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Calendar No. 472 

110TH CONGRESS 

1ST SESSION H. R. 1567 

IN THE SENATE OF THE UNITED STATES 

NOVEMBER 6, 2007 

Received; read twice and placed on the calendar 

AN ACT 

To amend the Foreign Assistance Act of 1961 to provide 

increased assistance for the prevention, treatment, and 

control of 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, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Stop Tuberculosis 

5 (TB) Now Act of 2007’’. 

6 SEC. 2. FINDINGS. 

7 Congress finds the following: 

8 (1) Tuberculosis is one of the greatest infec9 tious causes of death of adults worldwide, killing 1.6 

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1 million people per year—one person every 20 sec2 onds. 

3 (2) One-third of the world’s population is in4 fected with the tuberculosis bacterium and an esti5 mated 8.8 million individuals develop active tuber6 culosis each year. 

7 (3) Tuberculosis is the leading infectious killer 

8 among individuals who are HIV-positive due to their 

9 weakened immune systems, and it is estimated that 

10 one-third of people with HIV infection have tuber11 culosis. 

12 (4) Today, tuberculosis is a leading killer of 

13 women of reproductive age. 

14 (5) There are 22 countries that account for 80 

15 percent of the world’s burden of tuberculosis. The 

16 People’s Republic of China and India account for 36 

17 percent of all estimated new tuberculosis cases each 

18 year. 

19 (6) Driven by the HIV/AIDS pandemic, inci20 dence rates of tuberculosis in Africa have more than 

21 doubled on average since 1990. The problem is so 

22 pervasive that in August 2005, African Health Min23 isters and the World Health Organization (WHO) 

24 declared tuberculosis to be an emergency in Africa. 

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1 (7) The wide extent of drug resistance, includ2 ing both multi-drug resistant tuberculosis (MDR– 

3 TB) and extensively drug resistant tuberculosis 

4 (XDR–TB), represents both a critical challenge to 

5 the global control of tuberculosis and a serious 

6 worldwide public health threat. XDR–TB, which is 

7 characterized as being MDR–TB with additional re8 sistance to multiple second-line anti-tuberculosis 

9 drugs, is associated with worst treatment outcomes 

10 of any form of tuberculosis. XDR–TB is converging 

11 with the HIV epidemic, undermining gains in HIV 

12 prevention and treatment programs and requires ur13 gent interventions. Drug resistance surveillance re14 ports have confirmed the serious scale and spread of 

15 tuberculosis with XDR–TB strains confirmed on six 

16 continents. Demonstrating the lethality of XDR–TB, 

17 an initial outbreak in Tugela Ferry, South Africa, in 

18 2006 killed 52 of 53 patients with hundreds more 

19 cases reported since that time. Of the world’s re20 gions, sub-Saharan Africa, faces the greatest gap in 

21 capacity to prevent, find, and treat XDR–TB. 

22 (8) With more than 50 percent of tuberculosis 

23 cases in the United States attributable to foreign24 born individuals and with the increase in inter25 national travel, commerce, and migration, elimimstockstill on PROD1PC66 with BILLS

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1 nation of tuberculosis in the United States depends 

2 on efforts to control the disease in developing coun3 tries. Recent research has shown that to invest in 

4 tuberculosis control abroad, where treatment and 

5 program costs are significantly cheaper than in the 

6 United States, would be a cost-effective strategy to 

7 reduce tuberculosis-related morbidity and mortality 

8 domestically. 

9 (9) The threat that tuberculosis poses for 

10 Americans derives from the global spread of tuber11 culosis and the emergence and spread of strains of 

12 multi-drug resistant tuberculosis and extensively 

13 drug resistant tuberculosis, which are far more 

14 deadly, and more difficult and costly to treat. 

15 (10) DOTS (Directly Observed Treatment 

16 Short-course) is one of the most cost-effective health 

17 interventions available today and is a core compo18 nent of the new Stop TB Strategy. 

19 (11) The Stop TB Strategy, developed by the 

20 World Health Organization, builds on the success of 

21 DOTS and ongoing challenges so as to serve all 

22 those in need and reach targets for prevalence, mor23 tality, and incidence reduction. The Stop TB Strat24 egy includes six components: 

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1 (A) Pursuing high-quality expansion and 

2 enhancement of DOTS coverage. 

3 (B) Implementing tuberculosis and HIV 

4 collaborative activities, preventing and control5 ling multi-drug resistant tuberculosis, and ad6 dressing other special challenges. 

7 (C) Contributing to the strengthening of 

8 health systems. 

9 (D) Engaging all health care providers, in10 cluding promotion of the International Stand11 ards for Tuberculosis Care. 

12 (E) Empowering individuals with tuber13 culosis and communities. 

14 (F) Enabling and promoting research to 

15 develop new diagnostics, drugs, vaccines, and 

16 program-based operational research relating to 

17 tuberculosis. 

