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106TH CONGRESS

2D SESSION S. 2643

To amend the Foreign Assistance Act of 1961 to provide increased foreign

assistance for tuberculosis prevention, treatment, and control.

IN THE SENATE OF THE UNITED STATES

MAY 25, 2000

Mr. STEVENS (for himself and Mr. INOUYE) 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 provide

increased foreign assistance for tuberculosis prevention,

treatment, and control.

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’’.

6 SEC. 2. FINDINGS.

7 The Congress finds the following:

8 (1)(A) Tuberculosis is one of the greatest infec9 tious causes of death of adults worldwide, killing
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1 2,000,000 people per year—one person every 15 sec2 onds.

3 (B) Globally, tuberculosis is the leading cause

4 of death of young women and the leading cause of

5 death of people with HIV/AIDS.

6 (2) The World Health Organization estimates

7 that one-third of the world’s population is infected

8 with the bacteria that causes tuberculosis, including

9 an estimated 10,000,000 to 15,000,000 individuals

10 in the United States.

11 (3) An estimated 8,000,000 individuals develop

12 active tuberculosis each year.

13 (4) Tuberculosis is spreading as a result of in14 adequate treatment and it is a disease that knows

15 no national borders.

16 (5) The threat that tuberculosis poses for

17 Americans derives from the global spread of tuber18 culosis and the emergence and spread of strains of

19 multi-drug resistant tuberculosis (MDR–TB).

20 (6) With over 40 percent of tuberculosis cases

21 in the United States attributable to foreign-born in22 dividuals and with the increase in international trav23 el, commerce, and migration, elimination of tuber24 culosis in the United States depends on efforts to

25 control the disease in developing countries.
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1 (7) Multi-drug resistant tuberculosis, defined as

2 resistance to the 2 most important anti-tuberculosis

3 drugs, isoniazid and rifampicin, is caused by incor4 rect or incomplete treatment—where patients do not

5 take all of their medicines regularly for the required

6 period, doctors and health workers prescribe the

7 wrong drugs or the wrong combination of drugs, or

8 the drug supply is unreliable.

9 (8) Up to 50,000,000 individuals may be in10 fected with multi-drug resistant tuberculosis.

11 (9) The incidence of multi-drug resistant tuber12 culosis is particularly high in certain regions and

13 populations, such as Russian prisons where an esti14 mated 5 percent of prisoners have active multi-drug

15 resistant tuberculosis.

16 (10) In the United States, tuberculosis treat17 ment, normally about $2,000 per patient, skyrockets

18 to as much as $250,000 per patient to treat multi19 drug resistant tuberculosis, and treatment may not

20 even be successful.

21 (11) Multi-drug resistant tuberculosis kills more

22 than one-half of those individuals infected in the

23 United States and other industrialized nations and

24 it is a virtual death sentence in the developing world.
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1 (12) Tuberculosis is an immense economic

2 drain on families and on nations and is a significant

3 cause of poverty.

4 (13) Most cases of tuberculosis and deaths

5 caused by tuberculosis occur among individuals in

6 their most productive years of life, ages 15 to 50.

7 (14) Children bear the brunt of the tuberculosis

8 of their parents. Often they are taken out of school

9 to care for a sick parent or to earn money when

10 their parent can no longer work, and few other in11 fectious diseases create as many orphans as tuber12 culosis.

13 (15) There is a highly effective and inexpensive

14 treatment for tuberculosis. Recommended by the

15 World Health Organization as the best curative

16 method for tuberculosis, this strategy, known as Di17 rectly Observed Treatment, Short Course (DOTS),

18 includes low-cost effective diagnosis, treatment, mon19 itoring, and recordkeeping, as well as a reliable drug

20 supply. A centerpiece of DOTS is observing patients

21 to ensure that they take their medication and com22 plete treatment.

23 (16) DOTS produces high cure rates, prevents

24 the further spread of infection, and prevents devel25 opment of strains of multi-drug resistant tuber-
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1 culosis, yet fewer than 1 in 5 of those ill with tuber2 culosis are receiving DOTS treatment.

3 (17) Few public health expenditures provide so

4 much value for so little money as expenditures for

5 the prevention and treatment of tuberculosis. A full

6 course of DOTS drugs costs as little as $11–$20 in

7 developing countries.

8 (18) Based on World Bank estimates, DOTS

9 treatment is one of the most cost-effective health

10 interventions available—costing just $20–$100 to

11 save a life, and DOTS can produce cure rates of up

12 to 95 percent even in the poorest countries.

13 (19) In order to control tuberculosis in the

14 United States in a more effective manner, it is nec15 essary to ensure the effectiveness of tuberculosis

16 control programs worldwide.

