IB 

Union Calendar No. 238 

110TH CONGRESS 

1ST SESSION H. R. 1567 

[Report No. 110–381, Part I] 

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

for the prevention, treatment, and control of tuberculosis, and for other 

purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 19, 2007 

Mr. ENGEL (for himself, Mrs. WILSON of New Mexico, Mr. SMITH of Washington, and Mr. PAYNE) introduced the following bill; which was referred 

to the Committee on Foreign Affairs, and in addition to the Committee 

on Energy and Commerce, for a period to be subsequently determined by 

the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned 

OCTOBER 15, 2007 

Additional sponsors: Mr. MCDERMOTT, Mr. HOLT, Mr. WAXMAN, Mr. 

REICHERT, Ms. MCCOLLUM of Minnesota, Ms. LEE, Mrs. CAPPS, Ms. 

ESHOO, Mr. CONYERS, Mr. MCCOTTER, Mr. JOHNSON of Georgia, Mr. 

MILLER of North Carolina, Mr. SAXTON, Mr. GENE GREEN of Texas, 

Ms. WATSON, Mr. LEWIS of Georgia, Mr. MCCAUL of Texas, Mr. STARK, 

Mr. CROWLEY, Mr. RUSH, Mr. JEFFERSON, Mr. MCNULTY, Mr. LANTOS, 

Ms. BALDWIN, Mr. EMANUEL, Mr. GEORGE MILLER of California, Ms. 

JACKSON-LEE of Texas, Mr. EDWARDS, Mr. MATHESON, Mr. INSLEE, 

Mr. MCGOVERN, Mr. WEXLER, Mr. BAIRD, Ms. HERSETH SANDLIN, Mr. 

INGLIS of South Carolina, Ms. SCHAKOWSKY, Mr. HINOJOSA, Mr. 

LOEBSACK, Mr. WYNN, Mr. SERRANO, Mr. LARSEN of Washington, Mr. 

MORAN of Virginia, Mr. FILNER, Mr. YOUNG of Alaska, Mr. JACKSON

of Illinois, Mr. REYES, Mr. CARNAHAN, Mr. AL GREEN of Texas, Mr. 

ORTIZ, Mr. DOGGETT, Mr. POMEROY, Ms. GIFFORDS, Ms. DEGETTE, 

Mr. HASTINGS of Florida, Mr. MARSHALL, Mr. SHULER, Mrs. DAVIS of 

California, Mr. GRIJALVA, Mr. PLATTS, Mr. ELLISON, Ms. LINDA T. 

SA ́NCHEZ of California, Mr. BRADY of Pennsylvania, Mr. BURTON of Indiana, Mr. SCOTT of Georgia, Ms. WOOLSEY, Mr. BLUMENAUER, Mr. 

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nois, Mrs. LOWEY, Mr. FARR, Mr. BERMAN, Mr. ANDREWS, Mr. LEVIN, 

Ms. SOLIS, Mr. KUCINICH, Mr. ROTHMAN, Mr. SIRES, Ms. NORTON, Ms. 

HARMAN, Mr. GALLEGLY, Mr. TOM DAVIS of Virginia, Ms. ZOE

LOFGREN of California, Mr. ACKERMAN, Mr. WU, Ms. DELAURO, Mr. 

COHEN, Mr. TOWNS, Ms. KILPATRICK, Mr. CAPUANO, Mr. FATTAH, Mr. 

SHERMAN, Mrs. MALONEY of New York, Mr. WEINER, Mr. BILBRAY, 

Mrs. MCCARTHY of New York, Ms. BORDALLO, Mr. BOUCHER, Mr. GONZALEZ, Mr. WALSH of New York, Mr. HINCHEY, and Mr. OLVER

OCTOBER 15, 2007 

Reported from the Committee on Foreign Affairs with an amendment 

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

OCTOBER 15, 2007 

Committee on Energy and Commerce discharged; committed to the Committee 

of the Whole House on the State of the Union and ordered to be printed 

[For text of introduced bill, see copy of bill as introduced on March 19, 2007] 

A BILL 

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 (TB) 

5 Now Act of 2007’’. 

6 SEC. 2. FINDINGS. 

7 Congress finds the following: 

8 (1) Tuberculosis is one of the greatest infectious 

9 causes of death of adults worldwide, killing 1.6 mil10 lion people per year—one person every 20 seconds. 


