II 

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. 

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. 

7 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. 


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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. 

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 Centers for Disease Control and Pre11 vention have identified 17 neglected tropical diseases 

12 (referred to in this section as ‘‘NTDs’’). Approxi13 mately 2,000,000,000 people are at risk of con14 tracting an NTD, and more than 1,040,000,000 

15 people are currently afflicted with 1 or more NTDs. 

16 (2) In 2012, the London Declaration on Ne17 glected Tropical Diseases identified 10 NTDs with 


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1 the potential to be controlled, eliminated, or eradi2 cated by 2020. 

3 (3) In 2013, the World Health Organization 

4 (referred to in this section as ‘‘WHO’’) adopted a 

5 comprehensive resolution on NTDs, recognizing that 

6 increased national and international investments in 

7 prevention and control of these diseases have suc8 ceeded in improving health and social well-being in 

9 many countries. WHO’s World Health Assembly 

10 maintains and updates a list of the diverse NTDs 

11 across the world. 

12 (4) In its fourth Update Report, published in 

13 2017, WHO reported significant progress in expand14 ing NTD interventions worldwide, but challenges 

15 continue in— 

16 (A) developing improved evaluation and 

17 surveillance tools; and 

18 (B) maintaining sufficient funding to en19 sure that progress is sustained. 

20 (5) NTDs have an enormous impact in terms of 

21 disease burden and quality of life. NTDs cause the 

22 loss of up to 185,000 lives and up to 2,500,000,000 

23 disability-adjusted life years each year. NTDs sur24 pass both malaria and tuberculosis in causing great25 er loss of life-years to disability and premature 


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1 death. Many NTDs cause disfigurement and dis2 ability, in addition to significant morbidity and mor3 tality, leading to stigma, social discrimination, and 

4 societal marginalization. 

5 (6) NTDs create an economic burden of billions 

6 of dollars through the loss of productivity and high 

7 costs of health care required for treatment. People 

8 afflicted by NTDs are less productive than their 

9 healthy counterparts. NTDs jeopardize the ability of 

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

11 full capacity. For example, controlling 1 NTD 

12 (hookworm) in children can result in a 43 percent 

13 increase in future wage earnings. 

14 (7) The social, economic, and health burden of 

15 NTDs falls primarily on low- and middle-income 

16 countries, where access to safe water, sanitation, 

17 and health care is limited. At least 100 countries 

18 face 2 endemic NTD burdens, and 30 countries 

19 carry six or more endemic NTDs. All low-income 

20 countries are affected by at least 5 NTDs, and 149 

21 countries and territories are affected by at least 1 

22 NTD. 

23 (8) NTDs are not confined to the developing 

24 world. Several NTDs have been reported in the 

25 United States and other developed countries. In the 


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1 United States, NTDs disproportionately affect com2 munities of color and the poor, with up to 2,850,000 

3 African-Americans suffering from toxocariasis and 

4 at least 300,000 people, who are mostly Hispanic5 Americans, are afflicted with Chagas disease. 

6 (9) 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 (10) Research and development efforts are im14 mediately needed for all NTDs, especially to advance 

15 next-generation treatments, interventions, and 

16 diagnostics to ensure that countries endemic for 

17 NTDs are able to implement and sustain NTD con18 trol programs. 

19 (11) Epidemiological data that identify at-risk 

20 populations and ensure that these populations re21 ceive consistent and sufficient doses of treatment for 

22 their diseases are critical to developing robust NTD 

23 control strategies. 

24 (12) The benefits of deworming are immediate. 

25 A rigorous, randomized controlled trial has shown 


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1 school-based deworming treatment to reduce school 

2 absenteeism by 25 percent. School-based deworming 

3 also benefits young siblings and other children who 

4 live nearby but are too young to be treated, leading 

to large cognitive improvements equivalent to 1 5 ⁄2 of 

6 a year of schooling. 

7 (13) Improved access to water, sanitation, and 

8 hygiene can also reduce the transmission of NTDs, 

9 particularly NTDs caused by parasites. 

