End Neglected Tropical Diseases Act

II 116TH CONGRESS 1ST SESSION S. 2481 To facilitate effective research on and treatment of neglected tropical diseases through coordinated domestic and international efforts. IN THE SENATE OF THE UNITED STATES SEPTEMBER 17, 2019 Mr. BROWN (for himself and Mr. WICKER) introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions A BILL To facilitate effective research on and treatment of neglected tropical diseases through coordinated domestic and inter- national efforts. 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 Neglected Trop- 4 ical Diseases Act’’. 5 SEC. 2. TABLE OF CONTENTS. 6 The table of contents for this Act is as follows: 7 Sec. 1. Short title. Sec. 2. Table of contents. Sec. 3. Statement of policy. Sec. 4. Findings. VerDate Sep 11 2014 18:20 Sep 19, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6211 E:\BILLS\S2481.IS S2481 kjohnson on DSK79L0C42 with BILLS 2 •S 2481 IS Sec. 5. Definitions. Sec. 6. Rule of construction. TITLE I—FOREIGN AFFAIRS Sec. 101. United States Agency for International Development Neglected Trop- ical Diseases Program. Sec. 102. Actions by Department of State. Sec. 103. Multilateral development and health institutions. TITLE II—DEPARTMENT OF HEALTH AND HUMAN SERVICES Sec. 201. Promoting efforts through interagency working groups and inter- national forums. Sec. 202. Report on neglected tropical diseases in the United States. Sec. 203. Centers of excellence. Sec. 204. Panel on worm infection solutions. SEC. 3. STATEMENT OF POLICY. 1 It is the policy of the United States to support a 2 broad range of implementation and research and develop- 3 ment activities that work toward the achievement of cost- 4 effective and sustainable treatment, control and, where 5 possible, elimination of neglected tropical diseases for the 6 economic and social well-being of all people. 7 SEC. 4. FINDINGS. 8 Congress finds the following: 9 (1) The Centers for Disease Control and Pre- 10 vention have identified 17 neglected tropical diseases 11 (referred to in this section as ‘‘NTDs’’). Approxi- 12 mately 2,000,000,000 people are at risk of con- 13 tracting an NTD, and more than 1,040,000,000 14 people are currently afflicted with 1 or more NTDs. 15 (2) In 2012, the London Declaration on Ne- 16 glected Tropical Diseases identified 10 NTDs with 17 VerDate Sep 11 2014 18:20 Sep 19, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S2481.IS S2481 kjohnson on DSK79L0C42 with BILLS 3 •S 2481 IS the potential to be controlled, eliminated, or eradi- 1 cated by 2020. 2 (3) In 2013, the World Health Organization 3 (referred to in this section as ‘‘WHO’’) adopted a 4 comprehensive resolution on NTDs, recognizing that 5 increased national and international investments in 6 prevention and control of these diseases have suc- 7 ceeded in improving health and social well-being in 8 many countries. WHO’s World Health Assembly 9 maintains and updates a list of the diverse NTDs 10 across the world. 11 (4) In its fourth Update Report, published in 12 2017, WHO reported significant progress in expand- 13 ing NTD interventions worldwide, but challenges 14 continue in— 15 (A) developing improved evaluation and 16 surveillance tools; and 17 (B) maintaining sufficient funding to en- 18 sure that progress is sustained. 19 (5) NTDs have an enormous impact in terms of 20 disease burden and quality of life. NTDs cause the 21 loss of up to 185,000 lives and up to 2,500,000,000 22 disability-adjusted life years each year. NTDs sur- 23 pass both malaria and tuberculosis in causing great- 24 er loss of life-years to disability and premature 25 VerDate Sep 11 2014 18:20 Sep 19, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S2481.IS S2481 kjohnson on DSK79L0C42 with BILLS 4 •S 2481 IS death. Many NTDs cause disfigurement and dis- 1 ability, in addition to significant morbidity and mor- 2 tality, leading to stigma, social discrimination, and 3 societal marginalization. 4 (6) NTDs create an economic burden of billions 5 of dollars through the loss of productivity and high 6 costs of health care required for treatment. People 7 afflicted by NTDs are less productive than their 8 healthy counterparts. NTDs jeopardize the ability of 9 people to attend work and school, or to produce at 10 full capacity. For example, controlling 1 NTD 11 (hookworm) in children can result in a 43 percent 12 increase in future wage earnings. 