IIB 
116TH CONGRESS 
1ST SESSION H. R. 3460 
IN THE SENATE OF THE UNITED STATES 
DECEMBER 4, 2019 
Received; read twice and referred to the Committee on Foreign Relations 
AN ACT 
To facilitate effective research on and treatment of neglected 
tropical diseases through coordinated international efforts. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘End Neglected Trop-
ical Diseases Act’’. 
SEC. 2. TABLE OF CONTENTS. 
The table of contents for this Act is as follows: 
Sec. 1. Short title. 
Sec. 2. Table of contents. 
Sec. 3. Statement of policy. 
Sec. 4. Findings. 
Sec. 5. Definition. 
Sec. 6. Rule of construction. 
Sec. 7. Expansion of United States Agency for International Development Ne-
glected Tropical Diseases Program. 
Sec. 8. Actions by Department of State. 
Sec. 9. Multilateral development and health institutions. 
SEC. 3. STATEMENT OF POLICY. 
It is the policy of the United States to support a 
broad range of implementation and research and develop-
ment activities that work toward the achievement of cost- 
effective and sustainable treatment, control, and, where 
possible, elimination of neglected tropical diseases for the 
economic and social well-being of all people. 
SEC. 4. FINDINGS. 
Congress finds the following: 
(1) The World Health Organization (WHO) has 
identified 17 neglected tropical diseases (NTDs). 
Approximately 2 billion people, almost one-third of 
the world’s population, are at risk of contracting an 
NTD, and more than 1.4 billion people are currently 
afflicted with 1 or more NTDs. 
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(2) In 2013, WHO adopted a comprehensive 
resolution on NTDs recognizing that increased na-
tional and international investments in prevention 
and control of neglected tropical diseases have suc-
ceeded in improving health and social well-being in 
many countries. 
(3) NTDs have an enormous impact in terms of 
disease burden and quality of life. NTDs cause the 
loss of up to 534,000 lives and 57 million disability- 
adjusted life-years each year. NTDs surpass both 
malaria and tuberculosis in causing greater loss of 
life-years to disability and premature death. Many 
NTDs cause disfigurement and disability, leading to 
stigma, 
social 
discrimination, 
and 
societal 
marginalization. 
(4) NTDs create an economic burden of billions 
of dollars through the loss of productivity and high 
costs of health care required for treatment. People 
afflicted by NTDs are less productive than their 
healthy counterparts. NTDs jeopardize the ability of 
people to attend work and school, or to produce at 
full capacity. For example, controlling one NTD, 
hookworm, in children can result in a 43-percent in-
crease in future wage earnings. 
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(5) The social, economic, and health burden of 
NTDs falls primarily on low- and middle-income 
countries, where access to safe water, sanitation, 
and health care is limited. At least 100 countries 
face 2 endemic NTD burdens, and 30 countries 
carry 6 or more endemic NTDs. 
(6) NTDs are not confined to the developing 
world, however. Several NTD outbreaks have been 
reported in the United States and other developed 
countries, especially among the poor. In the United 
States, NTDs disproportionately affect people living 
in poverty, and especially minorities, including up to 
2.8 million African Americans with toxocariasis and 
300,000 or more people, mostly Hispanic Americans, 
with Chagas disease. 
(7) Many NTDs can be controlled, prevented, 
and even eliminated using low-cost, effective, and 
feasible solutions. Understanding the economic bur-
den of NTDs on productivity and health care costs 
can help to assure governments and donors that the 
resources directed toward NTDs represent a good 
investment. 
(8) Research and development efforts are imme-
diately needed for all NTDs, especially those for 
which limited or no treatment currently exists. 
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(9) Critical to developing robust NTD control 
strategies are epidemiological data that identify at- 
risk populations, ensure appropriate treatment fre-
quency, and inform decisions about when treatment 
can be reduced or stopped. 
(10) Of the 14 most common NTDs, roughly 
80 percent of infections are caused by soil-trans-
mitted helminths (STH) and schistosomiasis. STH 
are a group of 3 parasitic worms (roundworms, 
whipworms, and hookworms) that afflict more than 
1 billion people worldwide, including 600 million 
school-age children, of whom more than 300 million 
suffer from severe morbidity. Schistosomiasis is an-
other helminth infection affecting at least 200 mil-
lion people in developing countries, but some esti-
mates indicate that the true number of people af-
fected may be double or even triple that number. 
