I 
116TH CONGRESS 
1ST SESSION 
H. R. 826 
To facilitate effective research on and treatment of neglected tropical diseases, 
including Ebola, through coordinated domestic and international efforts. 
IN THE HOUSE OF REPRESENTATIVES 
JANUARY 28, 2019 
Mr. SMITH of New Jersey (for himself, Ms. BASS, and Mr. MEEKS) introduced 
the following bill; which was referred to the Committee on Energy and 
Commerce, and in addition to the Committees on Foreign Affairs, and 
Financial Services, 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 
A BILL 
To facilitate effective research on and treatment of neglected 
tropical diseases, including Ebola, through coordinated 
domestic and international efforts. 
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 ‘‘End Neglected Trop-
ical Diseases Act’’. 
SEC. 2. TABLE OF CONTENTS. 
The table of contents of this Act is as follows: 
Sec. 1. Short title. 
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Sec. 2. Table of contents. 
Sec. 3. Statement of policy. 
Sec. 4. Findings. 
Sec. 5. Definition. 
Sec. 6. Rule of construction. 
TITLE I—FOREIGN AFFAIRS 
Sec. 101. Expansion of United States Agency for International Development’s 
Neglected Tropical Diseases Program. 
Sec. 102. Actions by Department of State. 
Sec. 103. Multilateral development and health institutions. 
TITLE II—DEPARTMENT OF HEALTH AND HUMAN SERVICES 
Sec. 201. Promoting efforts through interagency working groups and inter-
national forums. 
Sec. 202. Report on neglected tropical diseases in the United States. 
Sec. 203. Centers of excellence. 
Sec. 204. Panel on worm infection solutions. 
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, includ-
ing Ebola, for the economic and social well-being for all 
people. 
SEC. 4. FINDINGS. 
Congress finds the following: 
(1) The World Health Organization (WHO) has 
identified 17 neglected tropical diseases (NTDs). 
Approximately two 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 cur-
rently afflicted with one 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 marginali-
zation. 
(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 two endemic NTD burdens, and 30 countries 
carry six 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) In 2014, an outbreak of Ebola Virus Dis-
eases (Ebola) caused a pandemic that infected more 
than 20,000 people, including more than 8,000 
deaths. Although not listed as an NTD by the World 
Health Organization, Ebola shares the same charac-
teristics as other NTDs by affecting people living 
‘‘under conditions of poverty’’ and is ‘‘concentrated 
almost exclusively in impoverished populations in the 
developing world’’. Even when the disease had 
spread to the United States and other developed 
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countries, it was contained and controlled by the 
well-equipped health systems in those areas. 
(8) 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. 
(9) Research and development efforts are imme-
diately needed for all NTDs, especially those for 
which limited or no treatment currently exists. 
(10) 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. 
(11) 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 three parasitic worms (roundworms, 
whipworms, and hookworms) that afflict more than 
one billion people worldwide, including 600 million 
school-age children, of whom more than 300 million 
suffer from severe morbidity. Schistosomiasis is an-
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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. 
(12) The main health problems caused by STH 
are related to their negative effect on childhood nu-
tritional status, which can cause stunting and wast-
ing. For example, STH infection may lead to ane-
mia, malabsorption of nutrients, loss of appetite, 
nausea, abdominal pain, diarrhea, and reduced food 
intake. When such health problems are experienced 
in early childhood, a peak growth and development 
period, the mental and physical damage—and loss of 
future productivity and wage-earning potential—will 
likely be irreversible. Schistosomiasis causes end- 
organ damage to the urinary tract, female genital 
tract, liver and intestines. It also results in chronic 
health conditions in children. 
