End Neglected Tropical Diseases Act

IIB 116TH CONGRESS 1ST SESSION H. R. 3460 IN THE SENATE OF THE UNITED STATES DECEMBER 4, 2019 Received; read twice and referred to the Committee on Foreign Relations AN ACT To facilitate effective research on and treatment of neglected tropical diseases through coordinated international efforts. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 VerDate Sep 11 2014 21:50 Dec 04, 2019 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H3460.RFS H3460 kjohnson on DSK79L0C42 with BILLS 2 HR 3460 RFS SECTION 1. SHORT TITLE. 1 This Act may be cited as the ‘‘End Neglected Trop- 2 ical Diseases Act’’. 3 SEC. 2. TABLE OF CONTENTS. 4 The table of contents for this Act is as follows: 5 Sec. 1. Short title. Sec. 2. Table of contents. Sec. 3. Statement of policy. Sec. 4. Findings. Sec. 5. Definition. Sec. 6. Rule of construction. Sec. 7. Expansion of United States Agency for International Development Ne- glected Tropical Diseases Program. Sec. 8. Actions by Department of State. Sec. 9. Multilateral development and health institutions. SEC. 3. STATEMENT OF POLICY. 6 It is the policy of the United States to support a 7 broad range of implementation and research and develop- 8 ment activities that work toward the achievement of cost- 9 effective and sustainable treatment, control, and, where 10 possible, elimination of neglected tropical diseases for the 11 economic and social well-being of all people. 12 SEC. 4. FINDINGS. 13 Congress finds the following: 14 (1) The World Health Organization (WHO) has 15 identified 17 neglected tropical diseases (NTDs). 16 Approximately 2 billion people, almost one-third of 17 the world’s population, are at risk of contracting an 18 NTD, and more than 1.4 billion people are currently 19 afflicted with 1 or more NTDs. 20 VerDate Sep 11 2014 21:50 Dec 04, 2019 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H3460.RFS H3460 kjohnson on DSK79L0C42 with BILLS 3 HR 3460 RFS (2) In 2013, WHO adopted a comprehensive 1 resolution on NTDs recognizing that increased na- 2 tional and international investments in prevention 3 and control of neglected tropical diseases have suc- 4 ceeded in improving health and social well-being in 5 many countries. 6 (3) NTDs have an enormous impact in terms of 7 disease burden and quality of life. NTDs cause the 8 loss of up to 534,000 lives and 57 million disability- 9 adjusted life-years each year. NTDs surpass both 10 malaria and tuberculosis in causing greater loss of 11 life-years to disability and premature death. Many 12 NTDs cause disfigurement and disability, leading to 13 stigma, social discrimination, and societal 14 marginalization. 15 (4) NTDs create an economic burden of billions 16 of dollars through the loss of productivity and high 17 costs of health care required for treatment. People 18 afflicted by NTDs are less productive than their 19 healthy counterparts. NTDs jeopardize the ability of 20 people to attend work and school, or to produce at 21 full capacity. For example, controlling one NTD, 22 hookworm, in children can result in a 43-percent in- 23 crease in future wage earnings. 24 VerDate Sep 11 2014 21:50 Dec 04, 2019 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H3460.RFS H3460 kjohnson on DSK79L0C42 with BILLS 4 HR 3460 RFS (5) The social, economic, and health burden of 1 NTDs falls primarily on low- and middle-income 2 countries, where access to safe water, sanitation, 3 and health care is limited. At least 100 countries 4 face 2 endemic NTD burdens, and 30 countries 5 carry 6 or more endemic NTDs. 6 (6) NTDs are not confined to the developing 7 world, however. Several NTD outbreaks have been 8 reported in the United States and other developed 9 countries, especially among the poor. In the United 10 States, NTDs disproportionately affect people living 11 in poverty, and especially minorities, including up to 12 2.8 million African Americans with toxocariasis and 13 300,000 or more people, mostly Hispanic Americans, 14 with Chagas disease. 15 (7) Many NTDs can be controlled, prevented, 16 and even eliminated using low-cost, effective, and 17 feasible solutions. Understanding the economic bur- 18 den of NTDs on productivity and health care costs 19 can help to assure governments and donors that the 20 resources directed toward NTDs represent a good 21 investment. 22 (8) Research and development efforts are imme- 23 diately needed for all NTDs, especially those for 24 which limited or no treatment currently exists. 25 VerDate Sep 11 2014 21:50 Dec 04, 2019 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H3460.RFS H3460 kjohnson on DSK79L0C42 with BILLS 5 HR 3460 RFS (9) Critical to developing robust NTD control 1 strategies are epidemiological data that identify at- 2 risk populations, ensure appropriate treatment fre- 3 quency, and inform decisions about when treatment 4 can be reduced or stopped. 