End Tuberculosis Now Act of 2023

I 118TH CONGRESS 1ST SESSION H. R. 1776 To prevent, treat, and cure tuberculosis globally. IN THE HOUSE OF REPRESENTATIVES MARCH 24, 2023 Mr. BERA (for himself, Ms. SALAZAR, Mr. SHERMAN, and Mr. FITZPATRICK) introduced the following bill; which was referred to the Committee on Foreign Affairs 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 2023’’. 5 SEC. 2. FINDINGS. 6 Congress makes the following findings: 7 (1) Tuberculosis (referred to in the Act as 8 ‘‘TB’’) is a preventable, treatable, and curable dis- 9 ease, yet more than 25 years after the World Health 10 Organization declared it to be a public health emer- 11 VerDate Sep 11 2014 02:29 Apr 07, 2023 Jkt 039200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H1776.IH H1776 kjohnson on DSK79L0C42PROD with BILLS 2 •HR 1776 IH gency and called on countries to make scaling up TB 1 control a priority, TB remains a deadly health 2 threat. 3 (2) In 2021 alone, an estimated 10,600,000 4 people became ill with TB, 11 percent of whom were 5 children, and an estimated 1,600,000 of these people 6 died from the illness. In order to achieve by 2035 7 the goals of the Political Declaration of the High- 8 Level Meeting of the General Assembly on the Fight 9 Against Tuberculosis, adopted by the United Na- 10 tions General Assembly October 10, 2018, and of 11 the World Health Organization End TB Strategy, 12 adopted by the World Health Assembly in 2014, new 13 and existing tools must be developed and scaled-up. 14 (3) More than 1⁄3 of people who become ill with 15 TB may be undiagnosed or misdiagnosed, resulting 16 in unnecessary illness, communicable infections, and 17 increased mortality. 18 (4) Since March 2020, the COVID–19 pan- 19 demic has severely disrupted TB responses in low- 20 and middle-income countries, stalling and reversing 21 years of progress made against TB. According to the 22 World Health Organization, from 2019 to 2020— 23 (A) global detection of TB dropped by 18 24 percent; 25 VerDate Sep 11 2014 02:29 Apr 07, 2023 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H1776.IH H1776 kjohnson on DSK79L0C42PROD with BILLS 3 •HR 1776 IH (B) an estimated 1,300,000 fewer people 1 were diagnosed and enrolled on TB treatment; 2 and 3 (C) in some countries, TB case notifica- 4 tions dropped by up to 41 percent, setting 5 progress back by up to 12 years. 6 (5) Failure to properly diagnose and treat TB 7 can lead to death, can exacerbate antimicrobial re- 8 sistance (a key contributor to rising cases of multi- 9 drug-resistant TB and extensively drug-resistant 10 TB), and can increase the probability of the intro- 11 duction of resistant TB into new geographic areas. 12 (6) TB programs have played a central role in 13 responding to COVID–19, including through 14 leveraging the expertise of medical staff with exper- 15 tise in TB and lung diseases, the repurposing of TB 16 hospitals, and the use of the TB rapid molecular 17 testing platforms and x-ray equipment for multiple 18 purposes, including the treatment of COVID–19. 19 (7) With sufficient resourcing, TB program ex- 20 pertise, infection control, laboratory capacity, active 21 case finding, and contact investigation can serve as 22 platforms for respiratory pandemic response against 23 existing and new infectious respiratory disease with- 24 out disrupting ongoing TB programs and activities. 25 VerDate Sep 11 2014 02:29 Apr 07, 2023 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H1776.IH H1776 kjohnson on DSK79L0C42PROD with BILLS 4 •HR 1776 IH (8) Globally, only about 1⁄2 of the 1 $13,000,000,000 required annually, as outlined in 2 the Stop TB Partnership’s Global Plan to End TB, 3 is currently available. 4 (9) According to estimates by the Global Fund 5 for AIDS, Tuberculosis, and Malaria, an additional 6 $3,500,000,000 was needed during 2021 for TB 7 programs in eligible countries in order to recover 8 from the negative impacts of COVID–19. 9 (10) On September 26, 2018, the United Na- 10 tions convened the first High-Level Meeting of the 11 General Assembly on the Fight Against Tuber- 12 culosis, during which 120 countries— 13 (A) signed a Political Declaration to accel- 14 erate progress against TB, including through 15 commitments to increase funding for TB pre- 16 vention, diagnosis, treatment, and research and 17 development programs, and to set ambitious 18 goals to successfully treat 40,000,000 people 19 with active TB and prevent at least 30,000,000 20 from becoming ill with TB between 2018 and 21 2022; and 22 (B) committed to ‘‘ending the epidemic in 23 all countries, and pledge[d] to provide leader- 24 ship and to work together to accelerate our na- 25 VerDate Sep 11 2014 02:29 Apr 07, 2023 Jkt 039200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H1776.IH H1776 kjohnson on DSK79L0C42PROD with BILLS 5 •HR 1776 IH tional and global collective actions, investments 1 and innovations urgently to fight this prevent- 2 able and treatable disease’’, as reflected in 3 United Nations General Assembly Resolution 4 73/3. 