I
106TH CONGRESS
2D SESSION
H. R. 4057
To amend the Foreign Assistance Act of 1961 to provide increased foreign
assistance for tuberculosis prevention, treatment, and control.
IN THE HOUSE OF REPRESENTATIVES
MARCH 22, 2000
Mr. BROWN of Ohio (for himself, Mrs. MORELLA, Ms. PELOSI, Mr. WAXMAN,
Mr. BONIOR, Mr. COBURN, Mr. STARK, Mr. LANTOS, Mr. HALL of Ohio,
Mr. GREENWOOD, Mr. ENGLISH, Mr. NEAL of Massachusetts, Mr.
GEORGE MILLER of California, Mr. HINOJOSA, Mr. INSLEE, Mr. BENT-
SEN, Mrs. MEEK of Florida, Mr. GREEN of Texas, Mr. LEWIS of Georgia,
Mr. ANDREWS, Mr. WYNN, Mrs. THURMAN, Mrs. WILSON, Mr. FROST,
Mr. GONZALEZ, Mr. FILNER, Ms. JACKSON-LEE of Texas, Mrs. CAPPS,
Mrs. LOWEY, Mr. BAIRD, Ms. RIVERS, Mr. MCDERMOTT, Mr. TRAFI-
CANT, and Mr. BILBRAY) introduced the following bill; which was referred
to the Committee on International Relations
A BILL
To amend the Foreign Assistance Act of 1961 to provide
increased foreign assistance for tuberculosis prevention,
treatment, and control.
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’’.
SEC. 2. FINDINGS.
The Congress finds the following:
(1)(A) Tuberculosis is one of the greatest infec-
tious causes of death of adults worldwide, killing
2,000,000 people per year—one person every 15 sec-
onds.
(B) Globally, tuberculosis is the leading cause
of death of young women and the leading cause of
death of people with HIV/AIDS.
(2) The World Health Organization estimates
that one-third of the world’s population is infected
with the bacteria that causes tuberculosis, including
an estimated 10,000,000 to 15,000,000 individuals
in the United States.
(3) An estimated 8,000,000 individuals develop
active tuberculosis each year.
(4) Tuberculosis is spreading as a result of in-
adequate treatment and it is a disease that knows
no national borders.
(5) The threat that tuberculosis poses for
Americans derives from the global spread of tuber-
culosis and the emergence and spread of strains of
multi-drug resistant tuberculosis (MDR–TB).
(6) With over 40 percent of tuberculosis cases
in the United States attributable to foreign-born in-
dividuals and with the increase in international trav-
el, commerce, and migration, elimination of tuber-
culosis in the United States depends on efforts to
control the disease in developing countries.
(7) Multi-drug resistant tuberculosis, defined as
resistance to the 2 most important anti-tuberculosis
drugs, isoniazid and rifampicin, is caused by incor-
rect or incomplete treatment—where patients do not
take all of their medicines regularly for the required
period, doctors and health workers prescribe the
wrong drugs or the wrong combination of drugs, or
the drug supply is unreliable.
(8) Up to 50,000,000 individuals may be in-
fected with multi-drug resistant tuberculosis.
(9) The incidence of multi-drug resistant tuber-
culosis is particularly high in certain regions and
populations, such as Russian prisons where an esti-
mated 5 percent of prisoners have active multi-drug
resistant tuberculosis.
(10) In the United States, tuberculosis treat-
ment, normally about $2,000 per patient, skyrockets
to as much as $250,000 per patient to treat multi-
drug resistant tuberculosis, and treatment may not
even be successful.
(11) Multi-drug resistant tuberculosis kills more
than one-half of those individuals infected in the
United States and other industrialized nations and
it is a virtual death sentence in the developing world.
(12) Tuberculosis is an immense economic
drain on families and on nations and is a significant
cause of poverty.
(13) Most cases of tuberculosis and deaths
caused by tuberculosis occur among individuals in
their most productive years of life, ages 15 to 50.
(14) Children bear the brunt of the tuberculosis
of their parents. Often they are taken out of school
to care for a sick parent or to earn money when
their parent can no longer work, and few other in-
fectious diseases create as many orphans as tuber-
culosis.
(15) There is a highly effective and inexpensive
treatment for tuberculosis. Recommended by the
World Health Organization as the best curative
method for tuberculosis, this strategy, known as Di-
rectly Observed Treatment, Short Course (DOTS),
includes low-cost effective diagnosis, treatment, mon-
itoring, and recordkeeping, as well as a reliable drug
supply. A centerpiece of DOTS is observing patients
to ensure that they take their medication and com-
plete treatment.
(16) DOTS produces high cure rates, prevents
the further spread of infection, and prevents devel-
opment of strains of multi-drug resistant tuber-
culosis, yet fewer than 1 in 5 of those ill with tuber-
culosis are receiving DOTS treatment.
