II 

Calendar No. 549 

110TH CONGRESS 

1ST SESSION S. 1551 

To amend the Public Health Service Act with respect to making progress 

toward the goal of eliminating tuberculosis, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

JUNE 5, 2007 

Mr. BROWN (for himself, Mrs. HUTCHISON, Mr. KENNEDY, Mrs. CLINTON, 

Mrs. MURRAY, Mrs. FEINSTEIN, Mr. SANDERS, Mr. BINGAMAN, Mr. 

MENENDEZ, Mr. HARKIN, Mrs. BOXER, Ms. LANDRIEU, Ms. CANTWELL, 

Ms. MURKOWSKI, and Mr. LAUTENBERG) introduced the following bill; 

which was read twice and referred to the Committee on Health, Education, Labor, and Pensions 

DECEMBER 18, 2007 

Reported by Mr. KENNEDY, with an amendment 

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

A BILL 

To amend the Public Health Service Act with respect to 

making progress toward the goal of eliminating tuberculosis, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 


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1 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

2 (a) SHORT TITLE.—This Act may be cited as the 

3 ‘‘Comprehensive Tuberculosis Elimination Act of 2007’’. 

4 (b) TABLE OF CONTENTS.—The table of contents for 

5 this Act is as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. Findings. 

TITLE I—CENTERS FOR DISEASE CONTROL AND PREVENTION 

Subtitle A—National Program for Elimination of Tuberculosis 

Sec. 101. National program. 

Subtitle B—Interagency Collaboration 

Sec. 111. Advisory council for elimination of tuberculosis. 

Subtitle C—New Tools for Tuberculosis Elimination 

Sec. 121. New tools. 

Subtitle D—Authorizations of Appropriations 

Sec. 131. Authorizations of appropriations. 

TITLE II—NATIONAL INSTITUTES OF HEALTH 

Sec. 201. Research and development concerning tuberculosis. 

Sec. 202. Activities of National institute of Allergy and Infectious Diseases. 

Sec. 203. John E. Fogarty International Center for Advanced Study in the 

Health Sciences. 

Sec. 204. Loan repayment programs regarding research on tuberculosis. 

Sec. 205. Authorization of appropriations. 

6 SEC. 2. FINDINGS. 

7 The Congress finds as follows: 

8 (1) Each year approximately 9,000,000 people 

9 become ill with active tuberculosis ( referred to in 

10 this section as ‘‘TB’’), and it is estimated that 

11 1,600,000 of those people die, a result of critical 

12 underinvestment in quality TB control and the re13 search and development of new TB drugs, 


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1 diagnostics and a vaccine, as well as the comorbid 

2 relationship between TB and HIV/AIDS. Such levels 

3 of morbidity and mortality are complicated by the 

4 disease having the ability to develop resistance to 

5 treatments and to travel easily across borders. 

6 (2) In 2006, there were 13,767 cases of active 

7 TB reported in the United States. The average an8 nual decline in the national TB rate slowed from 7.3 

9 percent per year in the period of 1993 to 2000 to 

10 3.8 percent per year in the period of 2000 to 2006. 

11 (3) In addition to those with active TB, an esti12 mated 10,000,000 to 15,000,000 people in the 

13 United States have latent TB infection. 

14 (4) The increasing occurrence of multidrug re15 sistant (‘‘MDR’’) TB, including extensively drug re16 sistant (‘‘XDR’’) TB—which is resistant to at least 

17 almost all drugs used to treat TB, including the two 

18 recommended first-line drugs and the recommended 

19 second-line medications, raises concerns of a future 

20 epidemic of virtually untreatable TB. 

21 (5) To prevent the spread of extensively drug 

22 resistant TB, the immediate strengthening of TB 

23 control systems must be a priority. This includes im24 proved case detection, strengthened laboratory ca25 pacity, rapid implementation of infection control 


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1 measures, enhanced treatment programs, and imme2 diate support to existing public sector infrastructure. 

3 (6) The Centers for Disease Control and Pre4 vention is increasingly relied upon globally for its ex5 pertise and technical assistance in global tuber6 culosis preparedness and outbreak response capacity 

7 to identify and investigate outbreaks of multidrug 

8 resistant and extensively drug resistant TB. 

9 (7) New tools are needed to more effectively 

10 prevent, diagnose, and treat TB. The standard 

11 method of diagnosing TB is over 100 years old, and 

12 fails to adequately detect TB, especially in children 

13 and those co-infected with HIV/AIDS. The newest 

14 class of anti-TB drug is over 40 years old, while 

15 rates of multidrug resistant TB are rising globally. 

16 The existing vaccine confers no protection to adoles17 cents and adults, protecting only against severe 

18 forms of TB in infants and young children. 

19 TITLE I—CENTERS FOR DISEASE 

20 CONTROL AND PREVENTION 

21 Subtitle A—National Program for 

22 Elimination of Tuberculosis 

23 SEC. 101. NATIONAL PROGRAM. 

24 Section 317E of the Public Health Service Act (42 

25 U.S.C. 247b–6) is amended— 


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1 (1) by striking the heading for the section and 

2 inserting the following: ‘‘NATIONAL PROGRAM FOR

3 ELIMINATION OF TUBERCULOSIS’’; and 

4 (2) by amending subsection (b) to read as fol5 lows: 

6 ‘‘(b) RESEARCH AND DEVELOPMENT; DEMONSTRA7 TION PROJECTS; EDUCATION AND TRAINING.—With re8 spect to the prevention, treatment, control, and elimi9 nation of tuberculosis, the Secretary may, directly or 

10 through grants to public or nonprofit private entities, 

11 carry out the following: 

12 ‘‘(1) Research, with priority given to research 

13 and development concerning— 

14 ‘‘(A) clinical trials to evaluate the safety 

15 and effectiveness of new drugs, diagnostics, and 

16 vaccines for latent tuberculosis infection and ac17 tive tuberculosis, including drug-resistant tuber18 culosis, that are suitable for use by patients 

19 with HIV/AIDS; 

20 ‘‘(B) epidemiological studies of populations 

21 at risk for tuberculosis; and 

22 ‘‘(C) field studies to evaluate the effective23 ness of new drugs, diagnostics, and vaccines, to 

24 assess the incidence and prevalence of 


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1 multidrug resistant and extensively drug resist2 ant strains of tuberculosis. 

