I 
117TH CONGRESS 
2D SESSION 
H. R. 8654 
To prevent, treat, and cure tuberculosis globally. 
IN THE HOUSE OF REPRESENTATIVES 
AUGUST 5, 2022 
Mr. BERA (for himself and Ms. SALAZAR) introduced the following bill; which 
was referred to the Committee on Foreign Affairs 
A BILL 
To prevent, treat, and cure tuberculosis globally. 
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 Tuberculosis Now 
Act of 2022’’. 
SEC. 2. FINDINGS. 
Congress makes the following findings: 
(1) Tuberculosis (referred to in the Act as 
‘‘TB’’) is a preventable, treatable, and curable dis-
ease, yet more than 25 years after the World Health 
Organization declared it to be a public health emer-
gency and called on countries to make scaling up TB 
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control a priority, TB remains a deadly health 
threat. 
(2) In 2019 alone, an estimated 10,000,000 
people became ill with TB, 10 percent of whom were 
children, and 1,400,000 of whom died. In order to 
achieve by 2035 the goals of the Political Declara-
tion of the High-Level Meeting of the General As-
sembly on the Fight Against Tuberculosis, adopted 
by the United Nations General Assembly October 
10, 2018, and of the World Health Organization 
End TB Strategy, adopted by the World Health As-
sembly in 2014, new and existing tools must be de-
veloped and scaled-up. 
(3) Over 1⁄3 of people who become ill with TB 
may be undiagnosed or misdiagnosed, resulting in 
unnecessary illness, communicable infections, and in-
creased mortality. 
(4) Since March 2020, the COVID–19 pan-
demic has severely disrupted TB responses in low- 
and middle-income countries, stalling and reversing 
years of progress made against TB. According to the 
World Health Organization, global detection dropped 
by 18 percent between 2019 and 2020 and an esti-
mated 1,300,000 fewer people were diagnosed and 
enrolled on TB treatment, and in some countries 
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case notifications dropped by up to 41 percent, set-
ting progress back by up to 12 years. 
(5) Failure to properly diagnose and treat TB 
can lead to death and can exacerbate antimicrobial 
resistance, a key contributor to rising cases of multi- 
drug-resistant TB and extensively drug-resistant 
TB, and increasing the probability of the introduc-
tion of resistant TB into new geographic areas. 
(6) TB programs have played a central role in 
responding 
to 
COVID–19, 
including 
through 
leveraging the expertise of medical staff with exper-
tise in TB and lung diseases, the repurposing of TB 
hospitals, and the use of the TB rapid molecular 
testing platforms and x-ray equipment for multiple 
purposes, including COVID–19. 
(7) With sufficient resourcing, TB program ex-
pertise, infection control, laboratory capacity, active 
case finding and contact investigation can serve as 
platforms for respiratory pandemic response against 
existing and new infectious respiratory disease with-
out disrupting ongoing TB programs and activities. 
(8) 
Globally, 
only 
about 
1⁄2
of 
the 
$13,000,000,000 required annually, as outlined in 
the Stop TB Partnership’s Global Plan to End TB, 
is currently available. 
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(9) On September 26, 2018, the United Na-
tions convened the first High-Level Meeting of the 
General Assembly on the Fight Against Tuber-
culosis, during which 120 countries— 
(A) signed a Political Declaration to accel-
erate progress against TB, including through 
commitments to increase funding for TB pre-
vention, diagnosis, treatment and research and 
development programs, and ambitious goals to 
successfully treat 40,000,000 people with active 
TB and prevent at least 30,000,000 from be-
coming ill with TB between 2018 and 2022; 
and 
(B) committed to ‘‘ending the epidemic in 
all countries, and pledge[d] to provide leader-
ship and to work together to accelerate our na-
tional and global collective actions, investments 
and innovations urgently to fight this prevent-
able and treatable disease’’, as reflected in 
United Nations General Assembly Resolution A/ 
RES/73/3. 
(10) The United States Government continues 
to be a lead funder of global TB research and devel-
opment, contributing 44 percent of the total 
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$915,000,000 in global funding in 2020, and can 
catalyze more investments from other countries. 
(11) Working with governments and partners 
around the world, USAID’s TB programming has 
saved 66,000,000 lives, demonstrating the effective-
ness of United States programs and activities. 
(12) On September 26, 2018, the USAID Ad-
ministrator announced a new performance-based 
Global Accelerator to End TB, aimed at catalyzing 
investments to meet the treatment target set by the 
United Nations High-Level Meeting, further dem-
onstrating the critical role that United States leader-
ship and assistance plays in the fight to eliminate 
TB. 
(13) It is essential to ensure that efforts among 
United States Government agencies, partner nations, 
international organizations, nongovernmental organi-
zations, the private sector, and other actors are com-
plementary and not duplicative in order to achieve 
the goal of ending the TB epidemic in all countries. 
