II 

Calendar No. 601 

117TH CONGRESS 

2D SESSION S. 3386 

To prevent, treat, and cure tuberculosis globally. 

IN THE SENATE OF THE UNITED STATES 

DECEMBER 14, 2021 

Mr. MENENDEZ (for himself, Mr. YOUNG, Mr. BRAUN, Mr. MARKEY, Mr. 

RUBIO, and Mr. VAN HOLLEN) introduced the following bill; which was 

read twice and referred to the Committee on Foreign Relations 

DECEMBER 7, 2022 

Reported by Mr. MENENDEZ, with an amendment 

[Strike out all after the enacting clause and insert the part printed in italic] 

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 2021’’. 

6 SEC. 2. FINDINGS. 

7 Congress makes the following findings: 


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1 (1) More than 25 years after the World Health 

2 Organization declared Tuberculosis (referred to in 

3 this Act as ‘‘TB’’) a public health emergency and 

4 called on countries to make scaling up tuberculosis 

5 control a priority, TB remains a deadly health 

6 threat despite the fact that TB is a preventable, 

7 treatable, and curable disease. 

8 (2) In 2019 alone, an estimated 10,000,000 

9 people became ill with TB, 10 percent of whom were 

10 children, and 1,400,000 of whom died. In order to 

11 achieve by 2035 the goals of the Political Declara12 tion of the High-Level Meeting of the General As13 sembly on the Fight Against Tuberculosis, adopted 

14 by the United Nations General Assembly October 

15 10, 2018, and of the World Health Organization 

16 End TB Strategy, adopted by the World Health As17 sembly in 2014, new tools must be developed and 

18 made available. 

(3) Over 1 19 ⁄3 of people who become ill with TB 

20 may be undiagnosed or misdiagnosed, resulting in 

21 unnecessary illness, communicable infections, and in22 creased mortality. 

23 (4) Since March 2020, the COVID–19 pan24 demic has severely disrupted TB responses in low25 and middle-income countries, stalling and reversing 


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1 years of progress made against TB, with detection 

2 dropping by 50 percent and an estimated 1,000,000 

3 fewer people will be diagnosed and enrolled on TB 

4 treatment. 

5 (5) In May 2020, a modeling study conducted 

6 by the Stop Tuberculosis Partnership (referred to in 

7 this Act as the ‘‘Stop TB Partnership’’) in collabo8 ration with the United States Agency for Inter9 national Development (referred to in this Act as 

10 ‘‘USAID’’) and partners estimated that a 3-month 

11 global lockdown followed by a protracted 10-month 

12 restoration could lead to an additional 6,300,000 

13 cases of TB between 2020 and 2025 and an addi14 tional 1,400,000 TB deaths during this period, caus15 ing a setback of at least 5 to 8 years in the fight 

16 against TB. 

17 (6) Findings released by the Stop TB Partner18 ship on March 18, 2021, found that TB diagnosis 

19 and enrolment on treatment in 2020 declined by an 

20 estimated total of 1,000,000 cases in 9 countries 

21 that collectively represent 60 percent of the global 

22 TB caseload, pushing the TB response back to 2008 

23 levels in terms of people diagnosed and treated. 

24 (7) Failure to properly diagnose and treat TB 

25 can lead to death and can exacerbate antimicrobial 


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1 resistance, a key contributor to rising cases of multi2 drug-resistant tuberculosis, and extensively drug-re3 sistant tuberculosis, and increasing the probability of 

4 the introduction of resistant TB into new geographic 

5 areas. 

6 (8) TB programs have played a central role in 

7 responding to COVID–19, including through 

8 leveraging the expertise of medical staff with exper9 tise in TB and lung diseases, the repurposing of TB 

10 hospitals, and the use of the TB rapid molecular 

11 testing platforms and X-Ray equipment for multiple 

12 purposes, including COVID–19. 

13 (9) With sufficient resourcing, TB program ex14 pertise, infection control, laboratory capacity, active 

15 case finding and contact investigation, can serve as 

16 a platform for respiratory pandemic response 

17 against existing and new infectious respiratory dis18 ease without such a response necessitating the dis19 ruption of ongoing TB programs and activities. 

(10) Globally, only about 1 20 ⁄2 of the 

21 $13,000,000,000 required annually outlined in the 

22 Stop TB Partnership’s Global Plan to End TB for 

23 tuberculosis prevention, diagnosis, and treatment is 

24 currently available. 


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1 (11) An estimated additional $3,500,000,000 

2 will be needed during 2021 for TB programs in 

3 countries eligible for Global Fund for AIDS, Tuber4 culosis, and Malaria programming to recover from 

5 the negative impacts of COVID–19, with a total an6 nual gap of at least $8,000,000,000 for TB diag7 nosis, prevention, and treatment in such countries. 

8 (12) On September 26, 2018, the United Na9 tions convened the first High-Level Meeting of the 

10 General Assembly on the Fight Against Tuber11 culosis, at which 120 countries— 

12 (A) signed a Political Declaration to accel13 erate progress against TB, including commit14 ments to increase funding for TB control and 

15 research and development programs, and ambi16 tious goals to successfully treat 40,000,000 peo17 ple with tuberculosis and prevent at least 

18 30,000,000 from becoming ill with TB between 

19 2018 and 2022; and 

20 (B) committed to ‘‘ending the epidemic in 

21 all countries, and pledge[d] to provide leader22 ship and to work together to accelerate our na23 tional and global collective actions, investments 

24 and innovations urgently to fight this prevent25 able and treatable disease,’’ as reflected in 


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1 United Nations General Assembly Resolution A/ 

2 RES/73/3. 

3 (13) The United States Government continues 

4 to be a lead funder of global TB research and devel5 opment, contributing 44 percent of the total 

6 $901,000,000 in global funding in 2019, and can 

7 catalyze more investments from other countries. 

8 (14) Working with governments and partners 

9 around the world, the TB efforts by USAID have 

10 saved 60,000,000 lives, demonstrating the effective11 ness of United States programs and activities. 

12 (15) On September 26, 2018, the USAID Ad13 ministrator announced a new performance-based 

14 Global Accelerator to End TB, aimed at catalyzing 

15 investments to meet the target set by the United 

16 Nations High-Level Meeting on tuberculosis of treat17 ing 40,000,000 people with the disease by 2022, fur18 ther demonstrating the critical role that United 

19 States leadership and assistance plays in the fight to 

20 eliminate TB. 

21 (16) It is essential to ensure that efforts among 

22 United States Government agencies, partner nations, 

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1 plementary and not duplicative in order to achieve 

2 the goal of ending the TB epidemic in all countries. 

