (5) Globally, only about half of the 

2 $13,000,000,000 required annually as outlined in 

3 the Stop TB Partnership’s Global Plan to End TB 

4 for tuberculosis prevention, diagnosis, and treatment 

5 is currently available. 

6 (6) There is an annual $1,300,000,000 gap in 

7 funding needed for the development of vaccines, ad8 ditional rapid, point-of-care diagnostic tests, and 

9 shorter, less toxic treatments which would facilitate 

10 patient adherence to treatment regimens, reduce 

11 program costs, and mitigate the growing threat of 

12 drug-resistant tuberculosis. The United States Gov13 ernment continues to be a lead funder of global tu14 berculosis research and development, contributing 40 

15 percent of the total $772,000,000 in global funding 

16 in 2017, and can catalyze more investments from 

17 other countries. 

18 (7) The rate of new cases of tuberculosis in 

19 countries that receive United States bilateral assist20 ance for tuberculosis prevention, treatment, and con21 trol has fallen by one quarter since 2000 dem22 onstrating the effectiveness of United States pro23 grams and activities. 

24 (8) In September 2018, United Nations Mem25 ber States in the first United National High Level 


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1 Meeting on Tuberculosis committed to ‘‘ending the 

2 epidemic in all countries, and pledge[d] to provide 

3 leadership and to work together to accelerate our na4 tional and global collective actions, investments, and 

5 innovations urgently to fight this preventable and 

6 treatable disease,’’ as reflected in United Nations 

7 General Assembly Resolution A/RES/73/3. 

8 (9) On September 26, 2018, the United Na9 tions convened the first High Level Meeting on Tu10 berculosis, where 120 countries signed a Political 

11 Declaration to accelerate progress against tuber12 culosis, including commitments to increase funding 

13 for tuberculosis control and research and develop14 ment programs, as well as ambitious goals to suc15 cessfully treat 40,000,000 people with tuberculosis 

16 and prevent at least 30,000,000 from becoming ill 

17 between 2018 and 2022. 

18 (10) On September 26, 2018, the Administrator 

19 for the United States Agency for International De20 velopment (USAID) announced a new business 

21 model to support the fight to end tuberculosis (TB). 

22 Through $30,000,000 in funding and a new per23 formance-based Global Accelerator to End TB, 

24 USAID will catalyze investments to meet the target 

25 set by the United Nations High-Level Meeting on 


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1 tuberculosis of treating 40,000,000 people with the 

2 disease by 2022. The Accelerator will increase sup3 port to governments and local partners as part of a 

4 multisectoral approach to ending tuberculosis. 

5 (11) It is essential that existing funding for tu6 berculosis programs be allocated prudently, and with 

7 an emphasis on coordination, to ensure that efforts 

8 among United States agencies, partner nations, 

9 international organizations, nongovernmental organi10 zations, both faith-based and non-faith-based, the 

11 private sector and other actors are complementary 

12 and not duplicative. Improved data on tuberculosis, 

13 access to services, accountability, and program qual14 ity can help ensure funding gets to where it is most 

15 needed. 

16 (12) If progress does not accelerate, the global 

17 tuberculosis epidemic, particularly increasing cases 

18 of MDR–TB and XDR–TB, where many cases are 

19 not curable and vastly more costly to treat, could 

20 erase decades of progress in global efforts to end 

21 both tuberculosis and HIV/AIDS, much of which has 

22 been achieved with United States investment. 


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1 SEC. 3. UNITED STATES GOVERNMENT ACTIONS TO END 

2 TUBERCULOSIS. 

3 Section 104B of the Foreign Assistance Act of 1961 

4 (22 U.S.C. 2151b–3(g)) is amended by striking sub5 sections (a) through (h) and inserting the following new 

6 subsections: 

7 ‘‘(a) FINDINGS.—Congress makes the following find8 ings: 

9 ‘‘(1) Congress recognizes the continuing chal10 lenge of the international tuberculosis epidemic and 

11 the deadly impact of its continued existence. 

12 ‘‘(2) The means exist to detect, treat, prevent, 

13 and cure tuberculosis to a large extent, but not 

14 enough to ensure ending it, due to inadequate means 

15 of diagnosis, prevention, and treatment. 

16 ‘‘(3) Absent accelerated efforts to address tu17 berculosis and increased domestic mobilization of re18 sources from high-burden tuberculosis countries, tar19 gets set forth in the End TB Strategy will not be 

20 met. 