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1 (2) One-third of the world’s population is in2 fected with the tuberculosis bacterium and an esti3 mated 8.8 million individuals develop active tuber4 culosis each year. 

5 (3) Tuberculosis is the leading infectious killer 

6 among individuals who are HIV-positive due to their 

7 weakened immune systems, and it is estimated that 

8 one-third of people with HIV infection have tuber9 culosis. 

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

11 women of reproductive age. 

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

13 percent of the world’s burden of tuberculosis. The Peo14 ple’s Republic of China and India account for 36 per15 cent of all estimated new tuberculosis cases each year. 

16 (6) Driven by the HIV/AIDS pandemic, inci17 dence rates of tuberculosis in Africa have more than 

18 doubled on average since 1990. The problem is so per19 vasive that in August 2005, African Health Ministers 

20 and the World Health Organization (WHO) declared 

21 tuberculosis to be an emergency in Africa. 

22 (7) The wide extent of drug resistance, including 

23 both multi-drug resistant tuberculosis (MDR–TB) 

24 and extensively drug resistant tuberculosis (XDR– 

25 TB), represents both a critical challenge to the global 


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1 control of tuberculosis and a serious worldwide public 

2 health threat. XDR–TB, which is characterized as 

3 being MDR–TB with additional resistance to mul4 tiple second-line anti-tuberculosis drugs, is associated 

5 with worst treatment outcomes of any form of tuber6 culosis. XDR–TB is converging with the HIV epi7 demic, undermining gains in HIV prevention and 

8 treatment programs and requires urgent interven9 tions. Drug resistance surveillance reports have con10 firmed the serious scale and spread of tuberculosis 

11 with XDR–TB strains confirmed on six continents. 

12 Demonstrating the lethality of XDR–TB, an initial 

13 outbreak in Tugela Ferry, South Africa, in 2006 

14 killed 52 of 53 patients with hundreds more cases re15 ported since that time. Of the world’s regions, sub-Sa16 haran Africa, faces the greatest gap in capacity to 

17 prevent, find, and treat XDR–TB. 

18 (8) With more than 50 percent of tuberculosis 

19 cases in the United States attributable to foreign-born 

20 individuals and with the increase in international 

21 travel, commerce, and migration, elimination of tu22 berculosis in the United States depends on efforts to 

23 control the disease in developing countries. Recent re24 search has shown that to invest in tuberculosis control 

25 abroad, where treatment and program costs are sigVerDate Aug 31 2005 01:08 Oct 16, 2007 Jkt 069200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6203 E:\BILLS\H1567.RH H1567

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1 nificantly cheaper than in the United States, would 

2 be a cost-effective strategy to reduce tuberculosis-re3 lated morbidity and mortality domestically. 

4 (9) The threat that tuberculosis poses for Ameri5 cans derives from the global spread of tuberculosis 

6 and the emergence and spread of strains of multi7 drug resistant tuberculosis and extensively drug re8 sistant tuberculosis, which are far more deadly, and 

9 more difficult and costly to treat. 

10 (10) DOTS (Directly Observed Treatment Short11 course) is one of the most cost-effective health inter12 ventions available today and is a core component of 

13 the new Stop TB Strategy. 

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

15 World Health Organization, builds on the success of 

16 DOTS and ongoing challenges so as to serve all those 

17 in need and reach targets for prevalence, mortality, 

18 and incidence reduction. The Stop TB Strategy in19 cludes six components: 

20 (A) Pursuing high-quality expansion and 

21 enhancement of DOTS coverage. 

22 (B) Implementing tuberculosis and HIV col23 laborative activities, preventing and controlling 

24 multi-drug resistant tuberculosis, and addressing 

25 other special challenges. 


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1 (C) Contributing to the strengthening of 

2 health systems. 

3 (D) Engaging all health care providers, in4 cluding promotion of the International Stand5 ards for Tuberculosis Care. 

6 (E) Empowering individuals with tuber7 culosis and communities. 

8 (F) Enabling and promoting research to de9 velop new diagnostics, drugs, vaccines, and pro10 gram-based operational research relating to tu11 berculosis. 

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

13 Actions for Life is a comprehensive plan developed by 

14 the Stop TB Partnership that sets out the actions nec15 essary to achieve the millennium development goal of 

16 cutting tuberculosis deaths and disease burden in half 

17 by 2015 and thus eliminate tuberculosis as a global 

18 health problem by 2050. 