5 (10) Of the 14 most common NTDs, roughly 6 80 percent of infections are caused by soil-trans- 7 mitted helminths (STH) and schistosomiasis. STH 8 are a group of 3 parasitic worms (roundworms, 9 whipworms, and hookworms) that afflict more than 10 1 billion people worldwide, including 600 million 11 school-age children, of whom more than 300 million 12 suffer from severe morbidity. Schistosomiasis is an- 13 other helminth infection affecting at least 200 mil- 14 lion people in developing countries, but some esti- 15 mates indicate that the true number of people af- 16 fected may be double or even triple that number. 17 (11) The benefits of deworming are immediate 18 and enduring. A rigorous randomized controlled trial 19 has shown school-based deworming treatment to re- 20 duce school absenteeism by 25 percent. School-based 21 deworming also benefits young siblings and other 22 children who live nearby but are too young to be 23 treated, leading to large cognitive improvements 24 equivalent to half a year of schooling. 25 VerDate Sep 11 2014 21:50 Dec 04, 2019 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H3460.RFS H3460 kjohnson on DSK79L0C42 with BILLS 6 HR 3460 RFS SEC. 5. DEFINITION. 1 In this Act, the term ‘‘neglected tropical diseases’’ or 2 ‘‘NTDs’’— 3 (1) means infections caused by pathogens, in- 4 cluding viruses, bacteria, protozoa, and helminths 5 that disproportionately impact individuals living in 6 extreme poverty, especially in developing countries; 7 and 8 (2) includes— 9 (A) Buruli ulcer (Mycobacterium Ulcerans 10 infection); 11 (B) Chagas disease; 12 (C) dengue or severe dengue fever; 13 (D) dracunculiasis (Guinea worm disease); 14 (E) echinococcosis; 15 (F) foodborne trematodiases; 16 (G) human African trypanosomiasis (sleep- 17 ing sickness); 18 (H) leishmaniasis; 19 (I) leprosy; 20 (J) lymphatic filariasis (elephantiasis); 21 (K) onchocerciasis (river blindness); 22 (L) scabies; 23 (M) schistosomiasis; 24 (N) soil-transmitted helminthiases (STH) 25 (roundworm, whipworm, and hookworm); 26 VerDate Sep 11 2014 21:50 Dec 04, 2019 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H3460.RFS H3460 kjohnson on DSK79L0C42 with BILLS 7 HR 3460 RFS (O) taeniasis/cysticercosis; 1 (P) trachoma; and 2 (Q) yaws (endemic treponematoses). 3 SEC. 6. RULE OF CONSTRUCTION. 4 Nothing in this Act shall be construed to increase au- 5 thorizations of appropriations for the United States Agen- 6 cy for International Development. 7 SEC. 7. EXPANSION OF UNITED STATES AGENCY FOR 8 INTERNATIONAL DEVELOPMENT NEGLECTED 9 TROPICAL DISEASES PROGRAM. 10 (a) FINDINGS.—Congress finds the following: 11 (1) Since fiscal year 2006, the United States 12 Government has been an essential leader in global 13 efforts to control seven targeted neglected tropical 14 diseases: lymphatic filariasis (elephantiasis), 15 onchocerciasis (river blindness), schistosomiasis, soil- 16 transmitted helminthiases (roundworm, whipworm, 17 and hookworm), and trachoma. Additional informa- 18 tion suggests that such efforts could also produce 19 collateral benefits for at least three other neglected 20 tropical diseases: foodborne trematodiases, scabies, 21 and yaws (endemic treponematoses). 22 (2) The United States Government is a partner 23 in the London Declaration on Neglected Tropical 24 Diseases (2012), which represents a new, coordi- 25 VerDate Sep 11 2014 21:50 Dec 04, 2019 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H3460.RFS H3460 kjohnson on DSK79L0C42 with BILLS 8 HR 3460 RFS nated international push to accelerate progress to- 1 ward eliminating or controlling 10 NTDs by 2020. 2 (3) While many of the most common NTDs 3 have safe, easy to use, and effective treatments, 4 treatment options for the NTDs with the highest 5 death rates, including human African 6 trypanosomiasis (sleeping sickness), visceral leishma- 7 niasis, and Chagas disease, are extremely limited. 8 (4) The United States Agency for International 9 Development (USAID) Neglected Tropical Diseases 10 Program has made important and substantial con- 11 tributions to the global fight to control and eliminate 12 5 of the most common NTDs. Leveraging more than 13 $15,700,000,000 in donated medicines, USAID has 14 supported the distribution of more than 1 billion 15 treatments in 31 countries across Africa, Asia, and 16 Latin America and the Caribbean. 17 (5) Since 2014, the USAID Neglected Tropical 18 Diseases Program has been investing in research 19 and development for the treatment of certain NTDs 20 to ensure that promising new breakthrough medi- 21 cines can be rapidly evaluated, registered, and made 22 available to patients. 23 (6) The USAID Neglected Tropical Diseases 24 Program is a clear example of a successful public- 25 VerDate Sep 11 2014 21:50 Dec 04, 2019 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H3460.RFS H3460 kjohnson on DSK79L0C42 with BILLS 9 HR 3460 RFS private partnership between the Government and the 1 private sector and should be judiciously expanded, as 2 practicable and appropriate. 