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

22 assistance program of the United States to help end the 

23 global tuberculosis epidemic through actions to diagnose 

24 and treat all adults and children with all forms of tuber25 culosis, including tuberculosis infection, and to prevent 

26 new tuberculosis infections in adults and children. In all 


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1 countries in which the United States Government has es2 tablished development programs, particularly in countries 

3 with the highest burden of tuberculosis and other coun4 tries with high rates of tuberculosis, it is the policy of the 

5 United States to— 

6 ‘‘(1) support the objectives of the World Health 

7 Organization End TB Strategy, including goals to— 

8 ‘‘(A) reduce by 95 percent tuberculosis 

9 deaths by 2035; 

10 ‘‘(B) reduce by 90 percent the tuberculosis 

11 incidence rate by 2035; and 

12 ‘‘(C) reduce by 100 percent the number of 

13 families facing catastrophic health costs due to 

14 tuberculosis by 2035; 

15 ‘‘(2) support the Stop TB Partnership’s Global 

16 Plan to End TB 2016–2020, including support 

17 for— 

18 ‘‘(A) development and use of innovative 

19 new technologies and therapies to increase ac20 tive case finding to rapidly diagnose and treat 

21 children and adults with all forms of tuber22 culosis, alleviate suffering, and ensure tuber23 culosis treatment completion; 

24 ‘‘(B) the diagnosis and treatment of latent 

25 tuberculosis infection, in support of the global 


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1 goal of providing preventive therapy to at least 

2 30,000,000 people, including 4,000,000 children 

3 under five years of age, 20,000,000 household 

4 contacts of people affected by tuberculosis, and 

5 6,000,000 people living with HIV, by 2022; 

6 ‘‘(C) steps to ensure high-quality tuber7 culosis care by closing gaps in care cascades, 

8 implementing continuous quality improvement 

9 at all levels of care, and providing patient sup10 port; and 

11 ‘‘(D) sustainable procurement of tuber12 culosis commodities, to avoid interruptions in 

13 supply, procurement of commodities of un14 known quality, or payment of excessive com15 modity costs in countries impacted by tuber16 culosis; 

17 ‘‘(3) ensure United States funding supports ac18 tivities that simultaneously emphasize— 

19 ‘‘(A) the development of comprehensive 

20 person-centered programs which include diag21 nosis, treatment, and prevention strategies to 

22 ensure that those at high risk for infection are 

23 found and treated with preventive therapies in 

24 a timely manner; 


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1 ‘‘(B) robust tuberculosis infection control 

2 practices in all congregate settings, including 

3 hospitals and prisons; 

4 ‘‘(C) the deployment of diagnostic and 

5 treatment capacity in areas with the highest tu6 berculosis burdens, as well as for highly at-risk 

7 and impoverished populations, including patient 

8 support; 

9 ‘‘(D) program monitoring and evaluation 

10 based on critical tuberculosis indicators, includ11 ing infection control, the numbers of patients 

12 accessing tuberculosis treatment, along with pa13 tient support, and preventative therapy for 

14 those at risk, including all close contacts, as 

15 well as treatment completion for all forms of tu16 berculosis; 

17 ‘‘(E) training health care workers on the 

18 use of new diagnostic tools and therapies as 

19 they become available; 

20 ‘‘(F) coordination with domestic agencies 

21 on an aggressive research agenda to develop 

22 vaccines as well as new tools to diagnose, treat, 

23 and prevent tuberculosis globally; 

24 ‘‘(G) linkages with the private sector on 

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1 culosis, training for healthcare professionals on 

2 use of the most effective diagnostic and thera3 peutic tools, and research in the areas of vac4 cine development as well as the development of 

5 therapeutics and diagnostic tools; 

6 ‘‘(H) efforts to address barriers to patients 

7 seeking care including stigma and costs related 

8 to diagnosis and treatment; 

9 ‘‘(I) efforts to address human rights-re10 lated barriers to tuberculosis services, includ11 ing— 

12 ‘‘(i) training health workers; 

13 ‘‘(ii) sensitizing policy makers; 

14 ‘‘(iii) legal literacy and patient em15 powerment campaigns; 

16 ‘‘(iv) strengthening legal services; and 

17 ‘‘(v) monitoring laws and policies; and 

18 ‘‘(J) the establishment of independent ac19 countability mechanisms and inclusive country 

20 level systems to measure progress and ensure 

21 that commitments made by governments and 

22 relevant stakeholders are met. 