17 (20) A total of 22 countries contain an esti18 mated 80 percent of the tuberculosis cases world19 wide. Implementing DOTS programs in these coun20 tries must be a global priority. In addition, imple21 menting strategies to treat multi-drug resistant tu22 berculosis in these countries must also be a global

23 priority.
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1 (21) Tuberculosis experts estimate that it will

2 cost an additional $1,000,000,000 annually world3 wide to control this disease.

4 (22) The STOP TB Initiative, under the aus5 pices of the World Health Organization, has estab6 lished a global goal of reducing tuberculosis deaths

7 by one-half by 2005, reducing the tuberculosis bur8 den by one-half by 2010, and has further established

9 the targets of successfully treating 85 percent of de10 tected infectious cases and detecting 70 percent of

11 such cases by 2005.

12 SEC. 3. ASSISTANCE FOR TUBERCULOSIS PREVENTION,

13 TREATMENT, AND CONTROL.

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

15 (22 U.S.C. 2151b(c)) is amended by adding at the end

16 the following:

17 ‘‘(4)(A) Congress recognizes the growing inter18 national problem of tuberculosis and the threat its contin19 ued existence poses for the United States and other na20 tions which had previously largely controlled the disease.

21 Congress further recognizes that a cost-effective strategy

22 exists to control and treat tuberculosis, but that this treat23 ment regime is currently reaching fewer than one in five

24 of those ill with the disease, and that it is a major objec25 tive of the foreign assistance program of the United States
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1 to control this disease. To this end Congress expects the

2 agency primarily responsible for administering this part—

3 ‘‘(i) to focus its efforts on the implementation

4 of Directly Observed Treatment, Short Course

5 (DOTS), or other internationally accepted primary

6 tuberculosis control strategies developed in consulta7 tion with the World Health Organization, at the

8 local level with the intention of reaching the targets

9 of (I) detection of at least 70 percent of the cases

10 of infectious tuberculosis, (II) the cure of at least 85

11 percent of the cases detected, and (III) the reduction

12 in tuberculosis deaths by one-half, by 2005;

13 ‘‘(ii) to focus the efforts described in clause (i)

14 on the highest burden countries identified by the

15 World Health Organization as containing 80 percent

16 of tuberculosis cases globally; and

17 ‘‘(iii) to work in collaboration with the World

18 Health Organization, the STOP TB Initiative, the

19 United States Centers for Disease Control, the Na20 tional Institutes of Health, the International Union

21 Against TB and Lung Disease, and other organiza22 tions toward the development and implementation of

23 effective tuberculosis control programs, including

24 strategies to address multi-drug resistant tuber-
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1 culosis (MDR–TB), at the local level, especially in

2 the highest burden countries.

3 ‘‘(B) In conjunction with the submission of the an4 nual request for enactment of authorizations and appro5 priations for foreign assistance programs for each fiscal

6 year, the President shall include a report that contains

7 an estimate of the detection and cure rates of each pro8 gram, project, or activity to be carried out under the au9 thority of subparagraph (A) and progress on reaching the

10 targets described in subclauses (I) through (III) of sub11 paragraph (A)(i).

12 ‘‘(C)(i) There is authorized to be appropriated for

13 each of fiscal years 2001 and 2002 $100,000,000 to carry

14 out this paragraph.

15 ‘‘(ii) Of the amount appropriated pursuant to the au16 thorization of appropriations under clause (i), not less

17 than 80 percent of such amount shall be used for the diag18 nosis and treatment of tuberculosis for at-risk and af19 fected populations utilizing Directly Observed Treatment,

20 Short Course (DOTS), or other internationally accepted

21 primary tuberculosis control strategies developed in con22 sultation with the World Health Organization. An appro23 priate percentage of the remaining amount appropriated

24 pursuant to the authorization of appropriations under

25 clause (i) should be made available for implementation of
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1 Directly Observed Treatment, Short Course (DOTS–

2 PLUS), or other internationally accepted tuberculosis con3 trol strategies, to treat multi-drug resistant tuberculosis,

4 and for global tuberculosis coordination and surveillance

5 efforts. In addition, assistance provided using amounts ap6 propriated pursuant to the authorization of appropriations

7 under clause (i) shall be primarily used in those developing

8 countries identified by the World Health Organization as

9 having the highest incidence of tuberculosis, with special

10 emphasis given to the poorest regions of such countries.

11 ‘‘(iii) Amounts appropriated pursuant to the author12 ization of appropriations under this subparagraph are au13 thorized to remain available until expended.’’.

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