3 ‘‘(2) Demonstration projects for— 

4 ‘‘(A) the development of regional capabili5 ties to prevent, control and eliminate tuber6 culosis and prevent mutidrug resistant and ex7 tensively drug resistant strains of tuberculosis; 

8 ‘‘(B) the intensification of efforts— 

9 ‘‘(i) to prevent, detect, and treat tu10 berculosis among African Americans, His11 panic Americans, Asian Americans, and 

12 other United States-born populations with 

13 documented health disparities; and 

14 ‘‘(ii) to reduce or eliminate racial dis15 parities in the incidence of tuberculosis in 

16 these populations; 

17 ‘‘(C) the intensification of efforts to con18 trol tuberculosis along the United States-Mexico 

19 border and among United States-Mexico bina20 tional populations; 

21 ‘‘(D) the intensification of efforts to pre22 vent, detect, and treat tuberculosis among for23 eign-born persons who are in the United States; 

24 ‘‘(E) providing guidance to Immigration 

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1 based screening procedures based on current 

2 epidemiological data; 

3 ‘‘(F) the intensification of efforts to in4 crease targeted testing and treatment of latent 

5 tuberculosis infection and drug-resistant tuber6 culosis; and 

7 ‘‘(G) the intensification of efforts to pre8 vent, detect, and treat tuberculosis among other 

9 high risk populations and settings, including 

10 among children and adolescents, homeless per11 sons, detainees and prisoners, HIV-infected per12 sons, and within health care settings. 

13 ‘‘(3) A public information and education pro14 gram to include components that raise awareness re15 garding tuberculosis among the general population 

16 as well as those that target populations documented 

17 as having high risk for tuberculosis. 

18 ‘‘(4) Education, training and clinical skills im19 provement activities for health professionals, includ20 ing allied health personnel and emergency response 

21 employees. 

22 ‘‘(5) Provide support for the Tuberculosis 

23 Trials Consortium, the Tuberculosis Epidemiologic 

24 Studies Consortium, the National Laboratory Train25 ing Network, and Regional Training and Medical 


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1 Consultation Centers to carry out activities under 

2 paragraphs (1) through (4). 

3 ‘‘(6) Collaboration with international organiza4 tions and foreign countries in intensifying efforts to 

5 prevent, treat, control, and eliminate tuberculosis, 

6 including efforts that address risks associated with 

7 international travel. 

8 ‘‘(7) Develop, enhance, and expand information 

9 technologies that support tuberculosis control, in10 cluding surveillance and database management sys11 tems with cross-jurisdictional capabilities.’’. 

12 Subtitle B—Interagency 

13 Collaboration 

14 SEC. 111. ADVISORY COUNCIL FOR ELIMINATION OF TU15 BERCULOSIS. 

16 (a) IN GENERAL.—Section 317E(f) of the Public 

17 Health Service Act (42 U.S.C. 247b–6(f)) is amended— 

18 (1) by redesignating paragraph (5) as para19 graph (6); and 

20 (2) by striking paragraphs (2) through (4), and 

21 inserting the following: 

22 ‘‘(2) DUTIES.—The Council shall provide advice 

23 and recommendations regarding the elimination of 

24 tuberculosis to the Secretary, the Assistant Sec25 retary for Health, and the Director of the Centers 


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1 for Disease Control and Prevention. In addition, the 

2 Council shall, with respect to eliminating such dis3 ease, provide to the Secretary and other appropriate 

4 Federal officials advice on— 

5 ‘‘(A) coordinating the activities of the Pub6 lic Health Service and other Federal agencies 

7 that relate to the disease, including activities 

8 under subsection (b); 

9 ‘‘(B) responding rapidly and effectively to 

10 cases of extensively drug resistant strains of tu11 berculosis; and 

12 ‘‘(C) efficiently utilizing the Federal re13 sources involved. 

14 ‘‘(3) COMPREHENSIVE PLAN.— 

15 ‘‘(A) IN GENERAL.—In carrying out para16 graph (2), the Council shall make recommenda17 tions on the development, revision, and imple18 mentation of a comprehensive plan to eliminate 

19 tuberculosis in the United States. 

20 ‘‘(B) CONSULTATION.—In carrying out 

21 subparagraph (A), the Council shall consult 

22 with public and private entities, including— 

23 ‘‘(i) individuals who are scientists, 

24 physicians, laboratorians, and other health 

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1 ployees of the Federal Government and 

2 who represent the disciplines relevant to 

3 tuberculosis elimination; 

4 ‘‘(ii) members of public-private part5 nerships established to address the elimi6 nation of tuberculosis; 

7 ‘‘(iii) members of national and inter8 national nongovernmental organizations es9 tablished to address tuberculosis elimi10 nation; and 

11 ‘‘(iv) members from the general public 

12 who are knowledgeable with respect to tu13 berculosis elimination including individuals 

14 who have or have had tuberculosis. 

15 ‘‘(C) CERTAIN COMPONENTS OF PLAN.—In 

16 carrying out subparagraph (A), the Council 

17 shall— 

18 ‘‘(i) consider the recommendations of 

19 the Institute of Medicine regarding the 

20 elimination of tuberculosis; 

21 ‘‘(ii) consider recommendations for 

22 the involvement of the United States in 

23 continuing global and cross-border tuber24 culosis control activities in countries where 

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1 fects the United States such as Mexico; 

2 and 

3 ‘‘(iii) review the extent to which 

4 progress has been made toward eliminating 

5 tuberculosis. 

