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 Wash-
ington, 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 with-
in 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 In-
diana, Mr. SCOTT of Georgia, Ms. WOOLSEY, Mr. BLUMENAUER, Mr. 
PRICE of North Carolina, Mr. DOYLE, Mr. DELAHUNT, Mr. DAVIS of Illi-
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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. GON-
ZALEZ, 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. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Stop Tuberculosis (TB) 
Now Act of 2007’’. 
SEC. 2. FINDINGS. 
Congress finds the following: 
(1) Tuberculosis is one of the greatest infectious 
causes of death of adults worldwide, killing 1.6 mil-
lion people per year—one person every 20 seconds. 
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(2) One-third of the world’s population is in-
fected with the tuberculosis bacterium and an esti-
mated 8.8 million individuals develop active tuber-
culosis each year. 
(3) Tuberculosis is the leading infectious killer 
among individuals who are HIV-positive due to their 
weakened immune systems, and it is estimated that 
one-third of people with HIV infection have tuber-
culosis. 
(4) Today, tuberculosis is a leading killer of 
women of reproductive age. 
(5) There are 22 countries that account for 80 
percent of the world’s burden of tuberculosis. The Peo-
ple’s Republic of China and India account for 36 per-
cent of all estimated new tuberculosis cases each year. 
(6) Driven by the HIV/AIDS pandemic, inci-
dence rates of tuberculosis in Africa have more than 
doubled on average since 1990. The problem is so per-
vasive that in August 2005, African Health Ministers 
and the World Health Organization (WHO) declared 
tuberculosis to be an emergency in Africa. 
(7) The wide extent of drug resistance, including 
both multi-drug resistant tuberculosis (MDR–TB) 
and extensively drug resistant tuberculosis (XDR– 
TB), represents both a critical challenge to the global 
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control of tuberculosis and a serious worldwide public 
health threat. XDR–TB, which is characterized as 
being MDR–TB with additional resistance to mul-
tiple second-line anti-tuberculosis drugs, is associated 
with worst treatment outcomes of any form of tuber-
culosis. XDR–TB is converging with the HIV epi-
demic, undermining gains in HIV prevention and 
treatment programs and requires urgent interven-
tions. Drug resistance surveillance reports have con-
firmed the serious scale and spread of tuberculosis 
with XDR–TB strains confirmed on six continents. 
Demonstrating the lethality of XDR–TB, an initial 
outbreak in Tugela Ferry, South Africa, in 2006 
killed 52 of 53 patients with hundreds more cases re-
ported since that time. Of the world’s regions, sub-Sa-
haran Africa, faces the greatest gap in capacity to 
prevent, find, and treat XDR–TB. 
(8) With more than 50 percent of tuberculosis 
cases in the United States attributable to foreign-born 
individuals and with the increase in international 
travel, commerce, and migration, elimination of tu-
berculosis in the United States depends on efforts to 
control the disease in developing countries. Recent re-
search has shown that to invest in tuberculosis control 
abroad, where treatment and program costs are sig-
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nificantly cheaper than in the United States, would 
be a cost-effective strategy to reduce tuberculosis-re-
lated morbidity and mortality domestically. 
(9) The threat that tuberculosis poses for Ameri-
cans derives from the global spread of tuberculosis 
and the emergence and spread of strains of multi- 
drug resistant tuberculosis and extensively drug re-
sistant tuberculosis, which are far more deadly, and 
more difficult and costly to treat. 
(10) DOTS (Directly Observed Treatment Short- 
course) is one of the most cost-effective health inter-
ventions available today and is a core component of 
the new Stop TB Strategy. 
(11) The Stop TB Strategy, developed by the 
World Health Organization, builds on the success of 
DOTS and ongoing challenges so as to serve all those 
in need and reach targets for prevalence, mortality, 
and incidence reduction. The Stop TB Strategy in-
cludes six components: 
(A) Pursuing high-quality expansion and 
enhancement of DOTS coverage. 
(B) Implementing tuberculosis and HIV col-
laborative activities, preventing and controlling 
multi-drug resistant tuberculosis, and addressing 
other special challenges. 
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(C) Contributing to the strengthening of 
health systems. 
(D) Engaging all health care providers, in-
cluding promotion of the International Stand-
ards for Tuberculosis Care. 
(E) Empowering individuals with tuber-
culosis and communities. 
(F) Enabling and promoting research to de-
velop new diagnostics, drugs, vaccines, and pro-
gram-based operational research relating to tu-
berculosis. 