SEC. 3. UNITED STATES GOVERNMENT ACTIONS TO END 
TUBERCULOSIS. 
Section 104B of the Foreign Assistance Act of 1961 
(22 U.S.C. 2151b–3) is amended to read as follows: 
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‘‘SEC. 104B. ASSISTANCE TO COMBAT TUBERCULOSIS. 
‘‘(a) FINDINGS.—Congress makes the following find-
ings: 
‘‘(1) The continuing challenge of the inter-
national spread of tuberculosis (referred to in this 
section as ‘TB’), and the deadly impact of TB’s con-
tinued existence constitutes a continuing challenge. 
‘‘(2) Additional tools and resources are required 
to effectively diagnose, prevent, and treat TB. 
‘‘(3) Effectively resourced TB programs can 
serve as a critical platform for preventing and re-
sponding to future infectious respiratory disease 
pandemics. 
‘‘(b) POLICY.— 
‘‘(1) It is a major objective of the foreign as-
sistance program of the United States to help end 
the TB pandemic through accelerated actions to 
support the diagnosis and treatment of all adults 
and children with all forms of TB, and to prevent 
new TB infections from occurring. 
‘‘(2) In countries in which the United States 
Government has established foreign assistance pro-
grams under this Act, particularly in countries with 
the highest burden of TB and other countries with 
high rates of infection and transmission of TB, it is 
the policy of the United States to— 
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‘‘(A) support the objectives of the World 
Health Organization End TB Strategy, includ-
ing its goals to— 
‘‘(i) reduce by 95 percent TB deaths 
by 2035; 
‘‘(ii) reduce by 90 percent the TB in-
cidence rate by 2035; and 
‘‘(iii) reduce by 100 percent the num-
ber of families facing catastrophic health 
costs due to TB by 2035; 
‘‘(B) continue to support the Stop TB 
Partnership’s Global Plan to End TB 2018– 
2022, and successor plans, as appropriate, in-
cluding by providing support for— 
‘‘(i) developing and using innovative 
new technologies and therapies to increase 
active case finding and rapidly diagnose 
and treat children and adults with all 
forms of TB, alleviate suffering, and en-
sure TB treatment completion; 
‘‘(ii) expanding diagnosis and treat-
ment in line with the goals established by 
the Political Declaration of the High-Level 
Meeting of the General Assembly on the 
Fight Against Tuberculosis, including— 
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‘‘(I) 
successfully 
treating 
40,000,000 people with active TB by 
2023 including 3,500,000 children, 
and 1,500,000 people with drug-re-
sistant TB; and 
‘‘(II) diagnosing and treating la-
tent tuberculosis infection, in support 
of the global goal of providing preven-
tive therapy to at least 30,000,000 
people, including 4,000,000 children 
under 5 years of age, 20,000,000 
household contacts of people affected 
by TB, and 6,000,000 people living 
with HIV, by 2023; 
‘‘(iii) ensuring high quality TB care 
by closing gaps in care cascades, imple-
menting continuous quality improvement 
at all levels of care, and providing related 
patient support; and 
‘‘(iv) sustainable procurements of TB 
commodities to avoid interruptions in sup-
ply, the procurement of commodities of un-
known quality, or payment of excessive 
commodity costs in countries impacted by 
TB; and 
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‘‘(C) ensure, to the greatest extent prac-
ticable, that United States funding supports ac-
tivities that simultaneously emphasize— 
‘‘(i) the development of comprehensive 
person-centered programs, including diag-
nosis, treatment, and prevention strategies 
to ensure that— 
‘‘(I) all people sick with TB re-
ceive quality diagnosis and treatment 
through active case finding; and 
‘‘(II) people at high risk for TB 
infection are found and treated with 
preventive therapies in a timely man-
ner; 
‘‘(ii) robust TB infection control prac-
tices are implemented in all congregate set-
tings, including hospitals and prisons; 
‘‘(iii) the deployment of diagnostic 
and treatment capacity— 
‘‘(I) in areas with the highest TB 
burdens; and 
‘‘(II) for highly at-risk and im-
poverished populations, including pa-
tient support services; 
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‘‘(iv) program monitoring and evalua-
tion based on critical TB indicators, in-
cluding indicators relating to infection con-
trol, the numbers of patients accessing TB 
treatment and patient support services, 
and preventative therapy for those at risk, 
including all close contacts, and treatment 
outcomes for all forms of TB; 
‘‘(v) training and engagement of 
health care workers on the use of new di-
agnostic tools and therapies as they be-
come available, and increased support for 
training frontline health care workers to 
support expanded TB active case finding, 
contact tracing, and patient support serv-
ices; 
‘‘(vi) coordination with domestic agen-
cies and organizations to support an ag-
gressive research agenda to develop vac-
cines as well as new tools to diagnose, 
treat, and prevent TB globally; 
‘‘(vii) linkages with the private sector 
on— 
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‘‘(I) research and development of 
a vaccine, and on new tools for diag-
nosis and treatment of TB; 
‘‘(II) improving current tools for 
diagnosis and treatment of TB; and 
‘‘(III) training healthcare profes-
sionals on use of the newest and most 
effective diagnostic and therapeutic 
tools; 
‘‘(viii) the reduction of barriers to 
care, including stigma and treatment and 
diagnosis costs, including through— 
‘‘(I) training health workers; 
‘‘(II) sensitizing policy makers; 
‘‘(III) requiring access and af-
fordability provisions into all grants 
and funding agreements; 
‘‘(IV) support education and em-
powerment campaigns for TB patients 
regarding local TB services; 
‘‘(V) monitor barriers to access-
ing TB services; and 
‘‘(VI) increase support for pa-
tient-led and community-led TB out-
reach efforts; and 
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‘‘(ix) support for country-level, sus-
tainable accountability mechanisms and ca-
pacity to measure progress and ensure that 
commitments made by governments and 
relevant stakeholders are met. 
