[DOCID: f:sr193.110]
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Calendar No. 415
110th Congress Report
SENATE
1st Session 110-193
======================================================================
STOP TUBERCULOSIS (TB) NOW ACT OF 2007
_______
October 9, 2007.--Ordered to be printed
Filed under the authority of the order of the Senate of October 4, 2007
_______
Mr. Biden, from the Committee on Foreign Relations, submitted the
following
R E P O R T
[To accompany S. 968]
The Committee on Foreign Relations, having had under
consideration S. 968, a bill to amend the Foreign Assistance
Act of 1961 to provide increased assistance for the prevention,
treatment, and control of tuberculosis, and for other purposes,
reports favorably thereon and recommends that the bill do pass.
CONTENTS
Page
I. Purpose..........................................................1
II. Committee Action.................................................1
III. Discussion.......................................................2
IV. Cost Estimate....................................................3
V. Evaluation of Regulatory Impact..................................4
VI. Changes in Existing Law..........................................4
I. Purpose
The purpose of S. 968 is to improve the detection of
tuberculosis (TB), to reduce the global number of TB-related
deaths, and to support multilateral efforts to improve the
capacity of countries with high TB rates and other affected
countries to implement the Stop TB Strategy and specific
strategies related to addressing extensively drug resistant
tuberculosis (XDR-TB).
II. Committee Action
S. 968 was introduced by Senators Boxer, Smith, Durbin, and
Brown on March 22, 2007. An additional 10 members cosponsored
the legislation. On September 11, 2007, the committee ordered
the bill, with an amendment in the nature of a substitute,
reported favorably by voice vote.
III. Discussion
Tuberculosis is one of the deadliest infectious diseases in
the world, killing an estimated 1.6 million people per year.
One third of the world's population is infected with the
tuberculosis bacterium, and an estimated 8.8 million people
develop active TB each year. Resistance to standard drug
treatments for TB is increasing in number and severity: the
emergence of extensively drug-resistant tuberculosis (XDR-TB)
poses a significant global public health threat. Persons with
HIV/AIDS are particularly vulnerable to TB and the convergence
of these epidemics undermines gains in HIV/AIDS prevention,
care, and treatment.
S. 968 seeks to support the Global Plan to Stop TB, a ten-
year strategy launched last year at the World Economic Forum by
an international coalition of 500 governments, non-governmental
organizations, private sector organizations, and others to cut
the number of TB deaths in half by 2015. The bill identifies
the control of TB as a major United States foreign assistance
objective and calls for U.S. development programs in high
prevalence areas to prioritize the halving of the TB death and
disease burden in part through improvements in the TB detection
and cure rates in those countries.
In order to advance this strategy, the bill authorizes
support for a variety of activities, including: implementing
the Directly Observed Therapy Short-course (DOTS) approach;
treating persons who are co-infected with TB and HIV; treating
persons with multi-drug resistant tuberculosis (MDR-TB);
strengthening health systems; encouraging adherence to the
International Standards for Tuberculosis Care; and expanding
research to improve diagnostics, drugs, and vaccines to combat
TB. The bill states that the President should ensure that $15
million of the funds authorized in the legislation are used to
make a contribution to the Global Tuberculosis Facility. The
bill also authorizes the President to provide increased
resources to the World Health Organization (WHO) and the Stop
Tuberculosis Partnership to improve the capacity of countries
with high rates of TB to combat the epidemic and address the
issue of drug resistance.
The bill amends section 104A(e)(2)(C)(iii) of the Foreign
Assistance Act of 1961 (22 U.S.C. 2151b-2(e)(2)(C)(iii)) to
require inclusion of annual reporting on the percentage of
United States foreign assistance provided for diagnosis and
treatment of individuals with tuberculosis in countries with
the highest burden of tuberculosis, as determined by the World
Health Organization.
S. 968 authorizes the appropriation of up to $400 million
for fiscal year 2008 and up to $550 million for fiscal year
2009 to carry out the objectives of this Act. Of the amounts
subsequently appropriated for this purpose, the bill states
that up to $70 million may be available for fiscal year 2008
and up to $100 million may be available for fiscal year 2009
for the Centers for Disease Control and Prevention for the
purpose of carrying out global tuberculosis activities. Funds
appropriated pursuant to the authorization provided in this
bill are to remain available until expended.