6 ‘‘(4) ANNUAL REPORT.—The Council shall an7 nually submit to Congress and the Secretary a re8 port on the activities carried under this section, 

9 other than subsection (g). Each such report shall in10 clude the opinion of the Council on the extent to 

11 which its recommendations regarding the elimination 

12 of tuberculosis have been implemented, including 

13 with respect to— 

14 ‘‘(A) activities under subsection (b); and 

15 ‘‘(B) the national plan referred to in para16 graph (3). 

17 ‘‘(5) COMPOSITION.—The Council shall be com18 posed of— 

19 ‘‘(A) representatives from the Centers for 

20 Disease Control and Prevention, the National 

21 Institutes of Health, the United States Agency 

22 for International Development, the Agency for 

23 Healthcare Research and Quality, the Health 

24 Resources and Services Administration, the 

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1 sion, and other Federal departments and agen2 cies that carry out significant activities related 

3 to tuberculosis; 

4 ‘‘(B) State and local tuberculosis control 

5 and public health officials; 

6 ‘‘(C) individuals who are scientists, physi7 cians, laboratorians, and other health profes8 sionals who represent disciplines relevant to tu9 berculosis elimination; 

10 ‘‘(D) members of national and inter11 national nongovernmental organizations estab12 lished to address the elimination of tuberculosis; 

13 and 

14 ‘‘(E) members from the general public who 

15 are knowledgeable with respect to the elimi16 nation of tuberculosis, including individuals who 

17 have or have had tuberculosis.’’. 

18 (b) RULE OF CONSTRUCTION REGARDING CURRENT

19 MEMBERSHIP.—With respect to the advisory council 

20 under section 317E(f) of the Public Health Service Act, 

21 the amendments made by subsection (a) may not be con22 strued as terminating the membership on such council of 

23 any individual serving as such a member as of the day 

24 before the date of the enactment of this Act. 


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1 Subtitle C—New Tools for 

2 Tuberculosis Elimination 

3 SEC. 121. NEW TOOLS. 

4 Section 317E of the Public Health Service Act (42 

5 U.S.C. 247b–6) is amended— 

6 (1) by redesignating subsection (g) as sub7 section (h); and 

8 (2) by inserting after subsection (f) the fol9 lowing subsection: 

10 ‘‘(g) NEW TOOLS FOR ELIMINATION OF TUBER11 CULOSIS.— 

12 ‘‘(1) RESEARCH AND DEVELOPMENT ON DRUGS, 

13 DIAGNOSTICS, VACCINES, AND PUBLIC HEALTH

14 INTERVENTIONS.—The Secretary, acting through 

15 the Director of the Centers for Disease Control and 

16 Prevention, shall expand, intensify, and coordinate 

17 research and development and related activities of 

18 such Centers to develop new tools for the elimination 

19 of tuberculosis, including drugs, diagnostics, vac20 cines, and public health interventions, such as di21 rectly observed therapy and non-pharmaceutical 

22 intervention. 

23 ‘‘(2) FEDERAL TUBERCULOSIS TASK FORCE.— 

24 ‘‘(A) DUTIES.—The Federal Tuberculosis 

25 Task Force (established in December 2001 as 


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1 part of the Centers for Disease Control and 

2 Prevention) (in this subsection referred to as 

3 the ‘Task Force’) shall provide to the Secretary 

4 and other appropriate Federal officials advice 

5 on the implementation of paragraph (1), includ6 ing advice regarding the efficient utilization of 

7 the Federal resources involved. 

8 ‘‘(B) COMPREHENSIVE PLAN FOR NEW

9 TOOLS DEVELOPMENT.—In carrying out para10 graph (1), the Task Force shall make rec11 ommendations on the development of a com12 prehensive plan for the creation of new tools for 

13 the elimination of tuberculosis, including drugs, 

14 diagnostics, and vaccines. 

15 ‘‘(C) CONSULTATION.—In developing the 

16 comprehensive plan under paragraph (1), the 

17 Task Force shall consult with— 

18 ‘‘(i) scientists, physicians, 

19 laboratorians, and other health profes20 sionals and who represent the specialties 

21 and disciplines relevant to the research 

22 under consideration; 

23 ‘‘(ii) members from public-private 

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1 gaged in research relevant to research 

2 under consideration; 

3 ‘‘(iii) members of national and inter4 national nongovernmental organizations es5 tablished to address tuberculosis elimi6 nation; 

7 ‘‘(iv) members from the general public 

8 who are knowledgeable with respect to tu9 berculosis, including individuals who have 

10 or have had tuberculosis; and 

11 ‘‘(v) scientists, physicians, 

12 laboratorians, and other health profes13 sionals who reside in a foreign country 

14 with a substantial incidence or prevalence 

15 of tuberculosis, and who represent the spe16 cialties and disciplines relevant to the re17 search under consideration. 

18 ‘‘(3) GRANTS AND CONTRACTS.—The Secretary 

19 shall carry out paragraph (1) directly and through 

20 awards of grants, cooperative agreements, and con21 tracts to public and private entities, including— 

22 ‘‘(A) public-private partnerships; 

23 ‘‘(B) academic institutions, including insti24 tutions of higher education; 

25 ‘‘(C) research institutions; and 


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1 ‘‘(D) the Tuberculosis Trials Consortium 

2 and the Tuberculosis Epidemiologic Studies 

3 Consortium.’’. 

4 Subtitle D—Authorizations of 

5 Appropriations 

6 SEC. 131. AUTHORIZATIONS OF APPROPRIATIONS. 

7 Section 317E of the Public Health Service Act, as 

8 amended by section 121(1) of this Act, is amended by 

9 striking subsection (h) and inserting the following: 

10 ‘‘(h) AUTHORIZATION OF APPROPRIATIONS.— 

11 ‘‘(1) GENERAL PROGRAM.— 

12 ‘‘(A) IN GENERAL.—For the purpose of 

13 carrying out this section, other than subsections 

14 (b) and (g), there are authorized to be appro15 priated $300,000,000 for fiscal year 2008, and 

16 such sums as may be necessary for each of the 

17 fiscal years 2009 through 2012. 