10 SEC. 5. DEFINITIONS. 

11 In this Act: 

12 (1) GLOBAL FUND.—The term ‘‘Global Fund’’ 

13 means the public-private partnership known as the 

14 Global Fund to Fight AIDS, Tuberculosis, and Ma15 laria established pursuant to Article 80 of the Swiss 

16 Civil Code. 

17 (2) NEGLECTED TROPICAL DISEASES; NTDS.— 

18 The terms ‘‘neglected tropical diseases’’ and 

19 ‘‘NTDs’’— 

20 (A) mean infections caused by pathogens, 

21 including viruses, bacteria, protozoa, and 

22 helminths, that disproportionately impact indi23 viduals living in extreme poverty, especially in 

24 developing countries; and 

25 (B) include— 


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1 (i) Buruli ulcer; 

2 (ii) Chagas disease; 

3 (iii) Cysticercosis; 

4 (iv) Dengue fever; 

5 (v) Dracunculiasis (Guinea worm dis6 ease); 

7 (vi) Echinococcosis; 

8 (vii) Fascioliasis; 

9 (viii) Human African trypanosomiasis 

10 (sleeping sickness); 

11 (ix) Leishmaniasis; 

12 (x) Leprosy (Hansen’s disease); 

13 (xi) Lymphatic filariasis (elephan14 tiasis); 

15 (xii) Onchocerciasis (river blindness); 

16 (xiii) Rabies; 

17 (xiv) Schistosomiasis; 

18 (xv) Soil-transmitted Helminthiases 

19 (STH), such as round worm, whip worm, 

20 and hook worm; 

21 (xvi) Trachoma; and 

22 (xvii) Yaws. 

23 SEC. 6. RULE OF CONSTRUCTION. 

24 Nothing in this Act may be construed to increase the 

25 authorization of appropriations for— 


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1 (1) the United States Agency for International 

2 Development; or 

3 (2) the Department of Health and Human 

4 Services. 

5 TITLE I—FOREIGN AFFAIRS 

6 SEC. 101. UNITED STATES AGENCY FOR INTERNATIONAL 

7 DEVELOPMENT NEGLECTED TROPICAL DIS8 EASES PROGRAM. 

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

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

11 Agency for International Development (referred to 

12 in this title as ‘‘USAID’’) has been an essential 

13 leading partner in advancing control and elimination 

14 efforts for 5 targeted neglected tropical diseases: 

15 lymphatic filariasis (elephantiasis), onchocerciasis 

16 (river blindness), schistosomiasis, soil-transmitted 

17 helminthiases (round worm, whip worm, and hook 

18 worm), and trachoma. 

19 (2) USAID is an original endorser of the ‘‘Lon20 don Declaration on Neglected Tropical Diseases’’, 

21 signed in London on January 30, 2012, which rep22 resents a new, coordinated international push to ac23 celerate progress toward eliminating or controlling 

24 10 NTDs by 2020. 


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1 (3) The USAID Neglected Tropical Diseases 

2 Program has made important and substantial con3 tributions to the global fight to control and eliminate 

4 the 5 targeted NTDs. Leveraging more than 

5 $19,000,000,000 in donated medicines, USAID has 

6 supported the distribution of more than 

7 2,300,000,000 treatments in 31 countries across Af8 rica, Asia, Latin America, and the Caribbean. 

9 (4) Since 2014, the USAID Neglected Tropical 

10 Diseases Program has been investing in gathering 

11 research and development for the treatment of cer12 tain NTDs to ensure that promising new break13 through diagnostics and medicines can be rapidly 

14 evaluated, registered, and made available to patients. 

15 (5) The USAID Neglected Tropical Diseases 

16 Program— 

17 (A) is a clear example of a successful pub18 lic-private partnership between the Government 

19 and the private sector; and 

20 (B) already has contributed to the elimi21 nation of at least 1 NTD in 9 different coun22 tries. 