(13) STH and schistosomiasis are also particu-
larly detrimental to the health of women of repro-
ductive age and pregnant women. Their underlying 
poor iron status makes these women most suscep-
tible to developing anemia. Iron deficiency anemia 
resulting from hookworm infection during pregnancy 
has been linked to poor pregnancy outcomes such as 
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prematurity, low birth weight, and impaired lacta-
tion. Female genital schistosmiasis may be one of 
the most common gynecologic conditions in Africa 
leading to genital pain, itching, and bleeding and 
markedly increased susceptibility to HIV/AIDS. 
(14) Fortunately, there is a simple, cost-effec-
tive solution to STH and schistosomiasis infections: 
single-dose deworming pills that can be safely ad-
ministered once or twice annually to those at risk. 
Pharmaceutical companies have committed to donate 
the drugs needed to treat all at-risk, school-age chil-
dren in developing countries. Regular administration 
of deworming pills reduces morbidity associated with 
STH and schistosomiasis infections by reducing 
prevalence and transmission rates. 
(15) Improved access to water, sanitation, and 
hygiene (WASH) can also reduce the transmission of 
NTDs, particularly intestinal worms. 
(16) 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 
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treated, leading to large cognitive improvements 
equivalent to half a year of schooling. 
SEC. 5. DEFINITION. 
In this Act, the term ‘‘neglected tropical diseases’’ or 
‘‘NTDs’’— 
(1) means infections caused by pathogens, in-
cluding viruses, bacteria, protozoa, and helminths 
that disproportionately impact individuals living in 
extreme poverty, especially in developing countries; 
and 
(2) includes— 
(A) Buruli ulcer (Mycobacterium Ulcerans 
infection); 
(B) Chagas disease; 
(C) dengue or severe dengue fever; 
(D) dracunculiasis (Guinea worm disease); 
(E) echinococcosis; 
(F) foodborne trematodiases; 
(G) human African trypanosomiasis (sleep-
ing sickness); 
(H) leishmaniasis; 
(I) leprosy; 
(J) lymphatic filariasis (elephantiasis); 
(K) onchocerciasis (river blindness); 
(L) rabies; 
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(M) schistosomiasis; 
(N) soil-transmitted helminthiases (STH) 
(round worm, whip worm, and hook worm); 
(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 or authorizations of ap-
propriations for the Department of Health and Human 
Services. 
TITLE I—FOREIGN AFFAIRS 
SEC. 101. EXPANSION OF UNITED STATES AGENCY FOR 
INTERNATIONAL 
DEVELOPMENT’S 
NE-
GLECTED TROPICAL DISEASES PROGRAM. 
(a) FINDINGS.—Congress finds the following: 
(1) Since fiscal year 2006, the United States 
Government has been an essential leading partner in 
advancing control and elimination efforts for seven 
targeted neglected tropical diseases: lymphatic fila-
riasis (elephantiasis), onchocerciasis (river blind-
ness), schistosomiasis, soil-transmitted helminthiases 
(STH) (round worm, whip worm, and hook worm), 
and trachoma. Additional information suggests that 
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such efforts could also produce collateral benefits for 
at least three other NTDs: foodborne trematodiases, 
scabies, and yaws (endemic treponematoses). 
(2) The United States Agency for International 
Development’s (USAID) Neglected Tropical Dis-
eases Program has made important and substantial 
contributions to the global fight to control and elimi-
nate the seven most common NTDs. Leveraging 
more than $6.7 billion in donated medicines, USAID 
has supported the distribution of more than one bil-
lion treatments in 25 countries across Africa, Asia, 
and Latin America and the Caribbean. 
(3) United States Government leadership has 
been instrumental in maintaining the global fight 
against NTDs and is a partner in the London Dec-
laration on Neglected Tropical Diseases (2012), 
which represents a new, coordinated international 
push to accelerate progress toward eliminating or 
controlling 10 neglected tropical diseases by 2020. 
(4) USAID’s Neglected Tropical Diseases Pro-
gram is a clear example of a successful public-pri-
vate partnership between the Government and the 
private sector and should be judiciously expanded, as 
practicable and appropriate. 
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