‘‘(c) DEFINITIONS.—In this section: 
‘‘(1) APPROPRIATE
CONGRESSIONAL
COMMIT-
TEES.—The term ‘appropriate congressional com-
mittees’ means the Committee on Foreign Relations 
of the Senate and the Committee on Foreign Affairs 
of the House of Representatives. 
‘‘(2) END TB STRATEGY.—The term ‘End TB 
Strategy’ means the strategy to eliminate TB that 
was approved by the World Health Assembly in May 
2014, and is described in The End TB Strategy: 
Global strategy and targets for TB prevention, care 
and control after 2015. 
‘‘(3) GLOBAL
ALLIANCE
FOR
TUBERCULOSIS 
DRUG
DEVELOPMENT.—The term ‘Global Alliance 
for Tuberculosis Drug Development’ means the pub-
lic-private partnership that bring together leaders in 
health, science, philanthropy, and private industry to 
devise new approaches to TB. 
‘‘(4) GLOBAL
TUBERCULOSIS
DRUG
FACIL-
ITY.—The term ‘Global Tuberculosis Drug Facility’ 
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means the initiative of the Stop Tuberculosis Part-
nership to increase access to the most advanced, af-
fordable, quality-assured TB drugs and diagnostics. 
‘‘(5) MDR–TB.—The term ‘MDR–TB’ means 
multi-drug-resistant TB. 
‘‘(6) STOP TUBERCULOSIS PARTNERSHIP.—The 
term ‘Stop Tuberculosis Partnership’ means the 
partnership of 1,600 organizations (including inter-
national and technical organizations, government 
programs, research and funding agencies, founda-
tions, nongovernmental organizations, civil society 
and community groups, and the private sector), do-
nors including the United States, high TB burden 
countries, multilateral agencies, and nongovern-
mental and technical agencies, which is governed by 
the Stop TB Partnership Coordinating Board and 
hosted by a United Nations entity, committed to 
short- and long-term measures required to control 
and eventually eliminate TB as a public health prob-
lem in the world. 
‘‘(7) XDR–TB.—The term ‘XDR–TB’ means 
extensively drug-resistant TB. 
‘‘(d) AUTHORIZATION.—To carry out this section, the 
President is authorized, consistent with section 104(c), to 
furnish assistance, on such terms and conditions as the 
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President may determine, for the prevention, treatment, 
control, and elimination of TB. 
‘‘(e) GOALS.—In consultation with the appropriate 
congressional committees, the President shall establish 
goals, based on the policy and indicators described in sub-
section (b), for United States TB programs to detect, 
cure, and prevent all forms of TB globally for the period 
between 2023 and 2030 that are aligned with the End 
TB Strategy’s 2030 targets, by updating the United 
States Government Tuberculosis Strategy (2015–2019) 
and the National Action Plan for Combating Multidrug- 
Resistant Tuberculosis. 
‘‘(f) COORDINATION.— 
‘‘(1) IN GENERAL.—In carrying out this sec-
tion, the President shall coordinate with the World 
Health Organization, the Stop TB Partnership, the 
Global Fund to Fight AIDS, Tuberculosis, and Ma-
laria, and other organizations with respect to the de-
velopment and implementation of a comprehensive 
global TB response program. 
‘‘(2) BILATERAL ASSISTANCE.—In providing bi-
lateral assistance under this section, the President, 
acting through the Administrator of the United 
States 
Agency 
for 
International 
Development, 
shall— 
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