23 (b) SENSE OF CONGRESS.—It is the sense of Con24 gress that the USAID Neglected Tropical Diseases ProVerDate Sep 11 2014 18:20 Sep 19, 2019 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S2481.IS S2481

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1 gram, as in effect on the date of the enactment of this 

2 Act— 

3 (1) should be continued and may be judiciously 

4 expanded, as practicable and appropriate; 

5 (2) should continue to provide treatment to as 

6 many individuals suffering from an NTD or at risk 

7 of acquiring an NTD, including individuals displaced 

8 by manmade and natural disasters, as logistically 

9 feasible; 

10 (3) should integrate NTD control, treatment 

11 tools, and approaches into complementary develop12 ment and global health programs by coordinating, to 

13 the extent practicable and appropriate, across mul14 tiple sectors, including sectors relating to HIV/ 

15 AIDS, malaria, tuberculosis, education, nutrition, 

16 other infectious diseases, maternal and child health, 

17 and water, sanitation, and hygiene; 

18 (4) should continue to conduct low-cost, high19 impact community and school-based NTD programs 

20 to reach large at-risk populations, including school21 age children, with integrated drug treatment pack22 ages, as feasible; 

23 (5) should engage in research and development 

24 of new tools and approaches, as opportunities 

25 emerge and resources allow, to reach the goals relatVerDate Sep 11 2014 18:20 Sep 19, 2019 Jkt 089200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S2481.IS S2481

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1 ing to the elimination of NTDs set forth by the 

2 World Health Organization; and 

3 (6) should monitor research on and develop4 ments in the prevention and treatment of other 

5 NTDs so breakthroughs can be incorporated into the 

6 USAID Neglected Tropical Diseases Program, as 

7 practicable and appropriate. 

8 (c) PROGRAM PRIORITIES.—The Administrator of 

9 USAID should incorporate the following priorities into 

10 USAID’s Neglected Tropical Diseases Program (as in ef11 fect 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 primary and secondary education in order to ad22 vance the goals of the London Declaration on Ne23 glected Tropical Diseases. 

24 (3) Including morbidity management in Na25 tional NTD Master Plans. 


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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— 

7 (A) complement existing research invest8 ments; and 

9 (B) ensure that new discoveries make it 

10 through the pipeline and become available to in11 dividuals who need them. 

12 SEC. 102. ACTIONS BY DEPARTMENT OF STATE. 

13 (a) SENSE OF CONGRESS.—It is the sense of Con14 gress that the Coordinator of United States Government 

15 Activities to Combat HIV/AIDS Globally should fully con16 sider, as necessary and appropriate, evolving research on 

17 the impact of neglected tropical diseases on efforts to con18 trol HIV/AIDS when making future programming deci19 sions. 

20 (b) GLOBAL PROGRAMMING.—The Secretary of State 

21 should encourage the Global Fund to consider, as nec22 essary and appropriate, evolving research on the impact 

23 of NTDs on efforts to control HIV/AIDS, tuberculosis, 

24 and malaria when making programming decisions, par25 ticularly with regard to female genital schistosomiasis, 


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1 which studies suggest may be a significant co-factor in the 

2 AIDS epidemic in Africa. 

3 (c) G–20 COUNTRIES.—The Secretary of State, act4 ing through the Office of Global Health Diplomacy, should 

5 encourage G–20 countries to significantly increase their 

6 role in the control and elimination of NTDs. 

7 SEC. 103. MULTILATERAL DEVELOPMENT AND HEALTH IN8 STITUTIONS. 

9 (a) FINDING.—Congress finds that the treatment of 

10 NTDs, including community and school-based deworming 

11 programs, can be a highly cost-effective education inter12 vention and schools can serve as an effective delivery 

13 mechanism for reaching large numbers of children with 

14 safe treatment for soil-transmitted helminthiases (round 

15 worm, whip worm, and hook worm). 