18 ‘‘(B) RESERVATION FOR EMERGENCY

19 GRANTS.—Of the amounts appropriated under 

20 subparagraph (A) for a fiscal year, the Sec21 retary may reserve not more than 25 percent 

22 for emergency grants under subsection (a) for 

23 any State, political subdivision of a States, or 

24 other public entity in which there is, relative to 

25 other areas, a substantial number of cases of 


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1 tuberculosis, multidrug resistant tuberculosis, 

2 or extensively drug resistant tuberculosis or a 

3 substantial rate of increase in such cases. 

4 ‘‘(C) RESEARCH, DEMONSTRATION

5 PROJECTS, EDUCATION, AND TRAINING.—For 

6 the purpose of carrying out subsection (b), 

7 there are authorized to be appropriated such 

8 sums as may be necessary for each of fiscal 

9 years 2008 through 2012. 

10 ‘‘(D) PRIORITY.—In allocating amounts 

11 appropriated under subparagraph (A) and not 

12 reserved under subparagraph (B), the Secretary 

13 shall give priority to allocating such amounts 

14 for grants under subsection (a). 

15 ‘‘(E) ALLOCATION OF FUNDS.— 

16 ‘‘(i) REQUIREMENT OF FORMULA.—Of 

17 the amounts appropriated under subpara18 graph (A), not reserved under subpara19 graph (B), and allocated by the Secretary 

20 for grants under subsection (a), the Sec21 retary shall distribute such amounts to 

22 grantees under subsection (a) on the basis 

23 of a formula. 

24 ‘‘(ii) RELEVANT FACTORS.—The for25 mula developed by the Secretary under 


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1 clause (i) shall take into account the level 

2 of tuberculosis morbidity in the respective 

3 geographic area and may consider other 

4 factors relevant to tuberculosis in such 

5 area. 

6 ‘‘(iii) NO CHANGE TO FORMULA RE7 QUIRED.—This subparagraph does not re8 quire the Secretary to modify the formula 

9 that was used by the Secretary to dis10 tribute funds to grantees under subsection 

11 (a) for fiscal year 2007. 

12 ‘‘(2) NEW TOOLS.— 

13 ‘‘(A) IN GENERAL.—For the purpose of 

14 carrying out subsection (g), there are author15 ized to be appropriated $100,000,000 for fiscal 

16 year 2008, and such sums as may be necessary 

17 for each of the fiscal years 2009 through 2012. 

18 ‘‘(B) LIMITATION.—The authorization of 

19 appropriations established in subparagraph (A) 

20 for a fiscal year is effective only if the amount 

21 appropriated under paragraph (1) for such year 

22 equals or exceeds the amount appropriated to 

23 carry out this section for fiscal year 2007.’’. 


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1 TITLE II—NATIONAL INSTITUTES 

2 OF HEALTH 

3 SEC. 201. RESEARCH AND DEVELOPMENT CONCERNING TU4 BERCULOSIS. 

5 (a) IN GENERAL.—Subpart 2 of part C of title IV 

6 of the Public Health Service Act (42 U.S.C. 285b et seq.) 

7 is amended by inserting after section 424B the following 

8 section: 

9 ‘‘SEC. 424C. TUBERCULOSIS. 

10 ‘‘(a) IN GENERAL.—The Director of the National In11 stitutes of Health shall expand, intensify, and coordinate 

12 research and development and related activities of the In13 stitute with respect to tuberculosis, including activities to14 ward the goal of eliminating such disease. 

15 ‘‘(b) CERTAIN ACTIVITIES.—Activities under sub16 section (a) shall include— 

17 ‘‘(1) enhancing basic and clinical research on 

18 tuberculosis, including drug resistant tuberculosis; 

19 and 

20 ‘‘(2) expanding research on the relationship be21 tween such disease and the human immunodeficiency 

22 virus.’’. 

23 (b) RESEARCH EDUCATION.—Part A of title IV of 

24 the Public Health Service Act (42 U.S.C. 281 et seq.) is 

25 amended by adding at the end the following: 


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1 ‘‘SEC. 404I. TUBERCULOSIS ACADEMIC AWARDS. 

2 ‘‘(a) TUBERCULOSIS ACADEMIC AWARDS.—The Di3 rector of the National Institutes of Health may provide 

4 awards to faculty of schools of medicine, osteopathic medi5 cine, nursing, public health, or related fields to assist such 

6 faculty in developing high quality curricula in such schools 

7 designed to significantly increase the opportunities for in8 terested individuals, including students of the school and 

9 practicing physicians and nurses, to learn the principles 

10 and practices of preventing, managing, and controlling tu11 berculosis. 

12 ‘‘(b) TUBERCULOSIS/PULMONARY INFECTION

13 AWARDS.—The Director of the National Institutes of 

14 Health may provide awards to support the career develop15 ment of clinically trained professionals who are committed 

16 to research regarding pulmonary infections and tuber17 culosis by providing for supervised study and research.’’. 