3 SEC. 3. UNITED STATES GOVERNMENT ACTIONS TO END 

4 TUBERCULOSIS. 

5 Section 104B of the Foreign Assistance Act of 1961 

6 (22 U.S.C. 2151b–3) is amended to read as follows: 

7 ‘‘SECTION 104B. ASSISTANCE TO COMBAT TUBERCULOSIS. 

8 ‘‘(a) FINDINGS.—Congress makes the following find9 ings: 

10 ‘‘(1) Congress recognizes the continuing chal11 lenge of the international spread of tuberculosis, and 

12 the deadly impact of the continued existence of TB. 

13 ‘‘(2) Additional tools and resources are required 

14 to effectively diagnose, prevent, and treat tuber15 culosis. 

16 ‘‘(3) Effectively resourced tuberculosis pro17 grams can serve as a critical platform for respiratory 

18 pandemic response against existing and new infec19 tious respiratory disease. 

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

21 assistance program of the United States to help end the 

22 global tuberculosis pandemic through actions to support 

23 the diagnosis and treatment of all adults and children with 

24 all forms of tuberculosis, and to prevent new tuberculosis 

25 infections in adults and children. In all countries in which 


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1 the United States Government has established develop2 ment programs, particularly in countries with the highest 

3 burden of tuberculosis and other countries with high rates 

4 of tuberculosis, it is the policy of the United States— 

5 ‘‘(1) to support the objectives of the World 

6 Health Organization End TB Strategy, including 

7 goals— 

8 ‘‘(A) to reduce by 95 percent tuberculosis 

9 deaths by 2035; 

10 ‘‘(B) to reduce by 90 percent the tuber11 culosis incidence rate by 2035; and 

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

13 of families facing catastrophic health costs due 

14 to tuberculosis by 2035; 

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

16 Global Plan to End TB 2018–2022, and any follow 

17 up plan, including support for— 

18 ‘‘(A) developing and using innovative new 

19 technologies and therapies to increase active 

20 case finding to rapidly diagnose and treat chil21 dren and adults with all forms of tuberculosis, 

22 alleviate suffering, and ensure tuberculosis 

23 treatment completion; 

24 ‘‘(B) providing diagnosis and treatment 

25 with the goal of successfully treating 


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1 40,000,000 people with tuberculosis by 2022, 

2 including 3,500,000 children, and 1,500,000 

3 people with drug-resistant tuberculosis in sup4 port of the target set by the Political Declara5 tion of the High-Level Meeting of the General 

6 Assembly on the Fight Against Tuberculosis; 

7 ‘‘(C) diagnosing and treating latent tuber8 culosis infection, in support of the global goal 

9 of providing preventive therapy to at least 

10 30,000,000 people, including 4,000,000 children 

11 under 5 years of age, 20,000,000 household 

12 contacts of people affected by tuberculosis, and 

13 6,000,000 people living with HIV, by 2022; 

14 ‘‘(D) ensuring high quality tuberculosis 

15 care by closing gaps in care cascades, imple16 menting continuous quality improvement at all 

17 levels of care, and providing patient support; 

18 and 

19 ‘‘(E) sustainably procuring tuberculosis 

20 commodities to avoid interruptions in supply, 

21 the procurement of commodities of unknown 

22 quality, or payment of excessive commodity 

23 costs in countries impacted by tuberculosis; and 

24 ‘‘(3) to ensure that United States funding sup25 ports activities that simultaneously emphasize— 


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1 ‘‘(A) the development of comprehensive 

2 person-centered programs, including diagnosis, 

3 treatment, and prevention strategies to ensure 

4 that— 

5 ‘‘(i) all people sick with tuberculosis 

6 receive quality diagnosis and treatment 

7 through active case finding; and 

8 ‘‘(ii) people at high risk for tuber9 culosis infection are found and treated 

10 with preventive therapies in a timely man11 ner; 

12 ‘‘(B) robust tuberculosis infection control 

13 practices are implemented in all congregate set14 tings, including hospitals and prisons; 

15 ‘‘(C) the deployment of diagnostic and 

16 treatment capacity— 

17 ‘‘(i) in areas with the highest tuber18 culosis burdens; and 

19 ‘‘(ii) for highly at-risk and impover20 ished populations, including patient sup21 port; 

22 ‘‘(D) program monitoring and evaluation 

23 based on critical tuberculosis indicators, includ24 ing indicators relating to infection control, the 

25 numbers of patients accessing tuberculosis 


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1 treatment, along with patient support services, 

2 and preventative therapy for those at risk, in3 cluding all close contacts, and treatment out4 comes for all forms of tuberculosis; 

5 ‘‘(E) training and engagement of health 

6 care workers on the use of new diagnostic tools 

7 and therapies as they become available, and in8 creased support for training frontline health 

9 care workers to support expanded tuberculosis 

10 active case finding, contact tracing and patient 

11 support; 

12 ‘‘(F) coordination with domestic agencies 

13 and organizations on an aggressive research 

14 agenda to develop vaccines as well as new tools 

15 to diagnose, treat, and prevent tuberculosis 

16 globally; 

17 ‘‘(G) linkages with the private sector on— 

18 ‘‘(i) research and development of a 

19 vaccine, and on new tools for diagnosis and 

20 treatment of tuberculosis; 

21 ‘‘(ii) improving current tools for diag22 nosis and treatment of tuberculosis; and 

23 ‘‘(iii) training healthcare professionals 

24 on use of the newest and most effective di25 agnostic and therapeutic tools; 


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1 ‘‘(H) the reduction of barriers to care, in2 cluding stigma and treatment and diagnosis 

3 costs, through— 

4 ‘‘(i) training for health workers; 

5 ‘‘(ii) sensitizing of policy makers; 

6 ‘‘(iii) requirements for access and af7 fordability provisions in all grants and 

8 funding agreements; 

9 ‘‘(iv) education and empowerment 

10 campaigns for tuberculosis patients regard11 ing local tuberculosis services; 

12 ‘‘(v) monitoring barriers to accessing 

13 tuberculosis services; and 

14 ‘‘(vi) increased support for patient-led 

15 and community-led tuberculosis outreach 

16 efforts; and 

17 ‘‘(I) support for country-level, sustainable 

18 accountability mechanisms and capacity to 

19 measure progress and ensure that commitments 

20 made by governments and relevant stakeholders 

21 are met. 

22 ‘‘(c) DEFINITIONS.—In this section: 

23 ‘‘(1) APPROPRIATE CONGRESSIONAL COMMIT24 TEES.—The term ‘appropriate congressional com25 mittees’ means the Committee on Foreign Relations 


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1 of the Senate and the Committee on Foreign Affairs 

2 of the House of Representatives. 