18 (12) The Global Plan to Stop TB 2006–2015: 

19 Actions for Life is a comprehensive plan developed 

20 by the Stop TB Partnership that sets out the ac21 tions necessary to achieve the millennium develop22 ment goal of cutting tuberculosis deaths and disease 

23 burden in half by 2015 and thus eliminate tuber24 culosis as a global health problem by 2050. 

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1 (13) While innovations such as the Global Tu2 berculosis Drug Facility have enabled low-income 

3 countries to treat a standard case of tuberculosis 

4 with drugs that cost as little as $16 for a full course 

5 of treatment, there are still millions of individuals 

6 with no access to effective treatment. 

7 (14) As the global resource investment in fight8 ing tuberculosis increases, partner nations and inter9 national institutions must commit to a cor10 responding increase in the technical and program as11 sistance necessary to ensure that the most effective 

12 and efficient tuberculosis treatments are provided. 

13 (15) The Global Fund to Fight AIDS, Tuber14 culosis and Malaria is an important global partner15 ship established to combat these three infectious dis16 eases that together kill millions of people a year. Ex17 pansion of effective tuberculosis treatment programs 

18 constitutes a major component of Global Fund in19 vestment, along with integrated efforts to address 

20 HIV and tuberculosis in areas of high prevalence. 

21 (16) The United States Agency for Inter22 national Development and the Centers for Disease 

23 Control and Prevention are actively involved with 

24 global tuberculosis control efforts. Because the glob25 al tuberculosis epidemic directly impacts tuberculosis 

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1 in the United States, Congress has urged the Cen2 ters for Disease Control and Prevention each year to 

3 increase its involvement with international tuber4 culosis control efforts. 

5 (17) The United States Agency for Inter6 national Development is the lead United States Gov7 ernment agency for international tuberculosis ef8 forts, working in close partnership with the Centers 

9 for Disease Control and Prevention and with the 

10 President’s Emergency Plan for HIV/AIDS Relief. 

11 The goal of the United States Agency for Inter12 national Development is to contribute to the global 

13 reduction of morbidity and mortality associated with 

14 tuberculosis by building country capacity to prevent 

15 and cure tuberculosis and achieve global targets of 

16 70 percent case detection and 85 percent treatment 

17 success rates. The United States Agency for Inter18 national Development provides support for tuber19 culosis programs in countries that have a high bur20 den of tuberculosis, a high prevalence of tuberculosis 

21 and HIV, and a high risk of MDR–TB. 

22 SEC. 3. ASSISTANCE TO COMBAT TUBERCULOSIS. 

23 (a) POLICY.—Subsection (b) of section 104B of the 

24 Foreign Assistance Act of 1961 (22 U.S.C. 2151b–3) is 

25 amended to read as follows: 

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

2 assistance program of the United States to control tuber3 culosis. In all countries in which the Government of the 

4 United States has established development programs, par5 ticularly in countries with the highest burden of tuber6 culosis and other countries with high rates of tuberculosis, 

7 the United States Government should prioritize the 

8 achievement of the following goals by not later than De9 cember 31, 2015: 

10 ‘‘(1) Reduce by half the tuberculosis death and 

11 disease burden from the 1990 baseline. 

12 ‘‘(2) Sustain or exceed the detection of at least 

13 70 percent of sputum smear-positive cases of tuber14 culosis and the cure of at least 85 percent of those 

15 cases detected.’’. 

16 (b) AUTHORIZATION.—Subsection (c) of such section 

17 is amended— 

18 (1) in the heading, by striking ‘‘AUTHORIZA19 TION’’ and inserting ‘‘ASSISTANCE REQUIRED’’; and 

20 (2) by striking ‘‘is authorized to’’ and inserting 

21 ‘‘shall’’. 

22 (c) PRIORITY TO STOP TB STRATEGY.—Subsection 

23 (e) of such section is amended— 

24 (1) in the heading, to read as follows: ‘‘PRI25 ORITY TO STOP TB STRATEGY.—’’; 

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1 (2) in the first sentence, by striking ‘‘In fur2 nishing’’ and all that follows through ‘‘, including 

3 funding’’ and inserting the following: 

4 ‘‘(1) PRIORITY.—In furnishing assistance under 

5 subsection (c), the President shall give priority to— 

6 ‘‘(A) activities described in the Stop TB 

7 Strategy, including expansion and enhancement 

8 of DOTS coverage, treatment for individuals in9 fected with both tuberculosis and HIV and 

10 treatment for individuals with multi-drug resist11 ant tuberculosis (MDR–TB), strengthening of 

12 health systems, use of the International Stand13 ards for Tuberculosis Care by all providers, em14 powering individuals with tuberculosis, and ena15 bling and promoting research to develop new 

16 diagnostics, drugs, and vaccines, and program17 based operational research relating to tuber18 culosis; and 

19 ‘‘(B) funding’’; and 

20 (3) in the second sentence— 

21 (A) by striking ‘‘In order to’’ and all that 

22 follows through ‘‘not less than’’ and inserting 

23 the following: 

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1 ‘‘(2) AVAILABILITY OF AMOUNTS.—In order to 

2 meet the requirements of paragraph (1), the Presi3 dent— 

4 ‘‘(A) shall ensure that not less than’’; 

5 (B) by striking ‘‘for Directly Observed 

6 Treatment Short-course (DOTS) coverage and 

7 treatment of multi-drug resistant tuberculosis 

8 using DOTS–Plus,’’ and inserting ‘‘to imple9 ment the Stop TB Strategy; and’’; and 

10 (C) by striking ‘‘including’’ and all that 

11 follows and inserting the following: 

12 ‘‘(B) should ensure that not less than 

13 $15,000,000 of the amount made available to 

14 carry out this section for a fiscal year is used 

15 to make a contribution to the Global Tuber16 culosis Drug Facility.’’. 