18 SEC. 202. ACTIVITIES OF NATIONAL INSTITUTE OF AL19 LERGY AND INFECTIOUS DISEASES. 

20 Section 447A of the Public Health Service Act (42 

21 U.S.C. 285f–2) is amended— 

22 (1) by striking ‘‘In carrying out section 446’’ 

23 and inserting ‘‘(a) In carrying out section 446’’; and 

24 (2) by inserting at the end the following: 

25 ‘‘(b) Activities under subsection (a) shall include ac26 tivities to develop a tuberculosis vaccine. Such activities 


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1 shall be carried out in accordance with the blueprint for 

2 tuberculosis vaccine development described in the report 

3 prepared pursuant to the workshop convened in March 

4 1998 by the Advisory Council for Elimination of Tuber5 culosis, the Director of the National Vaccine Program, 

6 and the Director of the Institute.’’. 

7 SEC. 203. JOHN E. FOGARTY INTERNATIONAL CENTER FOR 

8 ADVANCED STUDY IN THE HEALTH 

9 SCIENCES. 

10 Section 482 of the Public Health Service Act (42 

11 U.S.C. 287b) is amended— 

12 (1) by inserting ‘‘(a) IN GENERAL.—’’ before 

13 ‘‘The general purpose’’; 

14 (2) in subsection (a) (as so designated), by in15 serting after ‘‘Health Sciences’’ the following: ‘‘(in 

16 this subpart referred to as the ‘Center’)’’; and 

17 (3) by adding at the end the following sub18 section: 

19 ‘‘(b) TUBERCULOSIS.— 

20 ‘‘(1) IN GENERAL.—In carrying out subsection 

21 (a) with respect to tuberculosis, the Center shall ex22 pand, intensify, and coordinate international activi23 ties of the Center for research and training. 

24 ‘‘(2) INTERNATIONAL TRAINING PROGRAM.—In 

25 carrying out paragraph (1), the Center shall carry 


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1 out an international training program regarding tu2 berculosis. Such program shall be modeled after the 

3 international training program carried out by the 

4 Center with respect to the human immunodeficiency 

5 virus.’’. 

6 SEC. 204. LOAN REPAYMENT PROGRAMS REGARDING RE7 SEARCH ON TUBERCULOSIS. 

8 Part G of title IV of the Public Health Service Act 

9 (42 U.S.C. 288 et seq.) is amended— 

10 (1) by redesignating the second section 487F as 

11 section 487G; and 

12 (2) by inserting after section 487G (as so re13 designated) the following section: 

14 ‘‘LOAN REPAYMENTS REGARDING RESEARCH ON

15 TUBERCULOSIS

16 ‘‘SEC. 487H. In carrying out sections 487C, 487E, 

17 and 487F, the Secretary shall seek to ensure that, for fis18 cal year 2008 and subsequent fiscal years, a portion of 

19 amounts appropriated to carry out such sections is re20 served for the purpose of entering into contracts under 

21 which (in accordance with the section involved) individuals 

22 will conduct research on tuberculosis. The Secretary shall 

23 have sole discretion for the administration of activities 

24 under this section.’’. 


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1 SEC. 205. AUTHORIZATION OF APPROPRIATIONS. 

2 For the purpose of carrying out this title and the 

3 amendments made by this title, there are authorized to 

4 be appropriated such sums as may be necessary. Such au5 thorization of appropriations shall be in addition to the 

6 authorization of appropriations established by section 

7 402A(a) of the Public Health Service Act and any other 

8 authorization of appropriations available for such purpose. 

9 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

10 (a) SHORT TITLE.—This Act may be cited as the 

11 ‘‘Comprehensive Tuberculosis Elimination Act of 2007’’. 

12 (b) TABLE OF CONTENTS.—The table of contents for 

13 this Act is as follows: 

Sec. 1. Short title; table of contents. 

TITLE I—DEPARTMENT OF HEALTH AND HUMAN SERVICES IN COORDINATION WITH THE CENTERS FOR DISEASE CONTROL AND 

PREVENTION AND OTHER APPROPRIATE AGENCIES 

Subtitle A—National Strategy for Combating and Eliminating Tuberculosis 

Sec. 101. National strategy. 

Subtitle B—Interagency Collaboration 

Sec. 111. Advisory council for elimination of tuberculosis. 

Subtitle C—New Tools for Tuberculosis Elimination 

Sec. 121. New tools. 

Subtitle D—Evaluation of Public Health Authorities 

Sec. 131. Evaluation of public health authorities. 

Subtitle E—Authorization of Appropriations 

Sec. 141. Authorizations of appropriations. 

TITLE II—NATIONAL INSTITUTES OF HEALTH 

Sec. 201. Research and development concerning tuberculosis. 


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1 TITLE I—DEPARTMENT OF 

2 HEALTH AND HUMAN SERV3 ICES IN COORDINATION WITH 

4 THE CENTERS FOR DISEASE 

5 CONTROL AND PREVENTION 

6 AND OTHER APPROPRIATE 

7 AGENCIES 

8 Subtitle A—National Strategy for 

9 Combating and Eliminating Tu10 berculosis 

11 SEC. 101. NATIONAL STRATEGY. 

12 Section 317E of the Public Health Service Act (42 

13 U.S.C. 247b–6) is amended— 

14 (1) by striking the heading for the section and 

15 inserting the following: ‘‘NATIONAL STRATEGY FOR

16 COMBATING AND ELIMINATING TUBERCULOSIS’’; 

17 (2) by amending subsection (b) to read as fol18 lows: 

19 ‘‘(b) RESEARCH AND DEVELOPMENT; DEMONSTRATION

20 PROJECTS; EDUCATION AND TRAINING.—With respect to 

21 the prevention, treatment, control, and elimination of tuber22 culosis, the Secretary may, directly or through grants to 

23 public or nonprofit private entities, carry out the following: 

24 ‘‘(1) Research, with priority given to research 

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1 tion, strains of tuberculosis resistant to drugs, and re2 search concerning cases of tuberculosis that affect cer3 tain populations at risk for tuberculosis. 