3 ‘‘(2) END TB STRATEGY.—The term ‘End TB 

4 Strategy’ means the strategy to eliminate tuber5 culosis that was approved by the World Health As6 sembly in May 2014, and is described in The End 

7 TB Strategy: Global strategy and targets for tuber8 culosis prevention, care and control after 2015. 

9 ‘‘(3) GLOBAL ALLIANCE FOR TUBERCULOSIS

10 DRUG DEVELOPMENT.—The term ‘Global Alliance 

11 for Tuberculosis Drug Development’ means the pub12 lic-private partnership that bring together leaders in 

13 health, science, philanthropy, and private industry to 

14 devise new approaches to tuberculosis. 

15 ‘‘(4) GLOBAL TUBERCULOSIS DRUG FACIL16 ITY.—The term ‘Global Tuberculosis Drug Facility’ 

17 means the initiative of the Stop Tuberculosis Part18 nership to increase access to the most advanced, af19 fordable, quality-assured tuberculosis drugs and 

20 diagnostics. 

21 ‘‘(5) MDR–TB.—The term ‘MDR–TB’ means 

22 multi-drug-resistant tuberculosis. 

23 ‘‘(6) STOP TUBERCULOSIS PARTNERSHIP.—The 

24 term ‘Stop Tuberculosis Partnership’ means the 

25 partnership of the United Nations Office for Project 


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1 Services, donors including the United States, high 

2 tuberculosis burden countries, multilateral agencies, 

3 and nongovernmental and technical agencies com4 mitted to short- and long-term measures required to 

5 control and eventually eliminate tuberculosis as a 

6 public health problem in the world. 

7 ‘‘(7) XDR–TB.—The term ‘XDR–TB’ means 

8 extensively drug-resistant tuberculosis. 

9 ‘‘(d) AUTHORIZATION.—To carry out this section, the 

10 President is authorized, consistent with section 104(c), to 

11 furnish assistance, on such terms and conditions as the 

12 President may determine, for the prevention, treatment, 

13 control, and elimination of tuberculosis. 

14 ‘‘(e) GOALS.—In consultation with the appropriate 

15 congressional committees, the President shall establish 

16 goals, based on the policy and indicators described in sub17 section (b), for United States tuberculosis programs to de18 tect, cure and prevent all forms of tuberculosis globally 

19 for the period between 2023 and 2030 that is aligned with 

20 the End TB Strategy’s 2030 targets, by updating the 

21 United States Government Tuberculosis Strategy (2015– 

22 2019) and the National Action Plan for Combating 

23 Multidrug-Resistant Tuberculosis. 

24 ‘‘(f) COORDINATION.— 


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1 ‘‘(1) IN GENERAL.—In carrying out this sec2 tion, the President shall coordinate with the World 

3 Health Organization, the Stop TB Partnership, the 

4 Global Fund to Fight AIDS, Tuberculosis, and Ma5 laria, and other organizations with respect to the de6 velopment and implementation of a comprehensive 

7 global tuberculosis response program. 

8 ‘‘(2) BILATERAL ASSISTANCE.—In providing bi9 lateral assistance under this section, the President, 

10 acting through the Administrator of the United 

11 States Agency for International Development, 

12 shall— 

13 ‘‘(A) catalyze support for research and de14 velopment of new tools to prevent, diagnose, 

15 treat, and control tuberculosis worldwide, par16 ticularly to reduce the incidence of, and mor17 tality from, all forms of drug-resistant tuber18 culosis; 

19 ‘‘(B) ensure United States programs and 

20 activities aimed at reaching those infected with 

21 tuberculosis provide quality diagnosis and treat22 ment, and reach those at high risk with preven23 tive therapy; and 

24 ‘‘(C) ensure coordination among relevant 

25 United States Government agencies, including 


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1 the Centers for Disease Control and Prevention, 

2 the National Institutes of Health, the Bio3 medical Advanced Research and Development 

4 Authority, the Food and Drug Administration, 

5 the National Science Foundation, the Depart6 ment of Defense (through its Congressionally 

7 Directed Medical Research Program), and other 

8 Federal agencies that engage in international 

9 tuberculosis activities to ensure accountability 

10 and transparency, reduce duplication of efforts 

11 and ensure appropriate integration and coordi12 nation of tuberculosis services into other United 

13 States-supported health programs. 

14 ‘‘(g) PRIORITY TO END TB STRATEGY.—In fur15 nishing assistance under subsection (d), the President 

16 shall give priority to— 

17 ‘‘(1) building and strengthening tuberculosis 

18 programs to diagnose and treat all people sick with 

19 TB, and ensuring everyone who is sick with tuber20 culosis have access to quality diagnosis and treat21 ment; 

22 ‘‘(2) direct, high-quality integrated services for 

23 all forms of tuberculosis, as described by the World 

24 Health Organization, which call for the coordination 

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1 berculosis disease and infection, patient support, and 

2 tuberculosis prevention; 

3 ‘‘(3) individuals co-infected with HIV and other 

4 co-morbidities, and other individuals with tuber5 culosis who may be at risk of stigma; 

6 ‘‘(4) strengthening the capacity of health sys7 tems to detect, prevent, and treat tuberculosis, in8 cluding MDR–TB and XDR–TB, as described in the 

9 International Standards for Tuberculosis Care, and 

10 the latest international guidance related to tuber11 culosis; 

12 ‘‘(5) research and development of innovative 

13 diagnostics, drug therapies, and vaccines, and pro14 gram-based operational research; 

15 ‘‘(6) the Stop Tuberculosis Partnership’s Global 

16 Drug Facility, and the Global Alliance for Tuber17 culosis Drug Development, and other organizations 

18 promoting the development of new products and 

19 drugs for tuberculosis; and 

20 ‘‘(7) ensuring tuberculosis programs can serve 

21 as key platforms for supporting national respiratory 

22 pandemic response against existing and new infec23 tious respiratory disease. 

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1 SHIP.—In carrying out this section, the President, acting 

2 through the Administrator of the United States Agency 

3 for International Development, is authorized to provide in4 creased resources to the World Health Organization and 

5 the Stop Tuberculosis Partnership to improve the capacity 

6 of countries with high burdens or rates of tuberculosis and 

7 other affected countries to implement the End TB Strat8 egy, the Stop TB Global Plan to End TB, their own na9 tional strategies and plans, other global efforts to control 

10 MDR–TB and XDR–TB. 

11 ‘‘(i) ANNUAL REPORT ON TUBERCULOSIS ACTIVI12 TIES.—Not later than December 15 of each year until the 

13 goals specified in subsection (b)(1) are met, the President 

14 shall submit an annual report to the appropriate congres15 sional committees that describes United States foreign as16 sistance to control tuberculosis and the impact of such ef17 forts, including— 

18 ‘‘(1) the number of individuals with active tu19 berculosis disease that were diagnosed and treated, 

20 including the rate of treatment completion and the 

21 number receiving patient support; 

