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106TH CONGRESS

1ST SESSION S. 1497

To amend the Foreign Assistance Act of 1961 to take steps to control

the growing international problem of tuberculosis.

IN THE SENATE OF THE UNITED STATES

AUGUST 4, 1999

Mrs. BOXER (for herself, Mr. SMITH of Oregon, and Mr. LAUTENBERG) introduced the following bill; which was read twice and referred to the Committee on Foreign Relations

A BILL

To amend the Foreign Assistance Act of 1961 to take steps

to control the growing international problem of tuberculosis.

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 ‘‘International Tuber5 culosis Control Act of 1999’’.

6 SEC. 2. FINDINGS.

7 Congress makes the following findings:

8 (1) Since the development of antibiotics in the

9 1950s, tuberculosis has been largely controlled in the

10 United States and the Western World.
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1 (2) Due to societal factors, including growing

2 urban decay, inadequate health care systems, per3 sistent poverty, overcrowding, and malnutrition, as

4 well as medical factors, including the HIV/AIDS epi5 demic and the emergence of multi-drug resistant

6 strains of tuberculosis, tuberculosis has again be7 come a leading and growing cause of adult deaths in

8 the developing world.

9 (3) According to the World Health

10 Organization—

11 (A) in 1998, about 1,860,000 people

12 worldwide died of tuberculosis-related illnesses;

13 (B) one-third of the world’s total popu14 lation is infected with tuberculosis; and

15 (C) tuberculosis is the world’s leading kill16 er of women between 15 and 44 years old and

17 is a leading cause of children becoming or18 phans.

19 (4) Because of the ease of transmission of tu20 berculosis, its international persistence and growth

21 pose a direct public health threat to those nations

22 that had previously largely controlled the disease.

23 This is complicated in the United States by the

24 growth of the homeless population, the rate of incar-
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1 ceration, international travel, immigration, and HIV/

2 AIDS.

3 (5) With nearly 40 percent of the tuberculosis

4 cases in the United States attributable to foreign5 born persons, tuberculosis will never be controlled in

6 the United States until it is controlled abroad.

7 (6) The means exist to control tuberculosis

8 through screening, diagnosis, treatment, patient

9 compliance, monitoring, and ongoing review of out10 comes.

11 (7) Efforts to control tuberculosis are com12 plicated by several barriers, including—

13 (A) the labor intensive and lengthy process

14 involved in screening, detecting, and treating

15 the disease;

16 (B) a lack of funding, trained personnel,

17 and medicine in virtually every nation with a

18 high rate of the disease;

19 (C) the unique circumstances in each coun20 try, which requires the development and imple21 mentation of country-specific programs; and

22 (D) the risk of having a bad tuberculosis

23 program, which is worse than having no tuber24 culosis program because it would significantly
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1 increase the risk of the development of more

2 widespread drug-resistant strains of the disease.

3 (8) Eliminating the barriers to the international

4 control of tuberculosis through a well-structured,

5 comprehensive, and coordinated worldwide effort

6 would be a significant step in dealing with the in7 creasing public health problem posed by the disease.

8 SEC. 3. ASSISTANCE FOR TUBERCULOSIS PREVENTION,

9 TREATMENT, CONTROL, AND ELIMINATION.

10 Section 104(c) of the Foreign Assistance Act of 1961

11 (22 U.S.C. 2151b(c)) is amended by adding at the end

12 the following:

13 ‘‘(4)(A) Congress recognizes the growing inter14 national problem of tuberculosis and the impact its contin15 ued existence has on those nations that had previously

16 largely controlled the disease. Congress further recognizes

17 that the means exist to control and treat tuberculosis, and

18 that it is therefore a major objective of the foreign assist19 ance program to control the disease. To this end, Congress

20 expects the agency primarily responsible for administering

21 this part—

22 ‘‘(i) to coordinate with the World Health Orga23 nization, the Centers for Disease Control, the Na24 tional Institutes of Health, and other organizations
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1 toward the development and implementation of a

2 comprehensive tuberculosis control program; and

3 ‘‘(ii) to set as a goal the detection of at least

4 70 percent of the cases of infectious tuberculosis,

5 and the cure of at least 85 percent of the cases de6 tected, in those countries in which the agency has

7 established development programs, by December 31,

8 2010.

9 ‘‘(B) There are authorized to be appropriated to the

10 President, $60,000,000 for fiscal year 2001 to be used to

11 carry out this paragraph. Funds appropriated under this

12 subparagraph are authorized to remain available until ex13 pended.’’.

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