End Tuberculosis Now Act of 2019

II 116TH CONGRESS 1ST SESSION S. 2438 To prevent, treat, and cure tuberculosis globally. IN THE SENATE OF THE UNITED STATES AUGUST 1, 2019 Mr. MENENDEZ (for himself and Mr. YOUNG) introduced the following bill; which was read twice and referred to the Committee on Foreign Relations A BILL To prevent, treat, and cure tuberculosis globally. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘End Tuberculosis Now 4 Act of 2019’’. 5 SEC. 2. FINDINGS. 6 Congress makes the following findings: 7 (1) Tuberculosis is a preventable, treatable, and 8 curable airborne infection; however more than 25 9 years after the World Health Organization declared 10 tuberculosis a public health emergency and called on 11 countries to make scaling up tuberculosis control a 12 VerDate Sep 11 2014 00:25 Aug 17, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S2438.IS S2438 lotter on DSKBCFDHB2PROD with BILLS 2 •S 2438 IS priority, tuberculosis still kills more people world- 1 wide than any other infectious disease, and is the 2 leading killer of people living with HIV/AIDS. 3 (2) In 2017, 10,000,000 people became ill with 4 tuberculosis, 10 percent of whom were children, and 5 1,600,000 people died from the disease. In order to 6 achieve the goals of the World Health Organization 7 End TB Strategy by 2035, new tools must be devel- 8 oped and made available. 9 (3) Over one-third of people who become ill with 10 tuberculosis may be undiagnosed, misdiagnosed, or 11 treated but not reported, resulting in unnecessary 12 illness, communicable infections, and increased mor- 13 tality. 14 (4) Failure to properly treat tuberculosis can 15 cause treatment failure and death, and exacerbates 16 antimicrobial resistance, increasing multi-drug-re- 17 sistant tuberculosis (MDR–TB) and extensively 18 drug-resistant tuberculosis (XDR–TB), which are 19 significantly costlier and more difficult to treat than 20 drug-sensitive tuberculosis and can also be trans- 21 mitted from person-to-person, increasing the likeli- 22 hood that drug-resistant tuberculosis will spread to 23 new geographic areas. 24 VerDate Sep 11 2014 23:29 Aug 15, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S2438.IS S2438 lotter on DSKBCFDHB2PROD with BILLS 3 •S 2438 IS (5) Globally, only about half of the 1 $13,000,000,000 required annually as outlined in 2 the Stop TB Partnership’s Global Plan to End TB 3 for tuberculosis prevention, diagnosis, and treatment 4 is currently available. 5 (6) There is an annual $1,300,000,000 gap in 6 funding needed for the development of vaccines, ad- 7 ditional rapid, point-of-care diagnostic tests, and 8 shorter, less toxic treatments which would facilitate 9 patient adherence to treatment regimens, reduce 10 program costs, and mitigate the growing threat of 11 drug-resistant tuberculosis. The United States Gov- 12 ernment continues to be a lead funder of global tu- 13 berculosis research and development, contributing 40 14 percent of the total $772,000,000 in global funding 15 in 2017, and can catalyze more investments from 16 other countries. 17 (7) The rate of new cases of tuberculosis in 18 countries that receive United States bilateral assist- 19 ance for tuberculosis prevention, treatment, and con- 20 trol has fallen by one quarter since 2000 dem- 21 onstrating the effectiveness of United States pro- 22 grams and activities. 23 (8) In September 2018, United Nations Mem- 24 ber States in the first United National High Level 25 VerDate Sep 11 2014 23:29 Aug 15, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S2438.IS S2438 lotter on DSKBCFDHB2PROD with BILLS 4 •S 2438 IS Meeting on Tuberculosis committed to ‘‘ending the 1 epidemic in all countries, and pledge[d] to provide 2 leadership and to work together to accelerate our na- 3 tional and global collective actions, investments, and 4 innovations urgently to fight this preventable and 5 treatable disease,’’ as reflected in United Nations 6 General Assembly Resolution A/RES/73/3. 7 (9) On September 26, 2018, the United Na- 8 tions convened the first High Level Meeting on Tu- 9 berculosis, where 120 countries signed a Political 10 Declaration to accelerate progress against tuber- 11 culosis, including commitments to increase funding 12 for tuberculosis control and research and develop- 13 ment programs, as well as ambitious goals to suc- 14 cessfully treat 40,000,000 people with tuberculosis 15 and prevent at least 30,000,000 from becoming ill 16 between 2018 and 2022. 17 (10) On September 26, 2018, the Administrator 18 for the United States Agency for International De- 19 velopment (USAID) announced a new business 20 model to support the fight to end tuberculosis (TB). 