22 ‘‘(2) the number of persons with MDR–TB and 

23 XDR–TB that were diagnosed and treated, includ24 ing the rate of completion, in countries receiving 


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1 United States bilateral foreign assistance for tuber2 culosis control programs; 

3 ‘‘(3) the numbers of people trained by the 

4 United States Government in tuberculosis surveil5 lance and control; 

6 ‘‘(4) the number of individuals with active TB 

7 disease identified as a result of engagement with the 

8 private sector and other nongovernmental partners 

9 in countries receiving United States bilateral foreign 

10 assistance for tuberculosis control programs; 

11 ‘‘(5) a description of the collaboration and co12 ordination of United States anti-tuberculosis efforts 

13 with the World Health Organization, the Stop TB 

14 Partnership, the Global Fund to Fight AIDS, Tu15 berculosis and Malaria, and other major public and 

16 private entities; 

17 ‘‘(6) a description of the collaboration and co18 ordination among the United States Agency for 

19 International Development and other United States 

20 agencies, including the Centers for Disease Control 

21 and Prevention and the Office of the Global AIDS 

22 Coordinator, for the purposes of combating tuber23 culosis; 

24 ‘‘(7) the constraints on implementation of pro25 grams posed by health workforce shortages, health 


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1 system limitations, other components of successful 

2 implementation, and strategies to address such con3 straints; 

4 ‘‘(8) a breakdown of expenditures for patient 

5 services supporting TB diagnosis, treatment, and 

6 prevention, including procurement of drugs and 

7 other commodities, drug management, training in di8 agnosis and treatment, health systems strengthening 

9 that directly impacts provision of TB services, and 

10 research; and 

11 ‘‘(9) for each country receiving bilateral United 

12 States assistance for the purpose of tuberculosis pre13 vention, treatment, and control— 

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

15 implement the most recent World Health Orga16 nization guidelines to improve diagnosis, treat17 ment, and prevention of tuberculosis for adults 

18 and children, disaggregated by sex, including 

19 the proportion of health facilities that have 

20 adopted the latest World Health Organization 

21 guidelines on strengthening surveillance systems 

22 and preventative, diagnostic, and therapeutic 

23 methods, including the use of rapid diagnostic 

24 tests and orally administered tuberculosis treat25 ment regimens; 


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1 ‘‘(B) the number of adults and children re2 ceiving tuberculosis preventive therapy, includ3 ing people with HIV and all close contacts, 

4 disaggregated by sex and, as possible, income or 

5 wealth quintile, and the establishment of effec6 tive tuberculosis infection control in all relevant 

7 congregant settings, including hospitals, clinics, 

8 and prisons; 

9 ‘‘(C) a description of progress in imple10 menting measures to reduce tuberculosis inci11 dence, including actions— 

12 ‘‘(i) to expand active case finding and 

13 contact tracing to identify and reach vul14 nerable groups; and 

15 ‘‘(ii) to expand tuberculosis preventive 

16 therapy, engagement of the private sector, 

17 and diagnostic capacity; 

18 ‘‘(D) a description of progress to expand 

19 diagnosis, prevention, and treatment for all 

20 forms of tuberculosis, including in pregnant 

21 women, children, and other high-risk individuals 

22 and groups at greater risk of TB, including mi23 grants, prisoners, miners, people exposed to sili24 ca, and people living with HIV/AIDS, 

25 disaggregated by sex; 


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1 ‘‘(E) the rate of successful completion of 

2 tuberculosis treatment for adults and children, 

3 disaggregated by sex, and the number of indi4 viduals receiving support for treatment comple5 tion; 

6 ‘‘(F) the number of people, disaggregated 

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

8 proportion of those treated with the latest regi9 mens endorsed by the World Health Organiza10 tion, any factors impeding scale up of such 

11 treatment, and a description of progress to ex12 pand community-based MDR–TB care; 

13 ‘‘(G) a description of tuberculosis com14 modity procurement challenges, including short15 ages, stockouts, or failed tenders for tuber16 culosis drugs or other commodities; 

17 ‘‘(H) the proportion of health facilities 

18 with specimen referral linkages to GeneXpert 

19 testing sites, and to reference labs for second 

20 line drug resistance testing, and a description 

21 of the turnaround time for test results; 

22 ‘‘(I) the number of people trained by the 

23 United States Government to deliver high-qual24 ity tuberculosis surveillance, laboratory services, 

25 prevention, treatment, and care; 


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1 ‘‘(J) a description of how supported activi2 ties are coordinated with— 

3 ‘‘(i) country national TB plans and 

4 strategies; and 

5 ‘‘(ii) tuberculosis control efforts sup6 ported by the Global Fund to Fight AIDS, 

7 Tuberculosis, and Malaria, and other inter8 national assistance funds, including in the 

9 areas of program development and imple10 mentation; and 

11 ‘‘(K) for the first 3 years of the report re12 quired under this subsection, a section that de13 scribes the progress in recovering from the neg14 ative impact of COVID–19 on tuberculosis, in15 cluding whether there has been the development 

16 and implementation of a comprehensive plan to 

17 ensure tuberculosis activities recover from di18 version of resources, the continued use of 

19 bidirectional TB–COVID testing, and progress 

20 on increased diagnosis and treatment of active 

21 tuberculosis. 

22 ‘‘(j) ANNUAL REPORT ON TUBERCULOSIS RESEARCH

23 AND DEVELOPMENT.—The President, acting through the 

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1 tional Institutes of Health, the Centers for Disease Con2 trol and Prevention, the Biomedical Advanced Research 

3 and Development Authority, the Food and Drug Adminis4 tration, the National Science Foundation, and the Office 

5 of the Global AIDS Coordinator, shall submit an annual 

6 report to Congress that— 

7 ‘‘(1) describes current progress and challenges 

8 to the development of new tools for the purpose of 

9 tuberculosis prevention, treatment, and control; 

10 ‘‘(2) identifies critical gaps and emerging prior11 ities for research and development, including for 

12 rapid and point-of-care diagnostics, shortened treat13 ments and prevention methods, and vaccines; and 

14 ‘‘(3) describes research investments by type, 

15 funded entities, and level of investment. 

16 ‘‘(k) EVALUATION REPORT.—Not later than 2 years 

17 after the date of the enactment of the End Tuberculosis 

18 Now Act of 2021, and every 5 years thereafter until 2036, 

19 the Comptroller General of the United States shall submit 

20 a report to the appropriate congressional committees that 

21 evaluates the performance and impact on tuberculosis pre22 vention, diagnosis, treatment, and care efforts that are 

23 supported by United States bilateral assistance funding, 

24 including recommendations for improving such pro25 grams.’’. 


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘End Tuberculosis Now 

3 Act of 2022’’. 

4 SEC. 2. FINDINGS. 

5 Congress makes the following findings: 

6 (1) Tuberculosis (referred to in the Act as ‘‘TB’’) 

7 is a preventable, treatable, and curable disease, yet 

8 more than 25 years after the World Health Organiza9 tion declared it to be a public health emergency and 

10 called on countries to make scaling up TB control a 

11 priority, TB remains a deadly health threat. 