(12) The Global Plan to Stop TB 2006–2015: 
Actions for Life is a comprehensive plan developed by 
the Stop TB Partnership that sets out the actions nec-
essary to achieve the millennium development goal of 
cutting tuberculosis deaths and disease burden in half 
by 2015 and thus eliminate tuberculosis as a global 
health problem by 2050. 
(13) While innovations such as the Global Tuber-
culosis Drug Facility have enabled low-income coun-
tries to treat a standard case of tuberculosis with 
drugs that cost as little as $16 for a full course of 
treatment, there are still millions of individuals with 
no access to effective treatment. 
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(14) As the global resource investment in fighting 
tuberculosis increases, partner nations and inter-
national institutions must commit to a corresponding 
increase in the technical and program assistance nec-
essary to ensure that the most effective and efficient 
tuberculosis treatments are provided. 
(15) The Global Fund to Fight AIDS, Tuber-
culosis and Malaria is an important global partner-
ship established to combat these three infectious dis-
eases that together kill millions of people a year. Ex-
pansion of effective tuberculosis treatment programs 
constitutes a major component of Global Fund invest-
ment, along with integrated efforts to address HIV 
and tuberculosis in areas of high prevalence. 
(16) The United States Agency for International 
Development and the Centers for Disease Control and 
Prevention are actively involved with global tuber-
culosis control efforts. Because the global tuberculosis 
epidemic directly impacts tuberculosis in the United 
States, Congress has urged the Centers for Disease 
Control and Prevention each year to increase its in-
volvement with international tuberculosis control ef-
forts. 
(17) The United States Agency for International 
Development is the lead United States Government 
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agency for international tuberculosis efforts, working 
in close partnership with the Centers for Disease Con-
trol and Prevention and with the President’s Emer-
gency Plan for HIV/AIDS Relief. The goal of the 
United States Agency for International Development 
is to contribute to the global reduction of morbidity 
and mortality associated with tuberculosis by build-
ing country capacity to prevent and cure tuberculosis 
and achieve global targets of 70 percent case detection 
and 85 percent treatment success rates. The United 
States Agency for International Development provides 
support for tuberculosis programs in countries that 
have a high burden of tuberculosis, a high prevalence 
of tuberculosis and HIV, and a high risk of MDR– 
TB. 
SEC. 3. ASSISTANCE TO COMBAT TUBERCULOSIS. 
(a) POLICY.—Subsection (b) of section 104B of the 
Foreign Assistance Act of 1961 (22 U.S.C. 2151b–3) is 
amended to read as follows: 
‘‘(b) POLICY.—It is a major objective of the foreign as-
sistance program of the United States to control tuber-
culosis. In all countries in which the Government of the 
United States has established development programs, par-
ticularly in countries with the highest burden of tuber-
culosis and other countries with high rates of tuberculosis, 
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the United States Government should prioritize the achieve-
ment of the following goals by not later than December 31, 
2015: 
‘‘(1) Reduce by half the tuberculosis death and 
disease burden from the 1990 baseline. 
‘‘(2) Sustain or exceed the detection of at least 
70 percent of sputum smear-positive cases of tuber-
culosis and the cure of at least 85 percent of those 
cases detected.’’. 
(b) AUTHORIZATION.—Subsection (c) of such section is 
amended— 
(1) in the heading, by striking ‘‘AUTHORIZA-
TION’’ and inserting ‘‘ASSISTANCE REQUIRED’’; and 
(2) by striking ‘‘is authorized to’’ and inserting 
‘‘shall’’. 
(c) PRIORITY TO STOP TB STRATEGY.—Subsection (e) 
of such section is amended— 
(1) in the heading, to read as follows: ‘‘PRIORITY 
TO STOP TB STRATEGY.—’’; 
(2) in the first sentence, by striking ‘‘In fur-
nishing’’ and all that follows through ‘‘, including 
funding’’ and inserting the following: 
‘‘(1) PRIORITY.—In furnishing assistance under 
subsection (c), the President shall give priority to— 
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‘‘(A) activities described in the Stop TB 
Strategy, including expansion and enhancement 
of DOTS coverage, treatment for individuals in-
fected with both tuberculosis and HIV and treat-
ment for individuals with multi-drug resistant 
tuberculosis (MDR–TB), strengthening of health 
systems, use of the International Standards for 
Tuberculosis Care by all providers, empowering 
individuals with tuberculosis, and enabling and 
promoting research to develop new diagnostics, 
drugs, and vaccines, and program-based oper-
ational research relating to tuberculosis; and 
‘‘(B) funding’’; and 
(3) in the second sentence— 
(A) by striking ‘‘In order to’’ and all that 
follows through ‘‘not less than’’ and inserting the 
following: 
‘‘(2) AVAILABILITY OF AMOUNTS.—In order to 
meet the requirements of paragraph (1), the Presi-
dent— 
‘‘(A) shall ensure that not less than’’; 
(B) by striking ‘‘for Directly Observed 
Treatment Short-course (DOTS) coverage and 
treatment of multi-drug resistant tuberculosis 
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using DOTS–Plus,’’ and inserting ‘‘to implement 
the Stop TB Strategy; and’’; and 
(C) by striking ‘‘including’’ and all that fol-
lows and inserting the following: 
‘‘(B) should ensure that not less than 
$15,000,000 of the amount made available to 
carry out this section for a fiscal year is used to 
make a contribution to the Global Tuberculosis 
Drug Facility.’’. 