16 (b) SENSE OF CONGRESS.—The President should di17 rect the United States Permanent Representative to the 

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

19 United States to urge the World Health Organization and 

20 the United Nations Development Programme— 

21 (1) to ensure the dissemination of best practices 

22 and programming on NTDs to governments and 

23 make data accessible to practitioners in an open and 

24 timely fashion; 


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1 (2) to highlight impacts of community and 

2 school-based deworming programs on children’s 

3 health and education, emphasizing the cost-effective4 ness of such programs; 

5 (3) to encourage governments to establish and 

6 implement national NTD programs; 

7 (4) to consider designating a portion of grant 

8 funds of the institutions to deworming initiatives 

9 and cross-sectoral collaboration with water, sanita10 tion, and hygiene efforts and nutrition or education 

11 programming, as practicable and appropriate; 

12 (5) to encourage accurate monitoring and eval13 uation of NTD programs, including deworming pro14 grams; and 

15 (6) to engage governments in cross-border ini16 tiatives for the treatment, control, prevention, and 

17 elimination of NTDs, and assist in developing 

18 transnational agreements, when and where nec19 essary. 


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1 TITLE II—DEPARTMENT OF 

2 HEALTH AND HUMAN SERVICES 

3 SEC. 201. PROMOTING EFFORTS THROUGH INTERAGENCY 

4 WORKING GROUPS AND INTERNATIONAL FO5 RUMS. 

6 The Secretary of Health and Human Services shall 

7 continue to promote the need for robust programs and ac8 tivities to diagnose, prevent, control, and treat neglected 

9 tropical diseases— 

10 (1) through interagency working groups on 

11 health; and 

12 (2) through relevant international forums on 

13 behalf of the United States, including the post-2015 

14 United Nations development agenda. 

15 SEC. 202. REPORT ON NEGLECTED TROPICAL DISEASES IN 

16 THE UNITED STATES. 

17 (a) IN GENERAL.—Not later than 1 year after the 

18 date of the enactment of this Act, the Secretary of Health 

19 and Human Services, acting through relevant agencies of 

20 the Department of Health and Human Services, shall sub21 mit a report to the Congress on neglected tropical diseases 

22 in the United States. 

23 (b) CONTENTS.—The report required under this sec24 tion shall— 


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1 (1) assess the epidemiology of, impact of, and 

2 appropriate funding required to address, neglected 

3 tropical diseases in the United States; and 

4 (2) include information necessary— 

5 (A) to guide future health policy with re6 spect to such diseases; 

7 (B) to accurately evaluate the current 

8 state of knowledge concerning such diseases; 

9 and 

10 (C) to define gaps in such knowledge. 

11 SEC. 203. CENTERS OF EXCELLENCE. 

12 Part P of title III of the Public Health Service Act 

13 is amended by inserting after section 399V–6 (42 U.S.C. 

14 280g–17) the following: 

15 ‘‘SEC. 399V–7. NEGLECTED TROPICAL DISEASE CENTERS OF 

16 EXCELLENCE. 

17 ‘‘(a) COOPERATIVE AGREEMENTS AND GRANTS.— 

18 ‘‘(1) IN GENERAL.—The Secretary, acting 

19 through the Director of the Centers for Disease 

20 Control and Prevention, may enter into cooperative 

21 agreements with, and award grants to, public or pri22 vate nonprofit entities to pay all or part of the cost 

23 of planning, establishing, or strengthening, and pro24 viding basic operating support for, one or more cen25 ters of excellence for research into, training in, and 


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1 development of diagnosis, prevention, control, and 

2 treatment methods for neglected tropical diseases, 

3 including tools to support elimination by building ca4 pacity for sustainable prevention efforts once epide5 miology has been characterized and initial control 

6 achieved. 

7 ‘‘(2) ELIGIBILITY.—To be eligible for a cooper8 ative agreement or grant under this section, an enti9 ty must— 

10 ‘‘(A) have demonstrated expertise in re11 search on, or the epidemiology and surveillance 

12 of, major neglected tropical diseases that are 

13 endemic to the United States, such as Chagas 

14 disease, dengue, leishmaniasis, West Nile virus, 

15 and helminth infections; and 

16 ‘‘(B) participate in one or more not-for17 profit product development partnerships. 

18 ‘‘(b) POLICIES.—A cooperative agreement or grant 

19 under subsection (a) shall be entered into or awarded in 

20 accordance with established policies. 

