A resolution supporting the goals of World Tuberculosis Day to raise awareness about tuberculosis.

III 117TH CONGRESS 1ST SESSION S. RES. 137 Supporting the goals of World Tuberculosis Day to raise awareness about tuberculosis. IN THE SENATE OF THE UNITED STATES MARCH 25, 2021 Mr. BROWN (for himself and Mr. SULLIVAN) submitted the following resolution; which was referred to the Committee on Foreign Relations RESOLUTION Supporting the goals of World Tuberculosis Day to raise awareness about tuberculosis. Whereas, in 2019, nearly 1⁄4 of the global population was in- fected with the tuberculosis bacterium (referred to in this preamble as ‘‘TB’’); Whereas the World Health Organization (referred to in this preamble as the ‘‘WHO’’) estimates that 10,000,000 peo- ple developed TB in 2019, 8.2 percent of whom were also infected with the human immunodeficiency virus (referred to in this preamble as ‘‘HIV’’); Whereas, in 2019, TB killed an estimated 1,408,000 people, causing more deaths worldwide than any other single in- fectious agent; VerDate Sep 11 2014 00:29 Mar 27, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6300 E:\BILLS\SR137.IS SR137 dlhill on DSK120RN23PROD with BILLS 2 •SRES 137 IS Whereas, globally in 2019, an estimated 1,200,000 children developed TB, and in 2017, 230,000 children died of TB; Whereas 2⁄3 of new TB infections in 2019 occurred in 8 coun- tries: India, Indonesia, China, the Philippines, Pakistan, Nigeria, Bangladesh, and South Africa; Whereas TB is a leading killer of people infected with HIV, and 208,000 people with HIV died of TB in 2019; Whereas vulnerable populations also at high risk for devel- oping TB include individuals who are pregnant and newborns; Whereas, in 2018, TB was one of the 6 leading causes of death among adult women between the ages of 15 and 49 in low-income countries; Whereas, in some settings, women with TB can face stigma, discrimination, and ostracization by their families and communities; Whereas the global TB epidemic and the spread of drug-re- sistant TB present a persistent public health threat to the United States because the disease does not recognize borders; Whereas antibiotic-resistant pathogens are a growing problem worldwide, and drug-resistant TB can occur when the drugs used to treat TB are mismanaged or not made consistently accessible; Whereas studies have demonstrated direct person-to-person transmission of drug-resistant TB; Whereas multi-drug resistant TB (referred to in this pre- amble as ‘‘MDR–TB’’) is caused by bacteria with resist- ance to rifampin and isoniazid, the 2 most potent treat- ments for TB infection; VerDate Sep 11 2014 18:27 Mar 26, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6300 E:\BILLS\SR137.IS SR137 dlhill on DSK120RN23PROD with BILLS 3 •SRES 137 IS Whereas, in 2019, according to the 2020 WHO Global Tu- berculosis Report, an estimated 3.3 percent of all new TB cases and 18 percent of previously treated cases were MDR–TB or rifampin-resistant TB; Whereas, in 2019, an estimated 465,000 people around the world developed MDR–TB or rifampin-resistant TB, yet only approximately 38 percent of those individuals were identified and treated; Whereas extensively drug-resistant TB (referred to in this preamble as ‘‘XDR–TB’’) is a rare type of TB that is re- sistant to nearly all medicines, and therefore can be very difficult and expensive to treat, especially among patients with HIV; Whereas, in 2019, every WHO region reported XDR–TB cases; Whereas, in 2019, the Centers for Disease Control and Pre- vention (referred to in this preamble as ‘‘CDC’’) esti- mated that the average cost of treating a single patient with MDR–TB in the United States was $178,000, and the average cost of treating a patient with XDR–TB was even higher at $553,000, compared with $20,000 to treat a patient with drug-susceptible TB; Whereas, between 2005 and 2007, according to an analysis by CDC, MDR–TB and XDR–TB cases in the United States collectively cost the health care system an esti- mated $53,000,000; Whereas CDC estimates that costs resulting from all forms of TB in the United States totaled more than $608,000,000 in 2019; Whereas, in a 2000 report, the Institute of Medicine found that a decrease in TB control funding and the spread of VerDate Sep 11 2014 18:27 Mar 26, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6300 E:\BILLS\SR137.IS SR137 dlhill on DSK120RN23PROD with BILLS 4 •SRES 137 IS HIV and acquired immune deficiency syndrome (com- monly referred to as ‘‘AIDS’’) caused a resurgence of TB in the late 1980s and early 1990s; Whereas a total of 8,916 TB cases were reported in the United States in 2019, representing all 50 States and the District of Columbia, and up to 13,000,000 people in the United States are estimated to be living with latent TB infection; Whereas 75 percent of States have reported an increase in the proportion of complex cases of TB in recent years due to factors such as homelessness, HIV infection, drug resistance, substance abuse, refugee status, and other factors; Whereas the rate of TB disease in African Americans is 8 times higher than the rate of disease in White, non-His- panic Americans, and significant disparities exist among other minorities in the United States, including Asian Americans, Hispanic Americans, and Native Americans and Alaska Natives, with approximately 88 percent of all reported TB cases in the United States in 2019 occur- ring in racial or ethnic minorities; Whereas smoking— (1) greatly increases the risks of contracting TB and infection recurrence; and (2) impairs therapeutic efficacy; Whereas diabetes is a major risk factor for TB, and people with diabetes are more likely to develop and succumb to TB; Whereas bedaquiline is an antibiotic that boosts an MDR–TB patient’s chance of survival from approximately 50 per- cent to as