(17) Few public health expenditures provide so
much value for so little money as expenditures for
the prevention and treatment of tuberculosis. A full
course of DOTS drugs costs as little as $11–$20 in
developing countries.
(18) Based on World Bank estimates, DOTS
treatment is one of the most cost-effective health
interventions available—costing just $20–$100 to
save a life, and DOTS can produce cure rates of up
to 95 percent even in the poorest countries.
(19) In order to control tuberculosis in the
United States in a more effective manner, it is nec-
essary to ensure the effectiveness of tuberculosis
control programs worldwide.
(20) A total of 22 countries contain an esti-
mated 80 percent of the tuberculosis cases world-
wide. Implementing DOTS programs in these coun-
tries must be a global priority. In addition, imple-
menting strategies to treat multi-drug resistant tu-
berculosis in these countries must also be a global
priority.
(21) Tuberculosis experts estimate that it will
cost an additional $1,000,000,000 annually world-
wide to control this disease.
(22) The STOP TB Initiative, under the aus-
pices of the World Health Organization, has estab-
lished a global goal of reducing tuberculosis deaths
by one-half by 2005, reducing the tuberculosis bur-
den by one-half by 2010, and has further established
the targets of successfully treating 85 percent of de-
tected infectious cases and detecting 70 percent of
such cases by 2005.
SEC. 3. ASSISTANCE FOR TUBERCULOSIS PREVENTION,
TREATMENT, AND CONTROL.
Section 104(c) of the Foreign Assistance Act of 1961
(22 U.S.C. 2151b(c)) is amended by adding at the end
the following:
‘‘(4)(A) Congress recognizes the growing inter-
national problem of tuberculosis and the threat its contin-
ued existence poses for the United States and other na-
tions which had previously largely controlled the disease.
Congress further recognizes that a cost-effective strategy
exists to control and treat tuberculosis, but that this treat-
ment regime is currently reaching fewer than one in five
of those ill with the disease, and that it is a major objec-
tive of the foreign assistance program of the United States
to control this disease. To this end Congress expects the
agency primarily responsible for administering this part—
‘‘(i) to focus its efforts on the implementation
of Directly Observed Treatment, Short Course
(DOTS), or other internationally accepted primary
tuberculosis control strategies developed in consulta-
tion with the World Health Organization, at the
local level with the intention of reaching the targets
of (I) detection of at least 70 percent of the cases
of infectious tuberculosis, (II) the cure of at least 85
percent of the cases detected, and (III) the reduction
in tuberculosis deaths by one-half, by 2005;
‘‘(ii) to focus the efforts described in clause (i)
on the highest burden countries identified by the
World Health Organization as containing 80 percent
of tuberculosis cases globally; and
‘‘(iii) to work in collaboration with the World
Health Organization, the STOP TB Initiative, the
United States Centers for Disease Control, the Na-
tional Institutes of Health, the International Union
Against TB and Lung Disease, and other organiza-
tions toward the development and implementation of
effective tuberculosis control programs, including
strategies to address multi-drug resistant tuber-
culosis (MDR–TB), at the local level, especially in
the highest burden countries.
‘‘(B) In conjunction with the submission of the an-
nual request for enactment of authorizations and appro-
priations for foreign assistance programs for each fiscal
year, the President shall include a report that contains
an estimate of the detection and cure rates of each pro-
gram, project, or activity to be carried out under the au-
thority of subparagraph (A) and progress on reaching the
targets described in subclauses (I) through (III) of sub-
paragraph (A)(i).
‘‘(C)(i) There is authorized to be appropriated for fis-
cal year 2001 $100,000,000 to carry out this paragraph.
‘‘(ii) Of the amount appropriated pursuant to the au-
thorization of appropriations under clause (i), not less
than 80 percent of such amount shall be used for the diag-
nosis and treatment of tuberculosis for at-risk and af-
fected populations utilizing Directly Observed Treatment,
Short Course (DOTS), or other internationally accepted
primary tuberculosis control strategies developed in con-
sultation with the World Health Organization. An appro-
priate percentage of the remaining amount appropriated
pursuant to the authorization of appropriations under
clause (i) should be made available for implementation of
Directly Observed Treatment, Short Course (DOTS–
PLUS), or other internationally accepted tuberculosis con-
trol strategies, to treat multi-drug resistant tuberculosis,
and for global tuberculosis coordination and surveillance
efforts. In addition, assistance provided using amounts ap-
propriated pursuant to the authorization of appropriations
under clause (i) shall be primarily used in those developing
countries identified by the World Health Organization as
having the highest incidence of tuberculosis, with special
emphasis given to the poorest regions of such countries.
‘‘(iii) Amounts appropriated pursuant to the author-
ization of appropriations under this subparagraph are au-
thorized to remain available until expended.’’.
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