13 (7) The social, economic, and health burden of 14 NTDs falls primarily on low- and middle-income 15 countries, where access to safe water, sanitation, 16 and health care is limited. At least 100 countries 17 face 2 endemic NTD burdens, and 30 countries 18 carry six or more endemic NTDs. All low-income 19 countries are affected by at least 5 NTDs, and 149 20 countries and territories are affected by at least 1 21 NTD. 22 (8) NTDs are not confined to the developing 23 world. Several NTDs have been reported in the 24 United States and other developed countries. In the 25 VerDate Sep 11 2014 18:20 Sep 19, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S2481.IS S2481 kjohnson on DSK79L0C42 with BILLS 5 •S 2481 IS United States, NTDs disproportionately affect com- 1 munities of color and the poor, with up to 2,850,000 2 African-Americans suffering from toxocariasis and 3 at least 300,000 people, who are mostly Hispanic- 4 Americans, are afflicted with Chagas disease. 5 (9) Many NTDs can be controlled, prevented, 6 and even eliminated using low-cost, effective, and 7 feasible solutions. Understanding the economic bur- 8 den of NTDs on productivity and health care costs 9 can help to assure governments and donors that the 10 resources directed toward NTDs represent a good 11 investment. 12 (10) Research and development efforts are im- 13 mediately needed for all NTDs, especially to advance 14 next-generation treatments, interventions, and 15 diagnostics to ensure that countries endemic for 16 NTDs are able to implement and sustain NTD con- 17 trol programs. 18 (11) Epidemiological data that identify at-risk 19 populations and ensure that these populations re- 20 ceive consistent and sufficient doses of treatment for 21 their diseases are critical to developing robust NTD 22 control strategies. 23 (12) The benefits of deworming are immediate. 24 A rigorous, randomized controlled trial has shown 25 VerDate Sep 11 2014 18:20 Sep 19, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S2481.IS S2481 kjohnson on DSK79L0C42 with BILLS 6 •S 2481 IS school-based deworming treatment to reduce school 1 absenteeism by 25 percent. School-based deworming 2 also benefits young siblings and other children who 3 live nearby but are too young to be treated, leading 4 to large cognitive improvements equivalent to 1⁄2 of 5 a year of schooling. 6 (13) Improved access to water, sanitation, and 7 hygiene can also reduce the transmission of NTDs, 8 particularly NTDs caused by parasites. 9 SEC. 5. DEFINITIONS. 10 In this Act: 11 (1) GLOBAL FUND.—The term ‘‘Global Fund’’ 12 means the public-private partnership known as the 13 Global Fund to Fight AIDS, Tuberculosis, and Ma- 14 laria established pursuant to Article 80 of the Swiss 15 Civil Code. 16 (2) NEGLECTED TROPICAL DISEASES; NTDS.— 17 The terms ‘‘neglected tropical diseases’’ and 18 ‘‘NTDs’’— 19 (A) mean infections caused by pathogens, 20 including viruses, bacteria, protozoa, and 21 helminths, that disproportionately impact indi- 22 viduals living in extreme poverty, especially in 23 developing countries; and 24 (B) include— 25 VerDate Sep 11 2014 18:20 Sep 19, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S2481.IS S2481 kjohnson on DSK79L0C42 with BILLS 7 •S 2481 IS (i) Buruli ulcer; 1 (ii) Chagas disease; 2 (iii) Cysticercosis; 3 (iv) Dengue fever; 4 (v) Dracunculiasis (Guinea worm dis- 5 ease); 6 (vi) Echinococcosis; 7 (vii) Fascioliasis; 8 (viii) Human African trypanosomiasis 9 (sleeping sickness); 10 (ix) Leishmaniasis; 11 (x) Leprosy (Hansen’s disease); 12 (xi) Lymphatic filariasis (elephan- 13 tiasis); 14 (xii) Onchocerciasis (river blindness); 15 (xiii) Rabies; 16 (xiv) Schistosomiasis; 17 (xv) Soil-transmitted Helminthiases 18 (STH), such as round worm, whip worm, 19 and hook worm; 20 (xvi) Trachoma; and 21 (xvii) Yaws. 22 SEC. 6. RULE OF CONSTRUCTION. 23 Nothing in this Act may be construed to increase the 24 authorization of appropriations for— 25 VerDate Sep 11 2014 18:20 Sep 19, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S2481.IS S2481 kjohnson on DSK79L0C42 with BILLS 8 •S 2481 IS (1) the United States Agency for International 1 Development; or 2 (2) the Department of Health and Human 3 Services. 4 TITLE I—FOREIGN AFFAIRS 5 SEC. 101. UNITED STATES AGENCY FOR INTERNATIONAL 6 DEVELOPMENT NEGLECTED TROPICAL DIS- 7 EASES PROGRAM. 8 (a) FINDINGS.—Congress finds the following: 9 (1) Since fiscal year 2006, the United States 10 Agency for International Development (referred to 11 in this title as ‘‘USAID’’) has been an essential 12 leading partner in advancing control and elimination 13 efforts for 5 targeted neglected tropical diseases: 14 lymphatic filariasis (elephantiasis), onchocerciasis 15 (river blindness), schistosomiasis, soil-transmitted 16 helminthiases (round worm, whip worm, and hook 17 worm), and trachoma. 18 (2) USAID is an original endorser of the ‘‘Lon- 19 don Declaration on Neglected Tropical Diseases’’, 20 signed in London on January 30, 2012, which rep- 21 resents a new, coordinated international push to ac- 22 celerate progress toward eliminating or controlling 23 10 NTDs by 2020. 