17 (d) ASSISTANCE FOR WHO AND THE STOP TUBER18 CULOSIS PARTNERSHIP.—Such section is further amend19 ed— 

20 (1) by redesignating subsection (f) as sub21 section (g); and 

22 (2) by inserting after subsection (e) the fol23 lowing new subsection: 

24 ‘‘(f) ASSISTANCE FOR WHO AND THE STOP TUBER25 CULOSIS PARTNERSHIP.—In carrying out this section, the 

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1 President, acting through the Administrator of the United 

2 States Agency for International Development, is author3 ized to provide increased resources to the World Health 

4 Organization (WHO) and the Stop Tuberculosis Partner5 ship to improve the capacity of countries with high rates 

6 of tuberculosis and other affected countries to implement 

7 the Stop TB Strategy and specific strategies related to 

8 addressing extensively drug resistant tuberculosis (XDR– 

9 TB).’’. 

10 (e) DEFINITIONS.—Subsection (g) of such section, as 

11 redesignated by subsection (d)(1), is amended— 

12 (1) in paragraph (1), by adding at the end be13 fore the period the following: ‘‘, including low cost 

14 and effective diagnosis and evaluation of treatment 

15 regimes, vaccines, and monitoring of tuberculosis, as 

16 well as a reliable drug supply, and a management 

17 strategy for public health systems, with health sys18 tem strengthening, promotion of the use of the 

19 International Standards for Tuberculosis Care by all 

20 care providers, bacteriology under an external qual21 ity assessment framework, short-course chemo22 therapy, and sound reporting and recording sys23 tems’’; and 

24 (2) by adding after paragraph (5) the following 

25 new paragraph: 

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1 ‘‘(6) STOP TB STRATEGY.—The term ‘Stop TB 

2 Strategy’ means the six-point strategy to reduce tu3 berculosis developed by the World Health Organiza4 tion. The strategy is described in the Global Plan to 

5 Stop TB 2007–2016: Actions for Life, a comprehen6 sive plan developed by the Stop Tuberculosis Part7 nership that sets out the actions necessary to 

8 achieve the millennium development goal of cutting 

9 tuberculosis deaths and disease burden in half by 

10 2016.’’. 

11 (f) ANNUAL REPORT.—Clause (iii) of section 

12 104A(e)(2)(C) of the Foreign Assistance Act of 1961 (22 

13 U.S.C. 2151b–2(e)(2)(C)) is amended by adding at the 

14 end before the semicolon the following: ‘‘, including the 

15 percentage of such United States foreign assistance pro16 vided for diagnosis and treatment of individuals with tu17 berculosis in countries with the highest burden of tuber18 culosis, as determined by the World Health Organization 

19 (WHO)’’. 

20 (g) AUTHORIZATION OF APPROPRIATIONS.— 

21 (1) IN GENERAL.—There are authorized to be 

22 appropriated to the President not more than 

23 $400,000,000 for fiscal year 2008 and not more 

24 than $550,000,000 for fiscal year 2009 to carry out 

25 section 104B of the Foreign Assistance Act of 1961 

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1 (22 U.S.C. 2151b–3), as amended by subsections (a) 

2 through (e) of this section. 

3 (2) FUNDING FOR CDC.—Of the amounts ap4 propriated pursuant to the authorization of appro5 priations under paragraph (1), not more than 

6 $70,000,000 for fiscal year 2008 and not more than 

7 $100,000,000 for fiscal year 2009 shall be made 

8 available for the purpose of carrying out global tu9 berculosis activities through the Centers for Disease 

10 Control and Prevention. 

11 (3) ADDITIONAL PROVISIONS.—Amounts appro12 priated pursuant to the authorization of appropria13 tions under paragraph (1) and amounts made avail14 able pursuant to paragraph (2)— 

15 (A) are in addition amounts otherwise 

16 made available for such purposes; and 

17 (B) are authorized to remain available 

18 until expended. 

Passed the House of Representatives November 5, 

2007. 

Attest: LORRAINE C. MILLER, 

Clerk. 

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Calendar No. 472 

110TH CONGRESS 

1ST SESSION H. R. 1567 

AN ACT 

To amend the Foreign Assistance Act of 1961 to 

other purposes. treatment, and control of tuberculosis, and for provide increased assistance for the prevention, 

NOVEMBER 6, 2007 

Received; read twice and placed on the calendar 

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