19 (13) While innovations such as the Global Tuber20 culosis Drug Facility have enabled low-income coun21 tries to treat a standard case of tuberculosis with 

22 drugs that cost as little as $16 for a full course of 

23 treatment, there are still millions of individuals with 

24 no access to effective treatment. 


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1 (14) As the global resource investment in fighting 

2 tuberculosis increases, partner nations and inter3 national institutions must commit to a corresponding 

4 increase in the technical and program assistance nec5 essary to ensure that the most effective and efficient 

6 tuberculosis treatments are provided. 

7 (15) The Global Fund to Fight AIDS, Tuber8 culosis and Malaria is an important global partner9 ship established to combat these three infectious dis10 eases that together kill millions of people a year. Ex11 pansion of effective tuberculosis treatment programs 

12 constitutes a major component of Global Fund invest13 ment, along with integrated efforts to address HIV 

14 and tuberculosis in areas of high prevalence. 

15 (16) The United States Agency for International 

16 Development and the Centers for Disease Control and 

17 Prevention are actively involved with global tuber18 culosis control efforts. Because the global tuberculosis 

19 epidemic directly impacts tuberculosis in the United 

20 States, Congress has urged the Centers for Disease 

21 Control and Prevention each year to increase its in22 volvement with international tuberculosis control ef23 forts. 

24 (17) The United States Agency for International 

25 Development is the lead United States Government 


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1 agency for international tuberculosis efforts, working 

2 in close partnership with the Centers for Disease Con3 trol and Prevention and with the President’s Emer4 gency Plan for HIV/AIDS Relief. The goal of the 

5 United States Agency for International Development 

6 is to contribute to the global reduction of morbidity 

7 and mortality associated with tuberculosis by build8 ing country capacity to prevent and cure tuberculosis 

9 and achieve global targets of 70 percent case detection 

10 and 85 percent treatment success rates. The United 

11 States Agency for International Development provides 

12 support for tuberculosis programs in countries that 

13 have a high burden of tuberculosis, a high prevalence 

14 of tuberculosis and HIV, and a high risk of MDR– 

15 TB. 

16 SEC. 3. ASSISTANCE TO COMBAT TUBERCULOSIS. 

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

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

19 amended to read as follows: 

20 ‘‘(b) POLICY.—It is a major objective of the foreign as21 sistance program of the United States to control tuber22 culosis. In all countries in which the Government of the 

23 United States has established development programs, par24 ticularly in countries with the highest burden of tuber25 culosis and other countries with high rates of tuberculosis, 


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1 the United States Government should prioritize the achieve2 ment of the following goals by not later than December 31, 

3 2015: 

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

5 disease burden from the 1990 baseline. 

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

7 70 percent of sputum smear-positive cases of tuber8 culosis and the cure of at least 85 percent of those 

9 cases detected.’’. 

10 (b) AUTHORIZATION.—Subsection (c) of such section is 

11 amended— 

12 (1) in the heading, by striking ‘‘AUTHORIZA13 TION’’ and inserting ‘‘ASSISTANCE REQUIRED’’; and 

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

15 ‘‘shall’’. 

16 (c) PRIORITY TO STOP TB STRATEGY.—Subsection (e) 

17 of such section is amended— 

18 (1) in the heading, to read as follows: ‘‘PRIORITY

19 TO STOP TB STRATEGY.—’’; 

20 (2) in the first sentence, by striking ‘‘In fur21 nishing’’ and all that follows through ‘‘, including 

22 funding’’ and inserting the following: 

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

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


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

2 Strategy, including expansion and enhancement 

3 of DOTS coverage, treatment for individuals in4 fected with both tuberculosis and HIV and treat5 ment for individuals with multi-drug resistant 

6 tuberculosis (MDR–TB), strengthening of health 

7 systems, use of the International Standards for 

8 Tuberculosis Care by all providers, empowering 

9 individuals with tuberculosis, and enabling and 

10 promoting research to develop new diagnostics, 

11 drugs, and vaccines, and program-based oper12 ational research relating to tuberculosis; and 

13 ‘‘(B) funding’’; and 

14 (3) in the second sentence— 

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

16 follows through ‘‘not less than’’ and inserting the 

17 following: 

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

19 meet the requirements of paragraph (1), the Presi20 dent— 

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

22 (B) by striking ‘‘for Directly Observed 

23 Treatment Short-course (DOTS) coverage and 

24 treatment of multi-drug resistant tuberculosis 


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1 using DOTS–Plus,’’ and inserting ‘‘to implement 