4 ‘‘(2) Demonstration projects for— 

5 ‘‘(A) the development of regional capabili6 ties to prevent, control and eliminate tuber7 culosis and prevent multidrug resistant and ex8 tensively drug resistant strains of tuberculosis; 

9 ‘‘(B) the intensification of efforts to reduce 

10 health disparities in the incidence of tuber11 culosis; 

12 ‘‘(C) the intensification of efforts to control 

13 tuberculosis along the United States-Mexico bor14 der and among United States-Mexico binational 

15 populations, including through expansion of the 

16 scope and number of programs that— 

17 ‘‘(i) detect and treat binational cases of 

18 tuberculosis; and 

19 ‘‘(ii) treat high-risk cases of tuber20 culosis referred from Mexican health depart21 ments; 

22 ‘‘(D) the intensification of efforts to prevent, 

23 detect, and treat tuberculosis among foreign-born 

24 persons who are in the United States; 


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1 ‘‘(E) the intensification of efforts to prevent, 

2 detect, and treat tuberculosis among populations 

3 and settings documented as having a high risk 

4 for tuberculosis; and 

5 ‘‘(F) tuberculosis detection, control, and 

6 prevention. 

7 ‘‘(3) Public information and education activities. 

8 ‘‘(4) Education, training, clinical skills improve9 ment activities, and workplace exposure prevention 

10 for health professionals, including allied health per11 sonnel and emergency response employees. 

12 ‘‘(5) Support of Centers to carry out activities 

13 under paragraphs (1) through (4). 

14 ‘‘(6) Collaboration with international organiza15 tions and foreign countries in carrying out such ac16 tivities. 

17 ‘‘(7) Develop, enhance, and expand information 

18 technologies that support tuberculosis control includ19 ing surveillance and database management systems 

20 with cross-jurisdictional capabilities, which shall con21 form to the standards and implementation specifica22 tions for such information technologies as rec23 ommended by the Secretary.’’; and 

24 (3) in subsection (d), by adding at the end the 

25 following: 


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1 ‘‘(3) DETERMINATION OF AMOUNT OF NON2 FEDERAL CONTRIBUTIONS.— 

3 ‘‘(A) PRIORITY.—In awarding grants under 

4 subsection (a) or (b), the Secretary shall give 

5 highest priority to an applicant that provides 

6 assurances that the applicant will contribute 

7 non-Federal funds to carry out activities under 

8 this section, which may be provided directly or 

9 through donations from public or private entities 

10 and may be in cash or in kind, including equip11 ment or services. 

12 ‘‘(B) FEDERAL AMOUNTS NOT TO BE IN13 CLUDED AS CONTRIBUTIONS.—Amounts provided 

14 by the Federal Government, or services assisted 

15 or subsidized to any significant extent by the 

16 Federal Government, may not be included in de17 termining the amount of non-Federal contribu18 tions as described in subparagraph (A).’’. 

19 Subtitle B—Interagency 

20 Collaboration 

21 SEC. 111. ADVISORY COUNCIL FOR ELIMINATION OF TUBER22 CULOSIS. 

23 (a) IN GENERAL.—Section 317E(f) of the Public 

24 Health Service Act (42 U.S.C. 247b–6(f)) is amended— 


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1 (1) by redesignating paragraph (5) as para2 graph (6); and 

3 (2) by striking paragraphs (2) through (4), and 

4 inserting the following: 

5 ‘‘(2) DUTIES.—The Council shall provide advice 

6 and recommendations regarding the elimination of 

7 tuberculosis to the Secretary. In addition, the Council 

8 shall, with respect to eliminating such disease, pro9 vide to the Secretary and other appropriate Federal 

10 officials advice on— 

11 ‘‘(A) coordinating the activities of the De12 partment of Health and Human Services and 

13 other Federal agencies that relate to the disease, 

14 including activities under subsection (b); 

15 ‘‘(B) responding rapidly and effectively to 

16 emerging issues in tuberculosis; and 

17 ‘‘(C) efficiently utilizing the Federal re18 sources involved. 

19 ‘‘(3) COMPREHENSIVE PLAN.— 

20 ‘‘(A) IN GENERAL.—In carrying out para21 graph (2), the Council shall make or update rec22 ommendations on the development, revision, and 

23 implementation of a comprehensive plan to 

24 eliminate tuberculosis in the United States. 


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1 ‘‘(B) CONSULTATION.—In carrying out sub2 paragraph (A), the Council may consult with 

3 appropriate public and private entities, which 

4 may, subject to the direction or discretion of the 

5 Secretary, include— 

6 ‘‘(i) individuals who are scientists, 

7 physicians, laboratorians, and other health 

8 professionals, who are not officers or em9 ployees of the Federal Government and who 

10 represent the disciplines relevant to tuber11 culosis elimination; 

12 ‘‘(ii) members of public-private part13 nerships or private entities established to 

14 address the elimination of tuberculosis; 

15 ‘‘(iii) members of national and inter16 national nongovernmental organizations 

17 whose purpose is to eliminate tuberculosis; 

18 and 

19 ‘‘(iv) members from the general public 

20 who are knowledgeable with respect to tuber21 culosis elimination including individuals 

22 who have or have had tuberculosis. 

23 ‘‘(C) CERTAIN COMPONENTS OF PLAN.—In 

24 carrying out subparagraph (A), the Council 


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1 shall, subject to the direction or discretion of the 

2 Secretary— 

3 ‘‘(i) consider recommendations for the 

4 involvement of the United States in con5 tinuing global and cross-border tuberculosis 

6 control activities in countries where a high 

7 incidence of tuberculosis directly affects the 

8 United States; and 

9 ‘‘(ii) review the extent to which 

10 progress has been made toward eliminating 

11 tuberculosis. 