(11) The benefits of deworming are immediate 
and enduring. A rigorous randomized controlled trial 
has shown school-based deworming treatment to re-
duce school absenteeism by 25 percent. School-based 
deworming also benefits young siblings and other 
children who live nearby but are too young to be 
treated, leading to large cognitive improvements 
equivalent to half a year of schooling. 
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(O) taeniasis/cysticercosis; 
(P) trachoma; and 
(Q) yaws (endemic treponematoses). 
SEC. 6. RULE OF CONSTRUCTION. 
Nothing in this Act shall be construed to increase au-
thorizations of appropriations for the United States Agen-
cy for International Development. 
SEC. 7. EXPANSION OF UNITED STATES AGENCY FOR 
INTERNATIONAL DEVELOPMENT NEGLECTED 
TROPICAL DISEASES PROGRAM. 
(a) FINDINGS.—Congress finds the following: 
(1) Since fiscal year 2006, the United States 
Government has been an essential leader in global 
efforts to control seven targeted neglected tropical 
diseases: 
lymphatic 
filariasis 
(elephantiasis), 
onchocerciasis (river blindness), schistosomiasis, soil- 
transmitted helminthiases (roundworm, whipworm, 
and hookworm), and trachoma. Additional informa-
tion suggests that such efforts could also produce 
collateral benefits for at least three other neglected 
tropical diseases: foodborne trematodiases, scabies, 
and yaws (endemic treponematoses). 
(2) The United States Government is a partner 
in the London Declaration on Neglected Tropical 
Diseases (2012), which represents a new, coordi-
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nated international push to accelerate progress to-
ward eliminating or controlling 10 NTDs by 2020. 
(3) While many of the most common NTDs 
have safe, easy to use, and effective treatments, 
treatment options for the NTDs with the highest 
death 
rates, 
including 
human 
African 
trypanosomiasis (sleeping sickness), visceral leishma-
niasis, and Chagas disease, are extremely limited. 
(4) The United States Agency for International 
Development (USAID) Neglected Tropical Diseases 
Program has made important and substantial con-
tributions to the global fight to control and eliminate 
5 of the most common NTDs. Leveraging more than 
$15,700,000,000 in donated medicines, USAID has 
supported the distribution of more than 1 billion 
treatments in 31 countries across Africa, Asia, and 
Latin America and the Caribbean. 
(5) Since 2014, the USAID Neglected Tropical 
Diseases Program has been investing in research 
and development for the treatment of certain NTDs 
to ensure that promising new breakthrough medi-
cines can be rapidly evaluated, registered, and made 
available to patients. 
(6) The USAID Neglected Tropical Diseases 
Program is a clear example of a successful public- 
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private partnership between the Government and the 
private sector and should be judiciously expanded, as 
practicable and appropriate. 
(b) SENSE OF CONGRESS.—It is the sense of Con-
gress that the USAID Neglected Tropical Diseases Pro-
gram, as in effect on the date of the enactment of this 
Act, should— 
(1) provide integrated drug treatment packages 
to as many individuals suffering from NTDs or at 
risk of acquiring NTDs, including individuals dis-
placed by manmade and natural disasters, as 
logistically feasible; 
(2) better integrate NTD control and treatment 
tools and approaches into complementary develop-
ment and global health programs by coordinating, to 
the extent practicable and appropriate, across mul-
tiple sectors, including those relating to HIV/AIDS, 
malaria, tuberculosis, education, nutrition, other in-
fectious diseases, maternal and child health, and 
water, sanitation, and hygiene; 
(3) establish low-cost, high-impact community- 
and school-based NTD programs to reach large at- 
risk populations, including school-age children, with 
integrated drug treatment packages, as feasible; 
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(4) as opportunities emerge and resources 
allow, engage in research and development of new 
tools and approaches to reach the goals relating to 
the elimination of NTDs as set forth by the 2012 
World Health Organization publication ‘‘Accel-
erating Work to Overcome the Global Impact of Ne-
glected Tropical Diseases: A Roadmap for Imple-
mentation’’, including for Chagas disease, Guinea 
worm, human African trypanosomiasis (sleeping 
sickness), leprosy, and visceral leishmaniasis; and 
(5) monitor research on and developments in 
the prevention and treatment of other NTDs so 
breakthroughs can be incorporated into the USAID 
Neglected Tropical Diseases Program, as practicable 
and appropriate. 