21 Through $30,000,000 in funding and a new per- 22 formance-based Global Accelerator to End TB, 23 USAID will catalyze investments to meet the target 24 set by the United Nations High-Level Meeting on 25 VerDate Sep 11 2014 00:25 Aug 17, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S2438.IS S2438 lotter on DSKBCFDHB2PROD with BILLS 5 •S 2438 IS tuberculosis of treating 40,000,000 people with the 1 disease by 2022. The Accelerator will increase sup- 2 port to governments and local partners as part of a 3 multisectoral approach to ending tuberculosis. 4 (11) It is essential that existing funding for tu- 5 berculosis programs be allocated prudently, and with 6 an emphasis on coordination, to ensure that efforts 7 among United States agencies, partner nations, 8 international organizations, nongovernmental organi- 9 zations, both faith-based and non-faith-based, the 10 private sector and other actors are complementary 11 and not duplicative. Improved data on tuberculosis, 12 access to services, accountability, and program qual- 13 ity can help ensure funding gets to where it is most 14 needed. 15 (12) If progress does not accelerate, the global 16 tuberculosis epidemic, particularly increasing cases 17 of MDR–TB and XDR–TB, where many cases are 18 not curable and vastly more costly to treat, could 19 erase decades of progress in global efforts to end 20 both tuberculosis and HIV/AIDS, much of which has 21 been achieved with United States investment. 22 VerDate Sep 11 2014 23:29 Aug 15, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S2438.IS S2438 lotter on DSKBCFDHB2PROD with BILLS 6 •S 2438 IS SEC. 3. UNITED STATES GOVERNMENT ACTIONS TO END 1 TUBERCULOSIS. 2 Section 104B of the Foreign Assistance Act of 1961 3 (22 U.S.C. 2151b–3(g)) is amended by striking sub- 4 sections (a) through (h) and inserting the following new 5 subsections: 6 ‘‘(a) FINDINGS.—Congress makes the following find- 7 ings: 8 ‘‘(1) Congress recognizes the continuing chal- 9 lenge of the international tuberculosis epidemic and 10 the deadly impact of its continued existence. 11 ‘‘(2) The means exist to detect, treat, prevent, 12 and cure tuberculosis to a large extent, but not 13 enough to ensure ending it, due to inadequate means 14 of diagnosis, prevention, and treatment. 15 ‘‘(3) Absent accelerated efforts to address tu- 16 berculosis and increased domestic mobilization of re- 17 sources from high-burden tuberculosis countries, tar- 18 gets set forth in the End TB Strategy will not be 19 met. 20 ‘‘(b) POLICY.—It is a major objective of the foreign 21 assistance program of the United States to help end the 22 global tuberculosis epidemic through actions to diagnose 23 and treat all adults and children with all forms of tuber- 24 culosis, including tuberculosis infection, and to prevent 25 new tuberculosis infections in adults and children. In all 26 VerDate Sep 11 2014 23:29 Aug 15, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S2438.IS S2438 lotter on DSKBCFDHB2PROD with BILLS 7 •S 2438 IS countries in which the United States Government has es- 1 tablished development programs, particularly in countries 2 with the highest burden of tuberculosis and other coun- 3 tries with high rates of tuberculosis, it is the policy of the 4 United States to— 5 ‘‘(1) support the objectives of the World Health 6 Organization End TB Strategy, including goals to— 7 ‘‘(A) reduce by 95 percent tuberculosis 8 deaths by 2035; 9 ‘‘(B) reduce by 90 percent the tuberculosis 10 incidence rate by 2035; and 11 ‘‘(C) reduce by 100 percent the number of 12 families facing catastrophic health costs due to 13 tuberculosis by 2035; 14 ‘‘(2) support the Stop TB Partnership’s Global 15 Plan to End TB 2016–2020, including support 16 for— 17 ‘‘(A) development and use of innovative 18 new technologies and therapies to increase ac- 19 tive case finding to rapidly diagnose and treat 20 children and adults with all forms of tuber- 21 culosis, alleviate suffering, and ensure tuber- 22 culosis treatment completion; 23 ‘‘(B) the diagnosis and treatment of latent 24 tuberculosis infection, in support of the global 25 VerDate Sep 11 2014 23:29 Aug 15, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S2438.IS S2438 lotter on DSKBCFDHB2PROD with BILLS 8 •S 2438 IS goal of providing preventive therapy to at least 1 30,000,000 people, including 4,000,000 children 2 under five years of age, 20,000,000 household 3 contacts of people affected by tuberculosis, and 4 6,000,000 people living with HIV, by 2022; 5 ‘‘(C) steps to ensure high-quality tuber- 6 culosis care by closing gaps in care cascades, 7 implementing continuous quality improvement 8 at all levels of care, and providing patient sup- 9 port; and 10 ‘‘(D) sustainable procurement of tuber- 11 culosis commodities, to avoid interruptions in 12 supply, procurement of commodities of un- 13 known quality, or payment of excessive com- 14 modity costs in countries impacted by tuber- 15 culosis; 16 ‘‘(3) ensure United States funding supports ac- 17 tivities that simultaneously