12 ‘‘(4) BIENNIAL REPORT.— 

13 ‘‘(A) IN GENERAL.—The Council shall sub14 mit a biennial report to the Secretary, as deter15 mined necessary by the Secretary, on the activi16 ties carried under this section, other than sub17 section (g). Each such report shall include the 

18 opinion of the Council on the extent to which its 

19 recommendations regarding the elimination of 

20 tuberculosis have been implemented, including 

21 with respect to— 

22 ‘‘(i) activities under subsection (b); 

23 and 

24 ‘‘(ii) the national plan referred to in 

25 paragraph (3). 


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1 ‘‘(B) PUBLIC.—The Secretary shall make a 

2 report submitted under subparagraph (A) public. 

3 ‘‘(5) COMPOSITION.—The Council shall be com4 posed of— 

5 ‘‘(A) ex officio representatives from the Cen6 ters for Disease Control and Prevention, the Na7 tional Institutes of Health, the United States 

8 Agency for International Development, the Agen9 cy for Healthcare Research and Quality, the 

10 Health Resources and Services Administration, 

11 the United States-Mexico Border Health Com12 mission, and other Federal departments and 

13 agencies that carry out significant activities re14 lated to tuberculosis; 

15 ‘‘(B) State and local tuberculosis control 

16 and public health officials; 

17 ‘‘(C) individuals who are scientists, physi18 cians, laboratorians, and other health profes19 sionals who represent disciplines relevant to tu20 berculosis elimination; and 

21 ‘‘(D) members of national and international 

22 nongovernmental organizations established to ad23 dress the elimination of tuberculosis.’’. 

24 (b) RULE OF CONSTRUCTION REGARDING CURRENT

25 MEMBERSHIP.—With respect to the advisory council under 


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1 section 317E(f) of the Public Health Service Act, the 

2 amendments made by subsection (a) may not be construed 

3 as terminating the membership on such council of any indi4 vidual serving as such a member as of the day before the 

5 date of the enactment of this Act. 

6 Subtitle C—New Tools for 

7 Tuberculosis Elimination 

8 SEC. 121. NEW TOOLS. 

9 Section 317E of the Public Health Service Act (42 

10 U.S.C. 247b–6) is amended— 

11 (1) by redesignating subsection (g) as subsection 

12 (h); and 

13 (2) by inserting after subsection (f) the following 

14 subsection: 

15 ‘‘(g) NEW TOOLS FOR ELIMINATION OF TUBER16 CULOSIS.— 

17 ‘‘(1) RESEARCH AND DEVELOPMENT ON DRUGS, 

18 DIAGNOSTICS, VACCINES, AND PUBLIC HEALTH INTER19 VENTIONS.—The Secretary may expand, intensify, 

20 and coordinate research and development and related 

21 activities to develop new tools for the elimination of 

22 tuberculosis, including drugs, diagnostics, vaccines, 

23 and public health interventions, such as directly ob24 served therapy and non-pharmaceutical intervention, 

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1 breaks of tuberculosis, including multidrug resistant 

2 tuberculosis. The Secretary shall give priority to pro3 grammatically relevant research so that new tools can 

4 be utilized in public health practice. 

5 ‘‘(2) FEDERAL TUBERCULOSIS TASK FORCE.— 

6 ‘‘(A) DUTIES.—The Federal Tuberculosis 

7 Task Force (in this subsection referred to as the 

8 ‘Task Force’) shall provide to the Secretary and 

9 other appropriate Federal officials advice on the 

10 implementation of paragraph (1), including ad11 vice regarding the efficient utilization of the Fed12 eral resources involved. 

13 ‘‘(B) COMPREHENSIVE PLAN FOR NEW

14 TOOLS DEVELOPMENT.—In carrying out para15 graph (1), the Task Force shall make rec16 ommendations on the development of a com17 prehensive plan for the creation of new tools for 

18 the elimination of tuberculosis, including drugs, 

19 diagnostics, and vaccines. 

20 ‘‘(C) CONSULTATION.—In developing the 

21 comprehensive plan under paragraph (1), the 

22 Task Force shall consult with external parties 

23 including representatives from groups such as— 

24 ‘‘(i) scientists, physicians, 

25 laboratorians, and other health professionals 


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1 who represent the specialties and disciplines 

2 relevant to the research under consideration; 

3 ‘‘(ii) members from public-private 

4 partnerships, private entities, or founda5 tions (or both) engaged in activities relevant 

6 to research under consideration; 

7 ‘‘(iii) members of national and inter8 national nongovernmental organizations es9 tablished to address tuberculosis elimi10 nation; 

11 ‘‘(iv) members from the general public 

12 who are knowledgeable with respect to tuber13 culosis including individuals who have or 

14 have had tuberculosis; and 

15 ‘‘(v) scientists, physicians, 

16 laboratorians, and other health professionals 

17 who reside in a foreign country with a sub18 stantial incidence or prevalence of tuber19 culosis, and who represent the specialties 

20 and disciplines relevant to the research 

21 under consideration. 

22 ‘‘(3) GRANTS AND CONTRACTS.—The Secretary 

23 may carry out paragraph (1) directly and through 

24 awards of grants, cooperative agreements, and con25 tracts to public and private entities, including— 


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1 ‘‘(A) public-private partnerships; 

2 ‘‘(B) academic institutions, including insti3 tutions of higher education; 

4 ‘‘(C) research institutions; and 

5 ‘‘(D) nonprofit entities established and dedi6 cated to tuberculosis vaccine and treatment prod7 uct development.’’. 

8 Subtitle D—Evaluation of Public 

9 Health Authorities 

10 SEC. 131. EVALUATION OF PUBLIC HEALTH AUTHORITIES. 

11 (a) IN GENERAL.—Not later than 180 days after the 

12 date of enactment of the Comprehensive Tuberculosis Elimi13 nation Act of 2007, the Secretary of Health and Human 

14 Services shall prepare and submit to the appropriate com15 mittees of Congress a report that evaluates and provides rec16 ommendations on changes needed to Federal and State pub17 lic health authorities to address current disease contain18 ment challenges such as isolation and quarantine. 