12 (2) In 2021 alone, an estimated 10,600,000 peo13 ple became ill with TB, 11 percent of whom were chil14 dren, and an estimated 1,600,000 of these people died 

15 from the illness. In order to achieve by 2035 the goals 

16 of the Political Declaration of the High-Level Meeting 

17 of the General Assembly on the Fight Against Tuber18 culosis, adopted by the United Nations General As19 sembly October 10, 2018, and of the World Health Or20 ganization End TB Strategy, adopted by the World 

21 Health Assembly in 2014, new and existing tools 

22 must be developed and scaled-up. 

(3) More than 1 23 ⁄3 of people who become ill with 

24 TB may be undiagnosed or misdiagnosed, resulting in 

25 unnecessary illness, communicable infections, and in26 creased mortality. 


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1 (4) Since March 2020, the COVID–19 pandemic 

2 has severely disrupted TB responses in low- and mid3 dle-income countries, stalling and reversing years of 

4 progress made against TB. According to the World 

5 Health Organization, from 2019 to 2020— 

6 (A) global detection of TB dropped by 18 

7 percent; 

8 (B) an estimated 1,300,000 fewer people 

9 were diagnosed and enrolled on TB treatment; 

10 and 

11 (C) in some countries, TB case notifications 

12 dropped by up to 41 percent, setting progress 

13 back by up to 12 years. 

14 (5) Failure to properly diagnose and treat TB 

15 can lead to death, can exacerbate antimicrobial resist16 ance (a key contributor to rising cases of multi-drug17 resistant TB and extensively drug-resistant TB), and 

18 can increase the probability of the introduction of re19 sistant TB into new geographic areas. 

20 (6) TB programs have played a central role in 

21 responding to COVID–19, including through 

22 leveraging the expertise of medical staff with expertise 

23 in TB and lung diseases, the repurposing of TB hos24 pitals, and the use of the TB rapid molecular testing 


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1 platforms and x-ray equipment for multiple purposes, 

2 including the treatment of COVID–19. 

3 (7) With sufficient resourcing, TB program ex4 pertise, infection control, laboratory capacity, active 

5 case finding, and contact investigation can serve as 

6 platforms for respiratory pandemic response against 

7 existing and new infectious respiratory disease with8 out disrupting ongoing TB programs and activities. 

(8) Globally, only about 1 9 ⁄2 of the 

10 $13,000,000,000 required annually, as outlined in the 

11 Stop TB Partnership’s Global Plan to End TB, is 

12 currently available. 

13 (9) According to estimates by the Global Fund 

14 for AIDS, Tuberculosis, and Malaria, an additional 

15 $3,500,000,000 was needed during 2021 for TB pro16 grams in eligible countries in order to recover from 

17 the negative impacts of COVID–19. 

18 (10) On September 26, 2018, the United Nations 

19 convened the first High-Level Meeting of the General 

20 Assembly on the Fight Against Tuberculosis, during 

21 which 120 countries— 

22 (A) signed a Political Declaration to accel23 erate progress against TB, including through 

24 commitments to increase funding for TB preven25 tion, diagnosis, treatment, and research and deVerDate Sep 11 2014 00:11 Dec 08, 2022 Jkt 039200 PO 00000 Frm 00027 Fmt 6652 Sfmt 6203 E:\BILLS\S3386.RS S3386

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1 velopment programs, and to set ambitious goals 

2 to successfully treat 40,000,000 people with ac3 tive TB and prevent at least 30,000,000 from be4 coming ill with TB between 2018 and 2022; and 

5 (B) committed to ‘‘ending the epidemic in 

6 all countries, and pledge[d] to provide leadership 

7 and to work together to accelerate our national 

8 and global collective actions, investments and in9 novations urgently to fight this preventable and 

10 treatable disease’’, as reflected in United Nations 

11 General Assembly Resolution 73/3. 

12 (11) The United States Government continues to 

13 be a lead funder of global TB research and develop14 ment, contributing 44 percent of the total 

15 $915,000,000 in global funding in 2020, and can 

16 catalyze more investments from other countries. 

17 (12) Working with governments and partners 

18 around the world, USAID’s TB programming has 

19 saved an estimated 66,000,000 lives, demonstrating 

20 the effectiveness of United States programs and ac21 tivities against the illness. 

22 (13) On September 26, 2018, the USAID Admin23 istrator announced a new performance-based Global 

24 Accelerator to End TB, aimed at catalyzing invest25 ments to meet the treatment target set by the United 


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1 Nations High-Level Meeting, further demonstrating 

2 the critical role that United States leadership and as3 sistance plays in the fight to eliminate TB. 

4 (14) It is essential to ensure that efforts among 

5 United States Government agencies, partner nations, 

6 international organizations, nongovernmental organi7 zations, the private sector, and other actors are com8 plementary and not duplicative in order to achieve 

9 the goal of ending the TB epidemic in all countries. 

10 SEC. 3. UNITED STATES GOVERNMENT ACTIONS TO END 

11 TUBERCULOSIS. 

12 Section 104B of the Foreign Assistance Act of 1961 

13 (22 U.S.C. 2151b–3) is amended to read as follows: 

14 ‘‘SEC. 104B. ASSISTANCE TO COMBAT TUBERCULOSIS. 

15 ‘‘(a) FINDINGS.—Congress makes the following find16 ings: 

17 ‘‘(1) The international spread of tuberculosis (re18 ferred to in this section as ‘TB’) and the deadly im19 pact of TB’s continued existence constitutes a con20 tinuing challenge. 

21 ‘‘(2) Additional tools and resources are required 

22 to effectively diagnose, prevent, and treat TB. 

23 ‘‘(3) Effectively resourced TB programs can serve 

24 as a critical platform for preventing and responding 

25 to future infectious respiratory disease pandemics. 


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1 ‘‘(b) POLICY.— 

2 ‘‘(1) IN GENERAL.—It is a major objective of the 

3 foreign assistance program of the United States to 

4 help end the TB public health emergency through ac5 celerated actions— 

6 ‘‘(A) to support the diagnosis and treatment 

7 of all adults and children with all forms of TB; 

8 and 

9 ‘‘(B) to prevent new TB infections from oc10 curring. 