5 (11) The United States Government continues 6 to be a lead funder of global TB research and devel- 7 opment, contributing 44 percent of the total 8 $915,000,000 in global funding in 2020, and can 9 catalyze more investments from other countries. 10 (12) Working with governments and partners 11 around the world, USAID’s TB programming has 12 saved an estimated 74,000,000 lives, demonstrating 13 the effectiveness of United States programs and ac- 14 tivities against the illness. 15 (13) On September 26, 2018, the USAID Ad- 16 ministrator announced a new performance-based 17 Global Accelerator to End TB, aimed at catalyzing 18 investments to meet the treatment target set by the 19 United Nations High-Level Meeting, further dem- 20 onstrating the critical role that United States leader- 21 ship and assistance plays in the fight to eliminate 22 TB. 23 (14) It is essential to ensure that efforts among 24 United States Government agencies, partner nations, 25 VerDate Sep 11 2014 02:29 Apr 07, 2023 Jkt 039200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H1776.IH H1776 kjohnson on DSK79L0C42PROD with BILLS 6 •HR 1776 IH international organizations, nongovernmental organi- 1 zations, the private sector, and other actors are com- 2 plementary and not duplicative in order to achieve 3 the goal of ending the TB epidemic in all countries. 4 SEC. 3. UNITED STATES GOVERNMENT ASSISTANCE TO 5 COMBAT TUBERCULOSIS. 6 Section 104B of the Foreign Assistance Act of 1961 7 (22 U.S.C. 2151b–3) is amended to read as follows: 8 ‘‘SEC. 104B. ASSISTANCE TO COMBAT TUBERCULOSIS. 9 ‘‘(a) FINDINGS.—Congress makes the following find- 10 ings: 11 ‘‘(1) The international spread of tuberculosis 12 (referred to in this section as ‘TB’) and the deadly 13 impact of TB’s continued existence constitutes a 14 continuing challenge. 15 ‘‘(2) Additional tools and resources are required 16 to effectively diagnose, prevent, and treat TB. 17 ‘‘(3) Effectively resourced TB programs can 18 serve as a critical platform for preventing and re- 19 sponding to future infectious respiratory disease 20 pandemics. 21 ‘‘(b) POLICY.— 22 ‘‘(1) IN GENERAL.—It is a major objective of 23 the foreign assistance program of the United States 24 VerDate Sep 11 2014 02:29 Apr 07, 2023 Jkt 039200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H1776.IH H1776 kjohnson on DSK79L0C42PROD with BILLS 7 •HR 1776 IH to help end the TB public health emergency through 1 accelerated actions— 2 ‘‘(A) to support the diagnosis and treat- 3 ment of all adults and children with all forms 4 of TB; and 5 ‘‘(B) to prevent new TB infections from 6 occurring. 7 ‘‘(2) SUPPORT FOR GLOBAL PLANS AND OBJEC- 8 TIVES.—In countries in which the United States 9 Government has established foreign assistance pro- 10 grams under this Act, particularly in countries with 11 the highest burden of TB and other countries with 12 high rates of infection and transmission of TB, it is 13 the policy of the United States— 14 ‘‘(A) to support the objectives of the World 15 Health Organization End TB Strategy, includ- 16 ing its goals— 17 ‘‘(i) to reduce TB deaths by 95 per- 18 cent by 2035; 19 ‘‘(ii) to reduce the TB incidence rate 20 by 90 percent by 2035; and 21 ‘‘(iii) to reduce the number of families 22 facing catastrophic health costs due to TB 23 by 100 percent by 2035; 24 VerDate Sep 11 2014 02:29 Apr 07, 2023 Jkt 039200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H1776.IH H1776 kjohnson on DSK79L0C42PROD with BILLS 8 •HR 1776 IH ‘‘(B) to support the Stop TB Partnership’s 1 Global Plan to End TB 2023–2030, including 2 by providing support for— 3 ‘‘(i) developing and using innovative 4 new technologies and therapies to increase 5 active case finding and rapidly diagnose 6 and treat children and adults with all 7 forms of TB, alleviate suffering, and en- 8 sure TB treatment completion; 9 ‘‘(ii) expanding diagnosis and treat- 10 ment in line with the goals established by 11 the Political Declaration of the High-Level 12 Meeting of the General Assembly on the 13 Fight Against Tuberculosis, including— 14 ‘‘(I) successfully treating 15 40,000,000 people with active TB by 16 2023, including 3,500,000 children, 17 and 1,500,000 people with drug-re- 18 sistant TB; and 19 ‘‘(II) diagnosing and treating la- 20 tent tuberculosis infection, in support 21 of the global goal of providing preven- 22 tive therapy to at least 30,000,000 23 people by 2023, including 4,000,000 24 children younger than 5 years of age, 25 VerDate Sep 11 2014 02:29 Apr 07, 2023 Jkt 039200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H1776.IH H1776 kjohnson on DSK79L0C42PROD with BILLS 9 •HR 1776 IH 20,000,000 household contacts of peo- 