19 (b) CONTENTS OF EVALUATION.—The report described 

20 in subsection (a) shall include— 

21 (1) an evaluation of the effectiveness of current 

22 policies to detain patients with active tuberculosis; 

23 (2) an evaluation of whether Federal laws should 

24 be strengthened to expressly address the movement of 

25 individuals with active tuberculosis; and 


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1 (3) specific legislative recommendations for 

2 changes to Federal laws, if any. 

3 (c) UPDATE OF QUARANTINE REGULATIONS.—Not 

4 later than 240 days after the date of enactment of this Act, 

5 the Secretary of Health and Human Services shall promul6 gate regulations to update the current interstate and foreign 

7 quarantine regulations found in parts 70 and 71 of title 

8 42, Code of Federal Regulations. 

9 Subtitle E—Authorization of 

10 Appropriations 

11 SEC. 141. AUTHORIZATIONS OF APPROPRIATIONS. 

12 Section 317E of the Public Health Service Act, as 

13 amended by section 121(1) of this Act, is amended by strik14 ing subsection (h) and inserting the following: 

15 ‘‘(h) AUTHORIZATION OF APPROPRIATIONS.— 

16 ‘‘(1) GENERAL PROGRAM.— 

17 ‘‘(A) IN GENERAL.—For the purpose of car18 rying out this section, other than subsections (b) 

19 and (g), there are authorized to be appropriated 

20 $300,000,000 for fiscal year 2008, and such sums 

21 as may be necessary for each of the fiscal years 

22 2009 through 2012. 

23 ‘‘(B) RESERVATION FOR EMERGENCY

24 GRANTS.—Of the amounts appropriated under 

25 subparagraph (A) for a fiscal year, the Secretary 


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1 may reserve not more than 25 percent for emer2 gency grants under subsection (a) for any geo3 graphic area, State, political subdivision of a 

4 State, or other public entity in which there is, 

5 relative to other areas, a substantial number of 

6 cases of tuberculosis, multidrug resistant tuber7 culosis, or extensively drug resistant tuberculosis 

8 or a substantial rate of increase in such cases. 

9 ‘‘(C) RESEARCH, DEMONSTRATION

10 PROJECTS, EDUCATION, AND TRAINING.—For the 

11 purpose of carrying out subsection (b), there are 

12 authorized to be appropriated such sums as may 

13 be necessary for each of fiscal years 2008 through 

14 2012. 

15 ‘‘(D) PRIORITY.—In allocating amounts ap16 propriated under subparagraph (A) and not re17 served under subparagraph (B), the Secretary 

18 shall give priority to allocating such amounts for 

19 grants under subsection (a). 

20 ‘‘(E) ALLOCATION OF FUNDS.— 

21 ‘‘(i) REQUIREMENT OF FORMULA.—Of 

22 the amounts appropriated under subpara23 graph (A), not reserved under subparagraph 

24 (B), and allocated by the Secretary for 

25 grants under subsection (a), the Secretary 


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1 shall distribute a portion of such amounts 

2 to grantees under subsection (a) on the basis 

3 of a formula. 

4 ‘‘(ii) RELEVANT FACTORS.—The for5 mula developed by the Secretary under 

6 clause (i) shall take into account the level of 

7 tuberculosis morbidity and case complexity 

8 in the respective geographic area and may 

9 consider other factors relevant to tuber10 culosis in such area. 

11 ‘‘(iii) NO CHANGE TO FORMULA RE12 QUIRED.—This subparagraph does not re13 quire the Secretary to modify the formula 

14 that was used by the Secretary to distribute 

15 funds to grantees under subsection (a) for 

16 fiscal year 2007. 

17 ‘‘(2) NEW TOOLS.— 

18 ‘‘(A) IN GENERAL.—For the purpose of car19 rying out subsection (g), there are authorized to 

20 be appropriated $100,000,000 for fiscal year 

21 2008, and such sums as may be necessary for 

22 each of the fiscal years 2009 through 2012. 

23 ‘‘(B) LIMITATION.—The authorization of 

24 appropriations established in subparagraph (A) 

25 for a fiscal year is effective only if the amount 


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1 appropriated under paragraph (1) for such year 

2 equals or exceeds the amount appropriated to 

3 carry out this section for fiscal year 2007.’’. 

4 TITLE II—NATIONAL INSTITUTES 

5 OF HEALTH 

6 SEC. 201. RESEARCH AND DEVELOPMENT CONCERNING TU7 BERCULOSIS. 

8 Subpart 2 of part C of title IV of the Public Health 

9 Service Act (42 U.S.C. 285b et seq.) is amended by inserting 

10 after section 424B the following section: 

11 ‘‘SEC. 424C. TUBERCULOSIS. 

12 ‘‘(a) IN GENERAL.—The Director of the National In13 stitutes of Health may expand, intensify, and coordinate 

14 research and development and related activities of the Insti15 tute with respect to tuberculosis including activities toward 

16 the goal of eliminating such disease. 

17 ‘‘(b) CERTAIN ACTIVITIES.—Activities under sub18 section (a) may include— 

19 ‘‘(1) enhancing basic and clinical research on tu20 berculosis, including drug resistant tuberculosis; and 

21 ‘‘(2) expanding research on the relationship be22 tween such disease and the human immunodeficiency 

23 virus.’’. 


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Calendar No. 549 

110TH CONGRESS 

1ST SESSION S. 1551 

A BILL 

To amend the Public Health Service Act with reeliminating tuberculosis, and for other purposes. spect to making progress toward the goal of 

DECEMBER 18, 2007 

Reported with an amendment 


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