11 ‘‘(2) SUPPORT FOR GLOBAL PLANS AND OBJEC12 TIVES.—In countries in which the United States Gov13 ernment has established foreign assistance programs 

14 under this Act, particularly in countries with the 

15 highest burden of TB and other countries with high 

16 rates of infection and transmission of TB, it is the 

17 policy of the United States— 

18 ‘‘(A) to support the objectives of the World 

19 Health Organization End TB Strategy, includ20 ing its goals— 

21 ‘‘(i) to reduce TB deaths by 95 percent 

22 by 2035; 

23 ‘‘(ii) to reduce the TB incidence rate 

24 by 90 percent by 2035; and 


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1 ‘‘(iii) to reduce the number of families 

2 facing catastrophic health costs due to TB 

3 by 100 percent by 2035; 

4 ‘‘(B) to support the Stop TB Partnership’s 

5 Global Plan to End TB 2023–2030, including by 

6 providing support for— 

7 ‘‘(i) developing and using innovative 

8 new technologies and therapies to increase 

9 active case finding and rapidly diagnose 

10 and treat children and adults with all 

11 forms of TB, alleviate suffering, and ensure 

12 TB treatment completion; 

13 ‘‘(ii) expanding diagnosis and treat14 ment in line with the goals established by 

15 the Political Declaration of the High-Level 

16 Meeting of the General Assembly on the 

17 Fight Against Tuberculosis, including— 

18 ‘‘(I) successfully treating 

19 40,000,000 people with active TB by 

20 2023, including 3,500,000 children, 

21 and 1,500,000 people with drug-resist22 ant TB; and 

23 ‘‘(II) diagnosing and treating la24 tent tuberculosis infection, in support 

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1 tive therapy to at least 30,000,000 peo2 ple by 2023, including 4,000,000 chil3 dren younger than 5 years of age, 

4 20,000,000 household contacts of people 

5 affected by TB, and 6,000,000 people 

6 living with HIV; 

7 ‘‘(iii) ensuring high-quality TB care 

8 by closing gaps in care cascades, imple9 menting continuous quality improvement at 

10 all levels of care, and providing related pa11 tient support; and 

12 ‘‘(iv) sustainable procurements of TB 

13 commodities to avoid interruptions in sup14 ply, the procurement of commodities of un15 known quality, or payment of excessive 

16 commodity costs in countries impacted by 

17 TB; 

18 ‘‘(C) ensure, to the greatest extent prac19 ticable, that United States funding supports ac20 tivities that simultaneously emphasize— 

21 ‘‘(i) the development of comprehensive 

22 person-centered programs, including diag23 nosis, treatment, and prevention strategies 

24 to ensure that— 


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1 ‘‘(I) all people sick with TB re2 ceive quality diagnosis and treatment 

3 through active case finding; and 

4 ‘‘(II) people at high risk for TB 

5 infection are found and treated with 

6 preventive therapies in a timely man7 ner; 

8 ‘‘(ii) robust TB infection control prac9 tices are implemented in all congregate set10 tings, including hospitals and prisons; 

11 ‘‘(iii) the deployment of diagnostic and 

12 treatment capacity— 

13 ‘‘(I) in areas with the highest TB 

14 burdens; and 

15 ‘‘(II) for highly at-risk and im16 poverished populations, including pa17 tient support services; 

18 ‘‘(iv) program monitoring and evalua19 tion based on critical TB indicators, includ20 ing indicators relating to infection control, 

21 the numbers of patients accessing TB treat22 ment and patient support services, and pre23 ventative therapy for those at risk, includ24 ing all close contacts, and treatment out25 comes for all forms of TB; 


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1 ‘‘(v) training and engagement of health 

2 care workers on the use of new diagnostic 

3 tools and therapies as they become avail4 able, and increased support for training 

5 frontline health care workers to support ex6 panded TB active case finding, contact 

7 tracing, and patient support services; 

8 ‘‘(vi) coordination with domestic agen9 cies and organizations to support an ag10 gressive research agenda to develop vaccines 

11 as well as new tools to diagnose, treat, and 

12 prevent TB globally; 

13 ‘‘(vii) linkages with the private sector 

14 on— 

15 ‘‘(I) research and development of 

16 a vaccine, and on new tools for diag17 nosis and treatment of TB; 

18 ‘‘(II) improving current tools for 

19 diagnosis and treatment of TB, includ20 ing telehealth solutions for prevention 

21 and treatment; and 

22 ‘‘(III) training healthcare profes23 sionals on use of the newest and most 

24 effective diagnostic and therapeutic 

25 tools; 


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1 ‘‘(viii) the reduction of barriers to care, 

2 including stigma and treatment and diag3 nosis costs, including through— 

4 ‘‘(I) training health workers; 

5 ‘‘(II) sensitizing policy makers; 

6 ‘‘(III) requiring that all relevant 

7 grants and funding agreements include 

8 access and affordability provisions; 

9 ‘‘(IV) supporting education and 

10 empowerment campaigns for TB pa11 tients regarding local TB services; 

12 ‘‘(V) monitoring barriers to ac13 cessing TB services; and 

14 ‘‘(VI) increasing support for pa15 tient-led and community-led TB out16 reach efforts; and 

17 ‘‘(ix) support for country-level, sus18 tainable accountability mechanisms and ca19 pacity to measure progress and ensure that 

20 commitments made by governments and rel21 evant stakeholders are met. 

22 ‘‘(c) DEFINITIONS.—In this section: 

23 ‘‘(1) APPROPRIATE CONGRESSIONAL COMMIT24 TEES.—The term ‘appropriate congressional commit25 tees’ means the Committee on Foreign Relations of the 


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1 Senate and the Committee on Foreign Affairs of the 

2 House of Representatives. 

3 ‘‘(2) END TB STRATEGY.—The term ‘End TB 

4 Strategy’ means the strategy to eliminate TB that 

5 was approved by the World Health Assembly in May 

6 2014, and is described in ‘The End TB Strategy: 

7 Global Strategy and Targets for Tuberculosis Preven8 tion, Care and Control After 2015’. 

9 ‘‘(3) GLOBAL ALLIANCE FOR TUBERCULOSIS

10 DRUG DEVELOPMENT.—The term ‘Global Alliance for 

11 Tuberculosis Drug Development’ means the public12 private partnership that bring together leaders in 

13 health, science, philanthropy, and private industry to 

14 devise new approaches to TB. 

15 ‘‘(4) GLOBAL TUBERCULOSIS DRUG FACILITY.— 

16 The term ‘Global Tuberculosis Drug Facility’ means 

17 the initiative of the Stop Tuberculosis Partnership to 

18 increase access to the most advanced, affordable, qual19 ity-assured TB drugs and diagnostics. 

20 ‘‘(5) MDR–TB.—The term ‘MDR–TB’ means 

21 multi-drug-resistant TB. 