2 the Stop TB Strategy; and’’; and 

3 (C) by striking ‘‘including’’ and all that fol4 lows and inserting the following: 

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

6 $15,000,000 of the amount made available to 

7 carry out this section for a fiscal year is used to 

8 make a contribution to the Global Tuberculosis 

9 Drug Facility.’’. 

10 (d) ASSISTANCE FOR WHO AND THE STOP TUBER11 CULOSIS PARTNERSHIP.—Such section is further amend12 ed— 

13 (1) by redesignating subsection (f) as subsection 

14 (g); and 

15 (2) by inserting after subsection (e) the following 

16 new subsection: 

17 ‘‘(f) ASSISTANCE FOR WHO AND THE STOP TUBER18 CULOSIS PARTNERSHIP.—In carrying out this section, the 

19 President, acting through the Administrator of the United 

20 States Agency for International Development, is authorized 

21 to provide increased resources to the World Health Organi22 zation (WHO) and the Stop Tuberculosis Partnership to 

23 improve the capacity of countries with high rates of tuber24 culosis and other affected countries to implement the Stop 


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1 TB Strategy and specific strategies related to addressing 

2 extensively drug resistant tuberculosis (XDR–TB).’’. 

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

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

5 (1) in paragraph (1), by adding at the end be6 fore the period the following: ‘‘, including low cost 

7 and effective diagnosis and evaluation of treatment 

8 regimes, vaccines, and monitoring of tuberculosis, as 

9 well as a reliable drug supply, and a management 

10 strategy for public health systems, with health system 

11 strengthening, promotion of the use of the Inter12 national Standards for Tuberculosis Care by all care 

13 providers, bacteriology under an external quality as14 sessment framework, short-course chemotherapy, and 

15 sound reporting and recording systems’’; and 

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

17 new paragraph: 

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

19 Strategy’ means the six-point strategy to reduce tu20 berculosis developed by the World Health Organiza21 tion. The strategy is described in the Global Plan to 

22 Stop TB 2007–2016: Actions for Life, a comprehen23 sive plan developed by the Stop Tuberculosis Partner24 ship that sets out the actions necessary to achieve the 


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1 millennium development goal of cutting tuberculosis 

2 deaths and disease burden in half by 2016.’’. 

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

4 104A(e)(2)(C) of the Foreign Assistance Act of 1961 (22 

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

6 before the semicolon the following: ‘‘, including the percent7 age of such United States foreign assistance provided for 

8 diagnosis and treatment of individuals with tuberculosis in 

9 countries with the highest burden of tuberculosis, as deter10 mined by the World Health Organization (WHO)’’. 

11 (g) AUTHORIZATION OF APPROPRIATIONS.— 

12 (1) IN GENERAL.—There are authorized to be ap13 propriated to the President not more than 

14 $400,000,000 for fiscal year 2008 and not more than 

15 $550,000,000 for fiscal year 2009 to carry out section 

16 104B of the Foreign Assistance Act of 1961 (22 

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

18 through (e) of this section. 

19 (2) FUNDING FOR CDC.—Of the amounts appro20 priated pursuant to the authorization of appropria21 tions under paragraph (1), not more than 

22 $70,000,000 for fiscal year 2008 and not more than 

23 $100,000,000 for fiscal year 2009 shall be made avail24 able for the purpose of carrying out global tuberVerDate Aug 31 2005 01:08 Oct 16, 2007 Jkt 069200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6203 E:\BILLS\H1567.RH H1567

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1 culosis activities through the Centers for Disease Con2 trol and Prevention. 

3 (3) ADDITIONAL PROVISIONS.—Amounts appro4 priated pursuant to the authorization of appropria5 tions under paragraph (1) and amounts made avail6 able pursuant to paragraph (2)— 

7 (A) are in addition amounts otherwise 

8 made available for such purposes; and 

9 (B) are authorized to remain available 

10 until expended. 


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Union Calendar No. 238 

110TH CONGRESS 

1ST SESSION H. R. 1567 

[Report No. 110

–381, Part I] 

A BILL 

To amend the Foreign Assistance Act of 1961 to 

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

OCTOBER 15, 2007 

Reported from the Committee on Foreign Affairs with an 

amendment 

OCTOBER 15, 2007 

Committee on Energy and Commerce discharged; comState of the Union and ordered to be printed mitted to the Committee of the Whole House on the 


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