23 ‘‘(c) AUTHORIZATION.—To carry out this section and 

24 consistent with section 104(c), the President is authorized 

25 to furnish assistance, on such terms and conditions as the 


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1 President may determine, for the prevention, treatment, 

2 control, and elimination of tuberculosis. 

3 ‘‘(d) GOALS.—In consultation with the appropriate 

4 congressional committees, the President shall establish 

5 new goals for United States efforts, based on the policy 

6 and indicators described in subsection (b), to reach, cure, 

7 and prevent all forms of tuberculosis globally over the 5- 

8 year period following the date of the enactment of this 

9 subsection by updating the United States Government Tu10 berculosis Strategy (2015–2019) and the National Action 

11 Plan for Combatting Multidrug-Resistant Tuberculosis. 

12 ‘‘(e) COORDINATION.— 

13 ‘‘(1) IN GENERAL.—In carrying out this sec14 tion, the President shall coordinate with the World 

15 Health Organization, the Stop TB Partnership, the 

16 Global Fund to Fight AIDS, Tuberculosis, and Ma17 laria, and other organizations with respect to the de18 velopment and implementation of a comprehensive 

19 tuberculosis response program. 

20 ‘‘(2) BILATERAL ASSISTANCE.—In providing bi21 lateral assistance under this section, the President, 

22 acting through the Administrator of the United 

23 States Agency for International Development, 

24 shall— 


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1 ‘‘(A) coordinate and catalyze intensified 

2 international tuberculosis research and develop3 ment, prevention, diagnosis, treatment, and 

4 control efforts, particularly to reduce the inci5 dence of, and mortality from, all forms of drug 

6 resistant tuberculosis; and 

7 ‘‘(B) ensure coordination among relevant 

8 United States Government agencies and pro9 grams, including the Centers for Disease Con10 trol and Prevention, the National Institutes of 

11 Health, the Biomedical Advanced Research and 

12 Development Authority, the Food and Drug Ad13 ministration, the National Science Foundation, 

14 the Department of Defense Congressionally Di15 rected Medical Research Program, and the 

16 President’s Emergency Plan for AIDS Relief 

17 (PEPFAR), that engage in international tuber18 culosis activities to ensure accountability and 

19 transparency, reduce duplication of efforts, en20 sure equitable shares in domestic expenditure 

21 and advancement on research and development, 

22 and ensure appropriate integration and coordi23 nation of tuberculosis services into other United 

24 States-supported health programs. 


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1 ‘‘(f) PRIORITY TO END TB STRATEGY.—In fur2 nishing assistance under subsection (b), the President 

3 shall give priority to— 

4 ‘‘(1) direct, high-quality services for all forms of 

5 tuberculosis described in international policies and 

6 guidelines, with a preference for programs that im7 plement a coordinated package of active case find8 ing, treatment of all forms of tuberculosis disease 

9 and infection, patient support and tuberculosis pre10 vention; 

11 ‘‘(2) individuals infected with both tuberculosis 

12 and HIV, and other co-morbidities, treatment for in13 dividuals with MDR–TB, XDR–TB, strengthening 

14 of health systems, use of the latest International 

15 Standards for Tuberculosis Care by all providers, 

16 and empowering individuals with tuberculosis; 

17 ‘‘(3) enabling and promoting tuberculosis re18 search to develop innovative new diagnostics, drug 

19 therapies, and vaccines, and program-based oper20 ational research; and 

21 ‘‘(4) funding for the Stop Tuberculosis Partner22 ship’s Global Drug Facility the Stop Tuberculosis 

23 Partnership, and the Global Alliance for Tuber24 culosis Drug Development. 


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1 ‘‘(g) ASSISTANCE FOR THE WORLD HEALTH ORGA2 NIZATION AND THE STOP TUBERCULOSIS PARTNER3 SHIP.—In carrying out this section, the President, acting 

4 through the Administrator of the United States Agency 

5 for International Development, is authorized to provide in6 creased resources to the World Health Organization and 

7 the Stop Tuberculosis Partnership to improve the capacity 

8 of countries with high rates of tuberculosis and other af9 fected countries to implement the Stop Tuberculosis Strat10 egy and specific strategies related to addressing MDR– 

11 TB and XDR–TB. 

12 ‘‘(h) ANNUAL REPORT ON TUBERCULOSIS ACTIVI13 TIES.—The President shall submit an annual report to 