emphasize— 18 ‘‘(A) the development of comprehensive 19 person-centered programs which include diag- 20 nosis, treatment, and prevention strategies to 21 ensure that those at high risk for infection are 22 found and treated with preventive therapies in 23 a timely manner; 24 VerDate Sep 11 2014 23:29 Aug 15, 2019 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S2438.IS S2438 lotter on DSKBCFDHB2PROD with BILLS 9 •S 2438 IS ‘‘(B) robust tuberculosis infection control 1 practices in all congregate settings, including 2 hospitals and prisons; 3 ‘‘(C) the deployment of diagnostic and 4 treatment capacity in areas with the highest tu- 5 berculosis burdens, as well as for highly at-risk 6 and impoverished populations, including patient 7 support; 8 ‘‘(D) program monitoring and evaluation 9 based on critical tuberculosis indicators, includ- 10 ing infection control, the numbers of patients 11 accessing tuberculosis treatment, along with pa- 12 tient support, and preventative therapy for 13 those at risk, including all close contacts, as 14 well as treatment completion for all forms of tu- 15 berculosis; 16 ‘‘(E) training health care workers on the 17 use of new diagnostic tools and therapies as 18 they become available; 19 ‘‘(F) coordination with domestic agencies 20 on an aggressive research agenda to develop 21 vaccines as well as new tools to diagnose, treat, 22 and prevent tuberculosis globally; 23 ‘‘(G) linkages with the private sector on 24 improved diagnosis and treatment of tuber- 25 VerDate Sep 11 2014 23:29 Aug 15, 2019 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S2438.IS S2438 lotter on DSKBCFDHB2PROD with BILLS 10 •S 2438 IS culosis, training for healthcare professionals on 1 use of the most effective diagnostic and thera- 2 peutic tools, and research in the areas of vac- 3 cine development as well as the development of 4 therapeutics and diagnostic tools; 5 ‘‘(H) efforts to address barriers to patients 6 seeking care including stigma and costs related 7 to diagnosis and treatment; 8 ‘‘(I) efforts to address human rights-re- 9 lated barriers to tuberculosis services, includ- 10 ing— 11 ‘‘(i) training health workers; 12 ‘‘(ii) sensitizing policy makers; 13 ‘‘(iii) legal literacy and patient em- 14 powerment campaigns; 15 ‘‘(iv) strengthening legal services; and 16 ‘‘(v) monitoring laws and policies; and 17 ‘‘(J) the establishment of independent ac- 18 countability mechanisms and inclusive country 19 level systems to measure progress and ensure 20 that commitments made by governments and 21 relevant stakeholders are met. 22 ‘‘(c) AUTHORIZATION.—To carry out this section and 23 consistent with section 104(c), the President is authorized 24 to furnish assistance, on such terms and conditions as the 25 VerDate Sep 11 2014 23:29 Aug 15, 2019 Jkt 089200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S2438.IS S2438 lotter on DSKBCFDHB2PROD with BILLS 11 •S 2438 IS President may determine, for the prevention, treatment, 1 control, and elimination of tuberculosis. 2 ‘‘(d) GOALS.—In consultation with the appropriate 3 congressional committees, the President shall establish 4 new goals for United States efforts, based on the policy 5 and indicators described in subsection (b), to reach, cure, 6 and prevent all forms of tuberculosis globally over the 5- 7 year period following the date of the enactment of this 8 subsection by updating the United States Government Tu- 9 berculosis Strategy (2015–2019) and the National Action 10 Plan for Combatting Multidrug-Resistant Tuberculosis. 11 ‘‘(e) COORDINATION.— 12 ‘‘(1) IN GENERAL.—In carrying out this sec- 13 tion, the President shall coordinate with the World 14 Health Organization, the Stop TB Partnership, the 15 Global Fund to Fight AIDS, Tuberculosis, and Ma- 16 laria, and other organizations with respect to the de- 17 velopment and implementation of a comprehensive 18 tuberculosis response program. 19 ‘‘(2) BILATERAL ASSISTANCE.—In providing bi- 20 lateral assistance under this section, the President, 21 acting through the Administrator of the United 22 States Agency for International Development, 23 shall— 24 VerDate Sep 11 2014 23:29 Aug 15, 2019 Jkt 089200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S2438.IS S2438 lotter on DSKBCFDHB2PROD with BILLS 12 •S 2438 IS ‘‘(A) coordinate and catalyze intensified 1 international tuberculosis research and develop- 2 ment, prevention, diagnosis, treatment, and 3 control efforts, particularly to reduce the inci- 4 dence of, and mortality from, all forms of drug 5 resistant tuberculosis; and 6 ‘‘(B) ensure coordination among relevant 7 United States Government agencies and pro- 8 grams, including the Centers for Disease Con- 9 trol and Prevention, the National Institutes of 10 Health, the Biomedical Advanced Research [Text truncated for display. 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