much as 80 percent, and through a public-pri- VerDate Sep 11 2014 18:27 Mar 26, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6300 E:\BILLS\SR137.IS SR137 dlhill on DSK120RN23PROD with BILLS 5 •SRES 137 IS vate partnership, the United States Agency for Inter- national Development (referred to in this preamble as ‘‘USAID’’) provided approximately 105,000 treatments in 110 eligible countries from 2015 through 2019; Whereas Bacillus Calmette-Guerin, a TB vaccine that is known as ‘‘BCG’’, provides some protection to infants and young children against serious forms of childhood TB but has had little epidemiologic impact on controlling TB worldwide; Whereas there is a critical need for new drugs, diagnostics, and vaccines for controlling the global TB epidemic; Whereas, in September 2018, the United Nations held the first high-level meeting on TB in which 120 countries, in- cluding the United States, signed a political declaration committing to accelerating the TB response, including by increasing funding for TB control programs and research and development efforts, with the goal of reaching all af- fected people with TB prevention and care; Whereas the enactment of the Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/ AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008 (Public Law 110–293; 122 Stat. 2918), and the Comprehensive Tuberculosis Elimination Act of 2008 (Public Law 110–392; 122 Stat. 4195) led to a historic United States commitment to support the global eradi- cation of TB, including a commitment to treat 4,500,000 TB patients and 90,000 MDR–TB patients between 2009 and 2013 and to provide additional treatment through coordinated multilateral efforts; Whereas USAID— VerDate Sep 11 2014 18:27 Mar 26, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6300 E:\BILLS\SR137.IS SR137 dlhill on DSK120RN23PROD with BILLS 6 •SRES 137 IS (1) provides technical assistance to 55 countries and implements bilateral programs in 23 high-burden TB countries that— (A) build capacity; and (B) support the adoption of state-of-the-art TB- related technologies; (2) supports the development of new diagnostic and treatment tools; and (3) supports research to develop new vaccines and other new methods to combat TB; Whereas, in 2018, USAID launched— (1) a new business model entitled ‘‘Global Accel- erator to End Tuberculosis’’ to accelerate progress and build capacity with respect to TB prevention and treat- ment; and (2) a new mechanism to directly support local orga- nizations in priority countries; Whereas TB incidence in the countries that receive bilateral TB funding from the United States through USAID has decreased by more than 29 percent since 2000; Whereas, according to the Copenhagen Consensus Center, TB prevention programs return $56 for each dollar invested, which is one of the highest returns on investment of any health intervention; Whereas CDC, in partnership with other entities of the United States and individual States and territories— (1) directs the national TB elimination program; (2) coordinates TB surveillance, technical assistance, and prevention activities; and (3) helps to support the development of new diag- nostic, treatment, and prevention tools to combat TB; VerDate Sep 11 2014 18:27 Mar 26, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6300 E:\BILLS\SR137.IS SR137 dlhill on DSK120RN23PROD with BILLS 7 •SRES 137 IS Whereas the National Institutes of Health, through its many institutes and centers, plays the leading role in basic and clinical research on the identification, treatment, and pre- vention of TB; Whereas the Global Fund to Fight AIDS, Tuberculosis and Malaria (referred to in this preamble as the ‘‘Global Fund’’), to which the United States is a top financial donor, provides more than 73 percent of all international financing for TB programs; Whereas, in 2019, Global Fund-supported programs detected and treated more than 5,700,000 cases of TB; Whereas the coronavirus disease 2019 (COVID–19) pandemic and mitigation efforts put in place as a result of the pan- demic have taken a devastating toll on countries with the highest burden of TB disease and on the global TB re- sponse, threatening to reverse up to 8 years of progress fighting the disease; Whereas, in 2020, in the 23 high-burden TB countries in which USAID implements bilateral programs, 1,000,000 fewer people with TB had access to diagnosis and treat- ment, a 23 percent decline from 2019; Whereas, between 2020 and 2025, global projections estimate that the impact of the COVID–19 pandemic will lead to an additional 6,300,000 cases of TB and an additional 1,400,000 TB deaths; and Whereas March 24, 2021, is World Tuberculosis Day, a day that commemorates the date in 1882 on which Dr. Rob- ert Koch announced his discovery of Mycobacterium tu- berculosis, the bacterium that causes TB: Now, therefore, be it Resolved, That the Senate— 1 VerDate Sep 11 2014 18:27 Mar 26, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\SR137.IS SR137 dlhill on DSK120RN23PROD with BILLS 8 •SRES 137 IS (1) supports the goals of World Tuberculosis 1 Day to raise awareness about tuberculosis; 2 (2) commends the progress of tuberculosis 3 elimination efforts by entities that include the 4 United States Agency for International Develop- 5 ment, the Centers for Disease Control and Preven- 6 tion, the National Institutes of Health, the World 7 Health Organization, and the Global Fund to Fight 8 AIDS, Tuberculosis and Malaria; and 9 (3) reaffirms the commitment to strengthen the 10 leadership role of the United States in, and the ef- 11 fectiveness of the global response to, the fight to end 12 the tuberculosis epidemic. 13 Æ VerDate Sep 11 2014 18:27 Mar 26, 2021 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6301 E:\BILLS\SR137.IS SR137 dlhill on DSK120RN23PROD with BILLS