14 Congress that describes the impact of United States for15 eign assistance on efforts to control tuberculosis, includ16 ing— 

17 ‘‘(1) the number of people with active tuber18 culosis and the number with tuberculosis infection 

19 diagnosed and treated, including the rate of treat20 ment completion and the number receiving patient 

21 support, in countries receiving United States bilat22 eral foreign assistance for tuberculosis control pur23 poses; 

24 ‘‘(2) the number of persons who have been di25 agnosed and started treatment for MDR–TB and 


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1 XDR–TB in countries receiving United States bilat2 eral foreign assistance for tuberculosis control pro3 grams; 

4 ‘‘(3) a description of the collaboration and co5 ordination of United States anti-tuberculosis efforts 

6 with the World Health Organization, the Global 

7 Fund, and other major public and private entities; 

8 ‘‘(4) a description of the collaboration and co9 ordination among the United States Agency for 

10 International Development and other United States 

11 agencies, including the Centers for Disease Control 

12 and the Office of the Global AIDS Coordinator, for 

13 the purposes of combatting tuberculosis; 

14 ‘‘(5) the constraints on implementation of pro15 grams posed by health workforce shortages, heath 

16 system limitations, and other capacities; 

17 ‘‘(6) the numbers of people trained by the 

18 United States Government in tuberculosis surveil19 lance and control; 

20 ‘‘(7) a breakdown of expenditures for direct pa21 tient tuberculosis services, drugs and other commod22 ities, drug management, training in diagnosis and 

23 treatment, health systems strengthening, research, 

24 and support costs; and 


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1 ‘‘(8) for each country receiving bilateral United 

2 States assistance for the purpose of tuberculosis pre3 vention, treatment, and control— 

4 ‘‘(A) a description of progress to adopt and 

5 implement the most recent World Health Orga6 nization guidelines to improve diagnosis, treat7 ment, and prevention of tuberculosis for adults 

8 and children, disaggregated by sex, including 

9 the proportion of health facilities which have 

10 adopted the latest WHO guidelines on strength11 ening surveillance systems and preventative, di12 agnostic, and therapeutic methods, including 

13 the use of rapid diagnostic tests and orally ad14 ministered TB treatment regimens; 

15 ‘‘(B) the rate of tuberculosis incidence for 

16 adults and children, disaggregated by sex, and 

17 a description of progress in implementing meas18 ures to reduce incidence, including the number 

19 of adults and children receiving tuberculosis 

20 preventive therapy, including people with HIV 

21 and all close contacts, disaggregated by sex, 

22 and the establishment of effective tuberculosis 

23 infection control in all congregant settings, in24 cluding hospitals, clinics, and prisons; 


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1 ‘‘(C) a description of progress to expand 

2 diagnosis, prevention, and treatment for all 

3 forms of tuberculosis, including in pregnant 

4 women, children, and other high-risk groups 

5 who are vulnerable or in vulnerable situations, 

6 such as migrants, prisoners, miners, and others 

7 exposed to silica, and people living with HIV/ 

8 AIDS, disaggregated by sex; 

9 ‘‘(D) the rate of successful completion of 

10 tuberculosis treatment for adults and children, 

11 disaggregated by sex, and the number of pa12 tients receiving support for treatment comple13 tion; 

14 ‘‘(E) the number of people, disaggregated 

15 by sex, receiving treatment for MDR–TB, the 

16 proportion of those treated with the latest regi17 mens endorsed by the World Health Organiza18 tion, any factors impeding scale up of such 

19 treatment, and a description of progress to ex20 pand community-based MDR–TB care; 

21 ‘‘(F) a description of tuberculosis com22 modity procurement challenges, including short23 ages, stockouts, or failed tenders for tuber24 culosis drugs or other commodities; 


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1 ‘‘(G) the proportion of health facilities with 

2 specimen referral linkages to GeneXpert testing 

3 sites, and to reference labs for second line drug 

4 resistance testing, and a description of the 

5 turnaround time for test results; 

6 ‘‘(H) the number of people trained by the 

7 United States Government to deliver high-qual8 ity tuberculosis surveillance, laboratory services, 

9 prevention, treatment, and care; 

10 ‘‘(I) a description of activities that serve to 

11 coordinate and leverage countries’ domestic re12 sources, including development of plans, proce13 dures, and disease estimates that support effec14 tive use of resources from the Global Fund to 

15 Fight AIDS, Tuberculosis, and Malaria; and 

16 ‘‘(J) the full text of any Statement of 

17 Partnership agreed to by the ministry of health 

18 and the United States Agency for International 

19 Development to establish a shared framework 

20 combatting tuberculosis. 