21 ‘‘(c) COORDINATION.—The Secretary shall ensure 

22 that activities under this section are coordinated with 

23 similar activities of the Department of Health and Human 

24 Services relating to neglected tropical diseases. 


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1 ‘‘(d) USES OF FUNDS.—A cooperative agreement or 

2 grant under subsection (a) may be used for— 

3 ‘‘(1) staffing, administrative, and other basic 

4 operating costs, including patient care costs that are 

5 required for research; 

6 ‘‘(2) clinical training, including training for al7 lied health professionals, continuing education for 

8 health professionals and allied health professions 

9 personnel, and information programs for the public 

10 with respect to neglected tropical diseases; and 

11 ‘‘(3) research and development programs. 

12 ‘‘(e) PERIOD OF SUPPORT; ADDITIONAL PERIODS.— 

13 ‘‘(1) IN GENERAL.—Except as provided in para14 graph (2), support of a center of excellence under 

15 this section may be for a period of not more than 

16 5 years. 

17 ‘‘(2) EXTENSIONS.—The period specified in 

18 paragraph (1) may be extended by the Secretary for 

19 additional periods of not more than 5 years each 

20 if— 

21 ‘‘(A) the operations of the center of excel22 lence involved have been reviewed by an appro23 priate technical and scientific peer review 

24 group; and 


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1 ‘‘(B) group referred to in subparagraph 

2 (A) has recommended to the Secretary that 

3 such period should be extended. 

4 ‘‘(f) DEFINITIONS.—In this section: 

5 ‘‘(1) The term ‘neglected tropical diseases’ has 

6 the meaning given that term in section 5 of the End 

7 Neglected Tropical Diseases Act. 

8 ‘‘(2) The term ‘product development partner9 ship’ means a partnership to bring together public 

10 and private sector researchers to develop new, or im11 prove on current, global health tools, such as drugs, 

12 diagnostics, insecticides, vaccines, and vector man13 agement strategies— 

14 ‘‘(A) that are for neglected tropical dis15 eases; and 

16 ‘‘(B) for which there is generally no profit17 able market.’’. 

18 SEC. 204. PANEL ON WORM INFECTION SOLUTIONS. 

19 (a) ESTABLISHMENT.—The Secretary of Health and 

20 Human Services shall establish a panel to conduct an eval21 uation of issues relating to worm infections, including po22 tential solutions such as deworming medicines. 

23 (b) STRATEGIES.—The panel established pursuant to 

24 subsection (a) shall develop recommendations for strate25 gies for solutions with respect to— 


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1 (1) repeat infections; 

2 (2) vector control; 

3 (3) clean water solutions; 

4 (4) identifying incentives to encourage basic re5 search for less toxic, more effective medicines; and 

6 (5) improving the success and cost efficiency of 

7 current programs in these areas, based on a thor8 ough scan of initiatives already underway in both 

9 the public and private sectors. 

10 (c) APPOINTMENT OF MEMBERS.—In addition to 

11 representatives from the Centers for Disease Control and 

12 Prevention and other relevant agencies working on ne13 glected tropical diseases, the Secretary of Health and 

14 Human Services shall appoint, as members of the panel 

15 established pursuant to subsection (a), individuals from 

16 the public and private sectors who are knowledgeable 

17 about or affected by worm infections, including— 

18 (1) at least 2 representatives of nongovern19 mental organizations; 

20 (2) at least 2 representatives of private industry 

21 involved in the development of de-worming medica22 tions; 

23 (3) at least 2 representatives from academia; 

24 and 


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1 (4) representatives of industries relating to 

2 sanitation, clean water, and vector control. 

3 (d) REPORT.—Not later than 1 year after the date 

4 of the enactment of this Act, the panel shall submit a re5 port to Congress and to the Secretary of Health and 

6 Human Services that includes— 

7 (1) the findings and recommended strategies of 

8 the panel; and 

9 (2) recommendations for such administrative 

10 action and legislation as the panel determines to be 

11 appropriate. 

12 (e) TERMINATION.—The panel shall terminate not 

13 later than 6 months after the submission of the report 

14 required under subsection (d). 

Æ 


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