3 (b) SENSE OF CONGRESS.—It is the sense of Con- 4 gress that the USAID Neglected Tropical Diseases Pro- 5 gram, as in effect on the date of the enactment of this 6 Act, should— 7 (1) provide integrated drug treatment packages 8 to as many individuals suffering from NTDs or at 9 risk of acquiring NTDs, including individuals dis- 10 placed by manmade and natural disasters, as 11 logistically feasible; 12 (2) better integrate NTD control and treatment 13 tools and approaches into complementary develop- 14 ment and global health programs by coordinating, to 15 the extent practicable and appropriate, across mul- 16 tiple sectors, including those relating to HIV/AIDS, 17 malaria, tuberculosis, education, nutrition, other in- 18 fectious diseases, maternal and child health, and 19 water, sanitation, and hygiene; 20 (3) establish low-cost, high-impact community- 21 and school-based NTD programs to reach large at- 22 risk populations, including school-age children, with 23 integrated drug treatment packages, as feasible; 24 VerDate Sep 11 2014 21:50 Dec 04, 2019 Jkt 099200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H3460.RFS H3460 kjohnson on DSK79L0C42 with BILLS 10 HR 3460 RFS (4) as opportunities emerge and resources 1 allow, engage in research and development of new 2 tools and approaches to reach the goals relating to 3 the elimination of NTDs as set forth by the 2012 4 World Health Organization publication ‘‘Accel- 5 erating Work to Overcome the Global Impact of Ne- 6 glected Tropical Diseases: A Roadmap for Imple- 7 mentation’’, including for Chagas disease, Guinea 8 worm, human African trypanosomiasis (sleeping 9 sickness), leprosy, and visceral leishmaniasis; and 10 (5) monitor research on and developments in 11 the prevention and treatment of other NTDs so 12 breakthroughs can be incorporated into the USAID 13 Neglected Tropical Diseases Program, as practicable 14 and appropriate. 15 (c) PROGRAM PRIORITIES.—The Administrator of 16 USAID should incorporate the following priorities into the 17 USAID Neglected Tropical Diseases Program (as in effect 18 on the date of the enactment of this Act): 19 (1) Planning for and conducting robust moni- 20 toring and evaluation of program investments in 21 order to accurately measure impact, identify and 22 share lessons learned, and inform future NTD con- 23 trol and elimination strategies. 24 VerDate Sep 11 2014 21:50 Dec 04, 2019 Jkt 099200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H3460.RFS H3460 kjohnson on DSK79L0C42 with BILLS 11 HR 3460 RFS (2) Coordinating program activities with com- 1 plementary USAID development and global health 2 programs, including programs relating to water, 3 sanitation, and hygiene, food and nutrition security, 4 and education (both primary and secondary), in 5 order to advance the goals of the London Declara- 6 tion on Neglected Tropical Diseases (2012). 7 (3) Including morbidity management in treat- 8 ment plans for high-burden NTDs. 9 (4) Incorporating NTDs included in the Global 10 Burden of Disease Study 2010 into the program as 11 opportunities emerge, to the extent practicable and 12 appropriate. 13 (5) Continuing investments in the research and 14 development of new tools and approaches that com- 15 plement existing research investments and ensure 16 that new discoveries make it through the pipeline 17 and become available to individuals who need them 18 most. 19 SEC. 8. ACTIONS BY DEPARTMENT OF STATE. 20 (a) OFFICE OF THE GLOBAL AIDS COORDINATOR.— 21 It is the sense of Congress that the Coordinator of United 22 States Government Activities to Combat HIV/AIDS Glob- 23 ally should fully consider evolving research on the impact 24 of NTDs on efforts to control HIV/AIDS when making 25 VerDate Sep 11 2014 21:50 Dec 04, 2019 Jkt 099200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H3460.RFS H3460 kjohnson on DSK79L0C42 with BILLS 12 HR 3460 RFS future programming decisions, as necessary and appro- 1 priate. 2 (b) GLOBAL PROGRAMMING.— 3 (1) IN GENERAL.—The Secretary of State 4 should encourage the Global Fund to take into con- 5 sideration evolving research on the impact of NTDs 6 on efforts to control HIV/AIDS when making pro- 7 gramming decisions, particularly with regard to fe- 8 male genital schistosomiasis, which studies suggest 9 may be one of the most significant cofactors in the 10 AIDS epidemic in Africa, as necessary and appro- 11 priate. 12 (2) GLOBAL FUND.—In this subsection, the 13 term ‘‘Global Fund’’ means the public-private part- 14 nership known as the Global Fund to Fight AIDS, 15 Tuberculosis and Malaria established pursuant to 16 Article 80 of the Swiss Civil Code. 17 (c) G–20 COUNTRIES.—The Secretary o [Text truncated for display. 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