(d) ASSISTANCE FOR WHO AND THE STOP TUBER-
CULOSIS PARTNERSHIP.—Such section is further amend-
ed— 
(1) by redesignating subsection (f) as subsection 
(g); and 
(2) by inserting after subsection (e) the following 
new subsection: 
‘‘(f) ASSISTANCE FOR WHO AND THE STOP TUBER-
CULOSIS PARTNERSHIP.—In carrying out this section, the 
President, acting through the Administrator of the United 
States Agency for International Development, is authorized 
to provide increased resources to the World Health Organi-
zation (WHO) and the Stop Tuberculosis Partnership to 
improve the capacity of countries with high rates of tuber-
culosis and other affected countries to implement the Stop 
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TB Strategy and specific strategies related to addressing 
extensively drug resistant tuberculosis (XDR–TB).’’. 
(e) DEFINITIONS.—Subsection (g) of such section, as 
redesignated by subsection (d)(1), is amended— 
(1) in paragraph (1), by adding at the end be-
fore the period the following: ‘‘, including low cost 
and effective diagnosis and evaluation of treatment 
regimes, vaccines, and monitoring of tuberculosis, as 
well as a reliable drug supply, and a management 
strategy for public health systems, with health system 
strengthening, promotion of the use of the Inter-
national Standards for Tuberculosis Care by all care 
providers, bacteriology under an external quality as-
sessment framework, short-course chemotherapy, and 
sound reporting and recording systems’’; and 
(2) by adding after paragraph (5) the following 
new paragraph: 
‘‘(6) STOP TB STRATEGY.—The term ‘Stop TB 
Strategy’ means the six-point strategy to reduce tu-
berculosis developed by the World Health Organiza-
tion. The strategy is described in the Global Plan to 
Stop TB 2007–2016: Actions for Life, a comprehen-
sive plan developed by the Stop Tuberculosis Partner-
ship that sets out the actions necessary to achieve the 
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millennium development goal of cutting tuberculosis 
deaths and disease burden in half by 2016.’’. 
(f) 
ANNUAL
REPORT.—Clause 
(iii) 
of 
section 
104A(e)(2)(C) of the Foreign Assistance Act of 1961 (22 
U.S.C. 2151b–2(e)(2)(C)) is amended by adding at the end 
before the semicolon the following: ‘‘, including the percent-
age of such United States foreign assistance provided for 
diagnosis and treatment of individuals with tuberculosis in 
countries with the highest burden of tuberculosis, as deter-
mined by the World Health Organization (WHO)’’. 
(g) AUTHORIZATION OF APPROPRIATIONS.— 
(1) IN GENERAL.—There are authorized to be ap-
propriated 
to 
the 
President 
not 
more 
than 
$400,000,000 for fiscal year 2008 and not more than 
$550,000,000 for fiscal year 2009 to carry out section 
104B of the Foreign Assistance Act of 1961 (22 
U.S.C. 2151b–3), as amended by subsections (a) 
through (e) of this section. 
(2) FUNDING FOR CDC.—Of the amounts appro-
priated pursuant to the authorization of appropria-
tions 
under 
paragraph 
(1), 
not 
more 
than 
$70,000,000 for fiscal year 2008 and not more than 
$100,000,000 for fiscal year 2009 shall be made avail-
able for the purpose of carrying out global tuber-
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culosis activities through the Centers for Disease Con-
trol and Prevention. 
(3) ADDITIONAL PROVISIONS.—Amounts appro-
priated pursuant to the authorization of appropria-
tions under paragraph (1) and amounts made avail-
able pursuant to paragraph (2)— 
(A) are in addition amounts otherwise 
made available for such purposes; and 
(B) are authorized to remain available 
until expended. 
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