1 ple affected by TB, and 6,000,000 2 people living with HIV; 3 ‘‘(iii) ensuring high-quality TB care 4 by closing gaps in care cascades, imple- 5 menting continuous quality improvement 6 at all levels of care, and providing related 7 patient support; and 8 ‘‘(iv) sustainable procurements of TB 9 commodities to avoid interruptions in sup- 10 ply, the procurement of commodities of un- 11 known quality, or payment of excessive 12 commodity costs in countries impacted by 13 TB; and 14 ‘‘(C) to ensure, to the greatest extent prac- 15 ticable, that United States funding supports ac- 16 tivities that simultaneously emphasize— 17 ‘‘(i) the development of comprehensive 18 person-centered programs, including diag- 19 nosis, treatment, and prevention strategies 20 to ensure that— 21 ‘‘(I) all people sick with TB re- 22 ceive quality diagnosis and treatment 23 through active case finding; and 24 VerDate Sep 11 2014 02:29 Apr 07, 2023 Jkt 039200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H1776.IH H1776 kjohnson on DSK79L0C42PROD with BILLS 10 •HR 1776 IH ‘‘(II) people at high risk for TB 1 infection are found and treated with 2 preventive therapies in a timely man- 3 ner; 4 ‘‘(ii) robust TB infection control prac- 5 tices are implemented in all congregate set- 6 tings, including hospitals and prisons; 7 ‘‘(iii) the deployment of diagnostic 8 and treatment capacity— 9 ‘‘(I) in areas with the highest TB 10 burdens; and 11 ‘‘(II) for highly at-risk and im- 12 poverished populations, including pa- 13 tient support services; 14 ‘‘(iv) program monitoring and evalua- 15 tion based on critical TB indicators, in- 16 cluding indicators relating to infection con- 17 trol, the numbers of patients accessing TB 18 treatment and patient support services, 19 and preventative therapy for those at risk, 20 including all close contacts, and treatment 21 outcomes for all forms of TB; 22 ‘‘(v) training and engagement of 23 health care workers on the use of new di- 24 agnostic tools and therapies as they be- 25 VerDate Sep 11 2014 02:29 Apr 07, 2023 Jkt 039200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H1776.IH H1776 kjohnson on DSK79L0C42PROD with BILLS 11 •HR 1776 IH come available, and increased support for 1 training frontline health care workers to 2 support expanded TB active case finding, 3 contact tracing, and patient support serv- 4 ices; 5 ‘‘(vi) coordination with domestic agen- 6 cies and organizations to support an ag- 7 gressive research agenda to develop vac- 8 cines as well as new tools to diagnose, 9 treat, and prevent TB globally; 10 ‘‘(vii) linkages with the private sector 11 on— 12 ‘‘(I) research and development of 13 a vaccine, and on new tools for diag- 14 nosis and treatment of TB; 15 ‘‘(II) improving current tools for 16 diagnosis and treatment of TB, in- 17 cluding telehealth solutions for pre- 18 vention and treatment; and 19 ‘‘(III) training healthcare profes- 20 sionals on use of the newest and most 21 effective diagnostic and therapeutic 22 tools; 23 VerDate Sep 11 2014 02:29 Apr 07, 2023 Jkt 039200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H1776.IH H1776 kjohnson on DSK79L0C42PROD with BILLS 12 •HR 1776 IH ‘‘(viii) the reduction of barriers to 1 care, including stigma and treatment and 2 diagnosis costs, including through— 3 ‘‘(I) training health workers; 4 ‘‘(II) sensitizing policy makers; 5 ‘‘(III) requiring that all relevant 6 grants and funding agreements in- 7 clude access and affordability provi- 8 sions; 9 ‘‘(IV) supporting education and 10 empowerment campaigns for TB pa- 11 tients regarding local TB services; 12 ‘‘(V) monitoring barriers to ac- 13 cessing TB services; and 14 ‘‘(VI) increasing support for pa- 15 tient-led and community-led TB out- 16 reach efforts; 17 ‘‘(ix) support for country-level, sus- 18 tainable accountability mechanisms and ca- 19 pacity to measure progress and ensure that 20 commitments made by governments and 21 relevant stakeholders are met; and 22 ‘‘(x) support for the integration of TB 23 diagnosis, treatment, and prevention activi- 24 VerDate Sep 11 2014 02:29 Apr 07, 2023 Jkt 039200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\H1776.IH H1776 kjohnson on DSK79L0C42PROD with BILLS 13 •HR 1776 IH ties into primary health care, as appro- 1 priate. 2 ‘‘(c) DEFINITIONS.—In this section: 3 ‘‘(1) APPROPRIATE CONGRESSIONAL COMMIT- 4 TEES.—The term ‘appropriate congressional com- 5 mittees’ means the Committee on Foreign Relations 6 of the Senate and the Committee on Foreign Affairs 7 of the House of Representatives. 8 ‘‘(2) END TB STRATEGY.—The term ‘End TB 9 Strategy’ means the strategy to eliminate TB that 10 was approved by the World Health Assembly in May 11 2014, and is described in ‘The End TB Strategy: 12 Global Strategy and Targets for Tuberculosis Pre- 13 vention [Text truncated for display. Full text available on Congress.gov.]