22 ‘‘(6) STOP TUBERCULOSIS PARTNERSHIP.—The 

23 term ‘Stop Tuberculosis Partnership’ means the part24 nership of 1,600 organizations (including inter25 national and technical organizations, government 


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1 programs, research and funding agencies, founda2 tions, nongovernmental organizations, civil society 

3 and community groups, and the private sector), do4 nors, including the United States, high TB burden 

5 countries, multilateral agencies, and nongovernmental 

6 and technical agencies, which is governed by the Stop 

7 TB Partnership Coordinating Board and hosted by a 

8 United Nations entity, committed to short- and long9 term measures required to control and eventually 

10 eliminate TB as a public health problem in the world. 

11 ‘‘(7) XDR–TB.—The term ‘XDR–TB’ means ex12 tensively drug-resistant TB. 

13 ‘‘(d) AUTHORIZATION.—To carry out this section, the 

14 President is authorized, consistent with section 104(c), to 

15 furnish assistance, on such terms and conditions as the 

16 President may determine, for the prevention, treatment, 

17 control, and elimination of TB. 

18 ‘‘(e) GOALS.—In consultation with the appropriate 

19 congressional committees, the President shall establish 

20 goals, based on the policy and indicators described in sub21 section (b), for— 

22 ‘‘(1) United States TB programs to detect, cure, 

23 and prevent all forms of TB globally for the period 

24 between 2023 and 2030 that are aligned with the End 


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1 TB Strategy’s 2030 targets and the USAID’s Global 

2 Tuberculosis (TB) Strategy 2023-2030; and 

3 ‘‘(2) updating the National Action Plan for 

4 Combating Multidrug-Resistant Tuberculosis. 

5 ‘‘(f) COORDINATION.— 

6 ‘‘(1) IN GENERAL.—In carrying out this section, 

7 the President shall coordinate with the World Health 

8 Organization, the Stop TB Partnership, the Global 

9 Fund to Fight AIDS, Tuberculosis, and Malaria, and 

10 other organizations with respect to the development 

11 and implementation of a comprehensive global TB re12 sponse program. 

13 ‘‘(2) BILATERAL ASSISTANCE.—In providing bi14 lateral assistance under this section, the President, 

15 acting through the Administrator of the United States 

16 Agency for International Development, shall— 

17 ‘‘(A) catalyze support for research and de18 velopment of new tools to prevent, diagnose, 

19 treat, and control TB worldwide, particularly to 

20 reduce the incidence of, and mortality from, all 

21 forms of drug-resistant TB; 

22 ‘‘(B) ensure United States programs and 

23 activities focus on finding individuals with ac24 tive TB disease and provide quality diagnosis 

25 and treatment, including through digital health 


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1 solutions, and reaching those at high risk with 

2 preventive therapy; and 

3 ‘‘(C) ensure coordination among relevant 

4 United States Government agencies, including 

5 the Department of State, the Centers for Disease 

6 Control and Prevention, the National Institutes 

7 of Health, the Biomedical Advanced Research 

8 and Development Authority, the Food and Drug 

9 Administration, the National Science Founda10 tion, the Department of Defense (through its 

11 Congressionally Directed Medical Research Pro12 grams), and other relevant Federal departments 

13 and agencies that engage in international TB 

14 activities— 

15 ‘‘(i) to ensure accountability and 

16 transparency; 

17 ‘‘(ii) to reduce duplication of efforts; 

18 and 

19 ‘‘(iii) to ensure appropriate integra20 tion and coordination of TB services into 

21 other United States-supported health pro22 grams. 

23 ‘‘(g) PRIORITY TO END TB STRATEGY.—In furnishing 

24 assistance under subsection (d), the President shall 

25 prioritize— 


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1 ‘‘(1) building and strengthening TB programs— 

2 ‘‘(A) to increase the diagnosis and treat3 ment of everyone who is sick with TB; and 

4 ‘‘(B) to ensure that such individuals have 

5 access to quality diagnosis and treatment; 

6 ‘‘(2) direct, high-quality integrated services for 

7 all forms of TB, as described by the World Health Or8 ganization, which call for the coordination of active 

9 case finding, treatment of all forms of TB disease and 

10 infection, patient support, and TB prevention; 

11 ‘‘(3) treating individuals co-infected with HIV 

12 and other co-morbidities, and other individuals with 

13 TB who may be at risk of stigma; 

14 ‘‘(4) strengthening the capacity of health systems 

15 to detect, prevent, and treat TB, including MDR–TB 

16 and XDR–TB, as described in the latest international 

17 guidance related to TB; 

18 ‘‘(5) researching and developing innovative 

19 diagnostics, drug therapies, and vaccines, and pro20 gram-based research; 

21 ‘‘(6) support for the Stop Tuberculosis Partner22 ship’s Global Drug Facility, the Global Alliance for 

23 Tuberculosis Drug Development, and other organiza24 tions promoting the development of new products and 

25 drugs for TB; and 


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1 ‘‘(7) ensuring that TB programs can serve as key 

2 platforms for supporting national respiratory pan3 demic response against existing and new infectious 

4 respiratory disease. 

5 ‘‘(h) ASSISTANCE FOR THE WORLD HEALTH ORGANI6 ZATION AND THE STOP TUBERCULOSIS PARTNERSHIP.—In 

7 carrying out this section, the President, acting through the 

8 Administrator of the United States Agency for Inter9 national Development, is authorized— 

10 ‘‘(1) to provide resources to the World Health 

11 Organization and the Stop Tuberculosis Partnership 

12 to improve the capacity of countries with high bur13 dens or rates of TB and other affected countries to 

14 implement the End TB Strategy, the Stop TB Global 

15 Plan to End TB, their own national strategies and 

16 plans, other global efforts to control MDR–TB and 

17 XDR–TB; and 

18 ‘‘(2) to leverage the contributions of other donors 

19 for the activities described in paragraph (1). 

20 ‘‘(i) ANNUAL REPORT ON TB ACTIVITIES.—Not later 

21 than December 15 of each year until the earlier of the date 

22 on which the goals specified in subsection (b)(2)(A) are met 

23 or the last day of 2035, the President shall submit an an24 nual report to the appropriate congressional committees 


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1 that describes United States foreign assistance to control TB 

2 and the impact of such efforts, including— 

3 ‘‘(1) the number of individuals with active TB 

4 disease that were diagnosed and treated, including the 

5 rate of treatment completion and the number receiv6 ing patient support; 

7 ‘‘(2) the number of persons with MDR–TB and 

8 XDR–TB that were diagnosed and treated, including 

9 the rate of completion, in countries receiving United 

10 States bilateral foreign assistance for TB control pro11 grams; 

12 ‘‘(3) the number of people trained by the United 

13 States Government in TB surveillance and control; 

14 ‘‘(4) the number of individuals with active TB 

15 disease identified as a result of engagement with the 

16 private sector and other nongovernmental partners in 

17 countries receiving United States bilateral foreign as18 sistance for TB control programs; 

19 ‘‘(5) a description of the collaboration and co20 ordination of United States anti-TB efforts with the 