(c) PROGRAM PRIORITIES.—The Administrator of 
USAID should incorporate the following priorities into the 
USAID Neglected Tropical Diseases Program (as in effect 
on the date of the enactment of this Act): 
(1) Planning for and conducting robust moni-
toring and evaluation of program investments in 
order to accurately measure impact, identify and 
share lessons learned, and inform future NTD con-
trol and elimination strategies. 
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(2) Coordinating program activities with com-
plementary USAID development and global health 
programs, including programs relating to water, 
sanitation, and hygiene, food and nutrition security, 
and education (both primary and secondary), in 
order to advance the goals of the London Declara-
tion on Neglected Tropical Diseases (2012). 
(3) Including morbidity management in treat-
ment plans for high-burden NTDs. 
(4) Incorporating NTDs included in the Global 
Burden of Disease Study 2010 into the program as 
opportunities emerge, to the extent practicable and 
appropriate. 
(5) Continuing investments in the research and 
development of new tools and approaches that com-
plement existing research investments and ensure 
that new discoveries make it through the pipeline 
and become available to individuals who need them 
most. 
SEC. 8. ACTIONS BY DEPARTMENT OF STATE. 
(a) OFFICE OF THE GLOBAL AIDS COORDINATOR.— 
It is the sense of Congress that the Coordinator of United 
States Government Activities to Combat HIV/AIDS Glob-
ally should fully consider evolving research on the impact 
of NTDs on efforts to control HIV/AIDS when making 
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future programming decisions, as necessary and appro-
priate. 
(b) GLOBAL PROGRAMMING.— 
(1) IN
GENERAL.—The Secretary of State 
should encourage the Global Fund to take into con-
sideration evolving research on the impact of NTDs 
on efforts to control HIV/AIDS when making pro-
gramming decisions, particularly with regard to fe-
male genital schistosomiasis, which studies suggest 
may be one of the most significant cofactors in the 
AIDS epidemic in Africa, as necessary and appro-
priate. 
(2) GLOBAL
FUND.—In this subsection, the 
term ‘‘Global Fund’’ means the public-private part-
nership known as the Global Fund to Fight AIDS, 
Tuberculosis and Malaria established pursuant to 
Article 80 of the Swiss Civil Code. 
(c) G–20 COUNTRIES.—The Secretary of State, act-
ing through the Office of Global Health Diplomacy, should 
encourage G–20 countries to significantly increase their 
role in the control and elimination of NTDs. 
SEC. 9. MULTILATERAL DEVELOPMENT AND HEALTH INSTI-
TUTIONS. 
(a) CONGRESSIONAL FINDING.—Congress finds that 
the treatment of NTDs, including community- and school- 
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based deworming programs, can be a highly cost-effective 
intervention, and schools can serve as an effective delivery 
mechanism for reaching large numbers of children with 
safe 
treatment 
for 
soil-transmitted 
helminthiases 
(roundworm, whipworm, and hookworm) in particular. 
(b) UNITED NATIONS.—The President should direct 
the United States permanent representative to the United 
Nations to use the voice, vote, and influence of the United 
States to urge the World Health Organization and the 
United Nations Development Programme to— 
(1) ensure the dissemination of best practices 
and programming on NTDs to governments and 
make data accessible to practitioners in an open and 
timely fashion; 
(2) highlight impacts of community- and school- 
based deworming programs on children’s health and 
education, emphasizing the cost-effectiveness of such 
programs; 
(3) 
encourage 
governments 
to 
implement 
deworming campaigns at the national level; 
(4) consider the designation of a portion of 
grant funds of the institutions to deworming initia-
tives and cross-sectoral collaboration with water, 
sanitation, and hygiene efforts and nutrition or edu-
cation programming, as practicable and appropriate; 
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(5) encourage accurate monitoring and evalua-
tion of NTD programs, including deworming pro-
grams; and 
(6) engage governments in cross-border initia-
tives for the treatment, control, prevention, and 
elimination of NTDs, and assist in developing 
transnational agreements, when and where nec-
essary. 
Passed the House of Representatives December 3, 
2019. 
Attest: 
CHERYL L. JOHNSON, 
Clerk. 
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