24 VerDate Sep 11 2014 18:20 Sep 19, 2019 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S2481.IS S2481 kjohnson on DSK79L0C42 with BILLS 9 •S 2481 IS (3) The USAID Neglected Tropical Diseases 1 Program has made important and substantial con- 2 tributions to the global fight to control and eliminate 3 the 5 targeted NTDs. Leveraging more than 4 $19,000,000,000 in donated medicines, USAID has 5 supported the distribution of more than 6 2,300,000,000 treatments in 31 countries across Af- 7 rica, Asia, Latin America, and the Caribbean. 8 (4) Since 2014, the USAID Neglected Tropical 9 Diseases Program has been investing in gathering 10 research and development for the treatment of cer- 11 tain NTDs to ensure that promising new break- 12 through diagnostics and medicines can be rapidly 13 evaluated, registered, and made available to patients. 14 (5) The USAID Neglected Tropical Diseases 15 Program— 16 (A) is a clear example of a successful pub- 17 lic-private partnership between the Government 18 and the private sector; and 19 (B) already has contributed to the elimi- 20 nation of at least 1 NTD in 9 different coun- 21 tries. 22 (b) SENSE OF CONGRESS.—It is the sense of Con- 23 gress that the USAID Neglected Tropical Diseases Pro- 24 VerDate Sep 11 2014 18:20 Sep 19, 2019 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S2481.IS S2481 kjohnson on DSK79L0C42 with BILLS 10 •S 2481 IS gram, as in effect on the date of the enactment of this 1 Act— 2 (1) should be continued and may be judiciously 3 expanded, as practicable and appropriate; 4 (2) should continue to provide treatment to as 5 many individuals suffering from an NTD or at risk 6 of acquiring an NTD, including individuals displaced 7 by manmade and natural disasters, as logistically 8 feasible; 9 (3) should integrate NTD control, treatment 10 tools, and approaches into complementary develop- 11 ment and global health programs by coordinating, to 12 the extent practicable and appropriate, across mul- 13 tiple sectors, including sectors relating to HIV/ 14 AIDS, malaria, tuberculosis, education, nutrition, 15 other infectious diseases, maternal and child health, 16 and water, sanitation, and hygiene; 17 (4) should continue to conduct low-cost, high- 18 impact community and school-based NTD programs 19 to reach large at-risk populations, including school- 20 age children, with integrated drug treatment pack- 21 ages, as feasible; 22 (5) should engage in research and development 23 of new tools and approaches, as opportunities 24 emerge and resources allow, to reach the goals relat- 25 VerDate Sep 11 2014 18:20 Sep 19, 2019 Jkt 089200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S2481.IS S2481 kjohnson on DSK79L0C42 with BILLS 11 •S 2481 IS ing to the elimination of NTDs set forth by the 1 World Health Organization; and 2 (6) should monitor research on and develop- 3 ments in the prevention and treatment of other 4 NTDs so breakthroughs can be incorporated into the 5 USAID Neglected Tropical Diseases Program, as 6 practicable and appropriate. 7 (c) PROGRAM PRIORITIES.—The Administrator of 8 USAID should incorporate the following priorities into 9 USAID’s Neglected Tropical Diseases Program (as in ef- 10 fect on the date of the enactment of this Act): 11 (1) Planning for, and conducting robust moni- 12 toring and evaluation of, program investments in 13 order to accurately measure impact, identify and 14 share lessons learned, and inform future NTD con- 15 trol and elimination strategies. 16 (2) Coordinating program activities with com- 17 plementary USAID development and global health 18 programs, including programs relating to water, 19 sanitation, and hygiene, food and nutrition security, 20 and primary and secondary education in order to ad- 21 vance the goals of the London Declaration on Ne- 22 glected Tropical Diseases. 23 (3) Including morbidity management in Na- 24 tional NTD Master Plans. 25 VerDate Sep 11 2014 18:20 Sep 19, 2019 Jkt 089200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S2481.IS S2481 kjohnson on DSK79L0C42 with BILLS 12 •S 2481 IS (4) Incorporating NTDs included in the Global 1 Burden of Disease Study 2010 into the program as 2 opportunities emerge, to the extent practicable and 3 appropriate. 4 (5) Continuing investments in the research and 5 development of new tools and approaches that— 6 (A) complement existing research invest- 7 ments; and 8 (B) ensure that new discoveries make it 9 through the pipeline and become available to in- 10 dividuals who need them. 11 SEC. 102. ACTIONS BY DEPARTMENT OF STATE. 12 (a) SENSE OF CONGRESS.—It is the sense of Con- 13 gress that the Coordinator of United States Government 14 Activities to Combat HIV/AIDS Globally should fully con- 15 sider, as necessary and appropriate, evolving research on 16 the impact of neglected tropical diseases on efforts to con- 17 trol HIV/AIDS when making future programming [Text truncated for display. Full text available on Congress.gov.]