21 ‘‘(i) ANNUAL REPORT ON TUBERCULOSIS RESEARCH

22 AND DEVELOPMENT.—The President, acting through the 

23 Administrator of the United States Agency for Inter24 national Development, shall submit to Congress an annual 

25 report, to be prepared in coordination with the National 


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1 Institutes of Health, the Centers for Disease Control and 

2 Prevention, the Biomedical Advanced Research and Devel3 opment Authority (BARDA), the Food and Drug Admin4 istration, the National Science Foundation, the Depart5 ment of Defense Congressionally Directed Medical Re6 search Program, and the President’s Emergency Plan for 

7 AIDS Relief (PEPFAR)— 

8 ‘‘(1) describing current progress and challenges 

9 to the development of new tools for the purpose of 

10 tuberculosis prevention, treatment, and control; 

11 ‘‘(2) identifying critical gaps and emerging pri12 orities for research and development, including for 

13 rapid and point-of-care diagnostics, shortened treat14 ments and prevention methods, and vaccines; and 

15 ‘‘(3) describing research investments by type, 

16 funded entities, and level of investment. 

17 ‘‘(j) EVALUATION REPORT.— 

18 ‘‘(1) IN GENERAL.—Not later than one year 

19 after the date of the enactment of this subsection, 

20 and every 5 years thereafter, the Comptroller Gen21 eral of the United States shall submit to the Admin22 istrator of the United States Agency for Inter23 national Development and the appropriate congres24 sional committees a report that evaluates the per25 formance and impact on tuberculosis prevention, diVerDate Sep 11 2014 23:29 Aug 15, 2019 Jkt 089200 PO 00000 Frm 00019 Fmt 6652 Sfmt 6201 E:\BILLS\S2438.IS S2438

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1 agnosis, treatment, and care efforts that are sup2 ported by United States bilateral assistance funding, 

3 including recommendations for improving such pro4 grams. 

5 ‘‘(2) FORM.—The report required under para6 graph (1) shall be submitted in unclassified form, 

7 but may contain a classified annex if necessary. 

8 ‘‘(3) PUBLIC AVAILABILITY.—The Comptroller 

9 General shall publish the unclassified portion of the 

10 report required under paragraph (1) on a publicly 

11 available website of the Government Accountability 

12 Office. 

13 ‘‘(k) DEFINITIONS.—In this section: 

14 ‘‘(1) APPROPRIATE CONGRESSIONAL COMMIT15 TEES.—The term ‘appropriate congressional com16 mittees’ means the Committee on Foreign Relations 

17 of the Senate and the Committee on Foreign Affairs 

18 of the House of Representatives. 

19 ‘‘(2) GLOBAL ALLIANCE FOR TUBERCULOSIS

20 DRUG DEVELOPMENT.—The term ‘Global Alliance 

21 for Tuberculosis Drug Development’ means the pub22 lic-private partnership that bring together leaders in 

23 health, science, philanthropy, and private industry to 

24 devise new approaches to tuberculosis. 


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1 ‘‘(3) GLOBAL TUBERCULOSIS DRUG FACIL2 ITY.—The term ‘Global Tuberculosis Drug Facility 

3 (GDF)’ means the initiative of the Stop Tuber4 culosis Partnership to increase access to the most 

5 advanced, affordable, quality-assured tuberculosis 

6 drugs and diagnostics. 

7 ‘‘(4) END TB STRATEGY.—The term ‘End TB 

8 Strategy’ means the strategy to eliminate tuber9 culosis approved by the World Health Assembly in 

10 May 2014, which is described in The End TB Strat11 egy: Global Strategy and Targets for Tuberculosis 

12 Prevention, Care and Control after 2015. 

13 ‘‘(5) STOP TUBERCULOSIS PARTNERSHIP.—The 

14 term ‘Stop Tuberculosis Partnership’ means the 

15 partnership of the United Nations Office for Project 

16 Services, donors including the United States, high17 burden tuberculosis countries, multilateral agencies, 

18 and nongovernmental and technical agencies com19 mitted to short- and long-term measures required to 

20 control and eventually eliminate tuberculosis as a 

21 public health problem in the world.’’. 

Æ 


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