21 World Health Organization, the Stop TB Partner22 ship, the Global Fund to Fight AIDS, Tuberculosis 

23 and Malaria, and other major public and private en24 tities; 


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1 ‘‘(6) a description of the collaboration and co2 ordination among the United States Agency for Inter3 national Development and other United States de4 partments and agencies, including the Centers for 

5 Disease Control and Prevention and the Office of the 

6 Global AIDS Coordinator, for the purposes of com7 bating TB; 

8 ‘‘(7) the constraints on implementation of pro9 grams posed by health workforce shortages, health sys10 tem limitations, barriers to digital health implemen11 tation, other challenges to successful implementation, 

12 and strategies to address such constraints; 

13 ‘‘(8) a breakdown of expenditures for patient 

14 services supporting TB diagnosis, treatment, and pre15 vention, including procurement of drugs and other 

16 commodities, drug management, training in diag17 nosis and treatment, health systems strengthening 

18 that directly impacts the provision of TB services, 

19 and research; and 

20 ‘‘(9) for each country, and when practicable, 

21 each project site receiving bilateral United States as22 sistance for the purpose of TB prevention, treatment, 

23 and control— 

24 ‘‘(A) a description of progress toward the 

25 adoption and implementation of the most recent 


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1 World Health Organization guidelines to im2 prove diagnosis, treatment, and prevention of TB 

3 for adults and children, disaggregated by sex, in4 cluding the proportion of health facilities that 

5 have adopted the latest World Health Organiza6 tion guidelines on strengthening monitoring sys7 tems and preventative, diagnostic, and thera8 peutic methods, including the use of rapid diag9 nostic tests and orally administered TB treat10 ment regimens; 

11 ‘‘(B) the number of individuals screened for 

12 TB disease and the number evaluated for TB in13 fection using active case finding outside of health 

14 facilities; 

15 ‘‘(C) the number of individuals with active 

16 TB disease that were diagnosed and treated, in17 cluding the rate of treatment completion and the 

18 number receiving patient support; 

19 ‘‘(D) the number of adults and children, in20 cluding people with HIV and close contacts, who 

21 are evaluated for TB infection, the number of 

22 adults and children started on treatment for TB 

23 infection, and the number of adults and children 

24 completing such treatment, disaggregated by sex 

25 and, as possible, income or wealth quintile; 


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1 ‘‘(E) the establishment of effective TB infec2 tion control in all relevant congregant settings, 

3 including hospitals, clinics, and prisons; 

4 ‘‘(F) a description of progress in imple5 menting measures to reduce TB incidence, in6 cluding actions— 

7 ‘‘(i) to expand active case finding and 

8 contact tracing to reach vulnerable groups; 

9 and 

10 ‘‘(ii) to expand TB preventive therapy, 

11 engagement of the private sector, and diag12 nostic capacity; 

13 ‘‘(G) a description of progress to expand di14 agnosis, prevention, and treatment for all forms 

15 of TB, including in pregnant women, children, 

16 and individuals and groups at greater risk of 

17 TB, including migrants, prisoners, miners, peo18 ple exposed to silica, and people living with 

19 HIV/AIDS, disaggregated by sex; 

20 ‘‘(H) the rate of successful completion of TB 

21 treatment for adults and children, disaggregated 

22 by sex, and the number of individuals receiving 

23 support for treatment completion; 

24 ‘‘(I) the number of people, disaggregated by 

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1 portion of those treated with the latest regimens 

2 endorsed by the World Health Organization, fac3 tors impeding scale up of such treatment, and a 

4 description of progress to expand community5 based MDR–TB care; 

6 ‘‘(J) a description of TB commodity pro7 curement challenges, including shortages, 

8 stockouts, or failed tenders for TB drugs or other 

9 commodities; 

10 ‘‘(K) the proportion of health facilities with 

11 specimen referral linkages to quality diagnostic 

12 networks, including established testing sites and 

13 reference labs, to ensure maximum access and re14 ferral for second line drug resistance testing, and 

15 a description of the turnaround time for test re16 sults; 

17 ‘‘(L) the number of people trained by the 

18 United States Government to deliver high-qual19 ity TB diagnostic, preventative, monitoring, 

20 treatment, and care services; 

21 ‘‘(M) a description of how supported activi22 ties are coordinated with— 

23 ‘‘(i) country national TB plans and 

24 strategies; and 


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1 ‘‘(ii) TB control efforts supported by 

2 the Global Fund to Fight AIDS, Tuber3 culosis, and Malaria, and other inter4 national assistance programs and funds, in5 cluding in the areas of program develop6 ment and implementation; and 

7 ‘‘(N) for the first 3 years of the report re8 quired under this subsection, a description of the 

9 progress in recovering from the negative impact 

10 of COVID–19 on TB, including— 

11 ‘‘(i) whether there has been the develop12 ment and implementation of a comprehen13 sive plan to recover TB activities from di14 version of resources; 

15 ‘‘(ii) the continued use of bidirectional 

16 TB–COVID testing; and 

17 ‘‘(iii) progress on increased diagnosis 

18 and treatment of active TB. 

19 ‘‘(j) ANNUAL REPORT ON TB RESEARCH AND DEVEL20 OPMENT.—The President, acting through the Administrator 

21 of the United States Agency for International Development, 

22 and in coordination with the National Institutes of Health, 

23 the Centers for Disease Control and Prevention, the Bio24 medical Advanced Research and Development Authority, 

25 the Food and Drug Administration, the National Science 


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1 Foundation, and the Office of the Global AIDS Coordinator, 

2 shall submit an annual report to the appropriate congres3 sional committees that— 

4 ‘‘(1) describes the current progress and challenges 

5 to the development of new tools for the purpose of TB 

6 prevention, treatment, and control; 

7 ‘‘(2) identifies critical gaps and emerging prior8 ities for research and development, including for 

9 rapid and point-of-care diagnostics, shortened treat10 ments and prevention methods, telehealth solutions for 

11 prevention and treatment, and vaccines; and 

12 ‘‘(3) describes research investments by type, 

13 funded entities, and level of investment. 

14 ‘‘(k) EVALUATION REPORT.—Not later than 2 years 

15 after the date of the enactment of the End Tuberculosis Now 

16 Act of 2022, and every 5 years thereafter until the last day 

17 of 2035, the Comptroller General of the United States shall 

18 submit a report to the appropriate congressional committees 

19 that evaluates the performance and impact on TB preven20 tion, diagnosis, treatment, and care efforts that are sup21 ported by United States bilateral assistance funding, in22 cluding recommendations for improving such programs.’’. 


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Calendar No. 601 

117TH CONGRESS 

2D SESSION S. 3386 

A BILL 

To prevent, treat, and cure tuberculosis globally. 

DECEMBER 7, 2022 

Reported with an amendment 


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