V. Cost Estimate
In accordance with Rule XXVI, paragraph 11(a) of the
Standing Rules of the Senate, the committee provides this
estimate of the costs of this legislation prepared by the
Congressional Budget Office.
United States Congress,
Congressional Budget Office,
Washington, DC, September 18, 2007.
Hon. Joseph R. Biden, Jr.,
Chairman, Committee on Foreign Relations,
U.S. Senate, Washington, DC.
Dear Mr. Chairman: The Congressional Budget Office has
prepared the enclosed cost estimate for S. 968, the Stop
Tuberculosis (TB) Now Act of 2007.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Sunita
D'Monte.
Sincerely,
Peter R. Orszag.
------
Congressional Budget Office Cost Estimate
September 18, 2007.
S. 968 would authorize the appropriation of $400 million in
2008 and $550 million in 2009 for programs working to control
the global spread of tuberculosis. CBO estimates that
implementing the bill would cost $93 million in 2008 and about
$900 million over the 2008-2012 period, assuming that the
authorized amounts are appropriated and that outlays will
follow historical spending patterns for those programs.
Enacting the bill would not affect direct spending or revenues.
The estimated budgetary impact of S. 968 is shown in the
following table. The costs of this legislation fall within
budget functions 150 (international affairs) and 550 (health).
ESTIMATED BUDGETARY IMPACT OF S. 968
By Fiscal Year, in Millions of Dollars
----------------------------------------------------------------------------------------------------------------
2008 2009 2010 2011 2012
----------------------------------------------------------------------------------------------------------------
CHANGES IN SPENDING SUBJECT TO APPROPRIATION
International Assistance
Authorization Level.................................... 330 450 0 0 0
Estimated Outlays...................................... 66 239 264 113 52
Centers for Disease Control and Prevention
Authorization Level.................................... 70 100 0 0 0
Estimated Outlays...................................... 27 68 52 16 5
Total Changes
Authorization Level.................................... 400 550 0 0 0
Estimated Outlays...................................... 93 307 316 129 57
----------------------------------------------------------------------------------------------------------------
S. 968 would authorize the appropriation of $400 million in
2008 and $550 million in 2009 for foreign assistance to improve
the detection of tuberculosis, to reduce the number of
tuberculosis-related deaths in other countries, and to provide
funds for those purposes to international organizations. Of
those amounts, $70 million in 2008 and $100 million in 2009
would be earmarked for global antituberculosis programs of the
Centers for Disease Control and Prevention.S. 968 contains no
intergovernmental or private-sector mandates as defined in the
Unfunded Mandates Reform Act and would not affect the budgets
of state, local, or tribal governments.
On September 7, 2007, CBO transmitted a cost estimate for
H.R. 1567, the Stop Tuberculosis (TB) Now Act of 2007, as
ordered reported by the House Committee on Foreign Affairs on
July 31, 2007. The two bills are similar, and their estimated
costs are identical.
The CBO staff contact for this estimate is Sunita D'Monte.
This estimate was approved by Peter H. Fontaine, Assistant
Director for Budget Analysis.
V. Evaluation of Regulatory Impact
Pursuant to Rule XXVI, paragraph 11(b) of the Standing
Rules of the Senate, the committee has determined that there is
no regulatory impact as a result of this legislation.
VI. Changes in Existing Law
In compliance with Rule XXVI, paragraph 12 of the Standing
Rules of the Senate, changes in existing law made by the bill,
as reported, are shown as follows (existing law proposed to be
omitted is enclosed in black brackets, new matter is printed in
italic, existing law in which no change is proposed is shown in
roman).
The Foreign Assistance Act of 1961
* * * * * * *
PART I
Chapter 1--Policy; Development Assistance Authorizations
* * * * * * *
SEC. 104A. ASSISTANCE TO COMBAT HIV/AIDS.
(a) Finding.--Congress recognizes that the alarming spread
of HIV/AIDS in countries in sub-Saharan Africa, the Caribbean,
and other developing countries is a major global health,
national security, development, and humanitarian crisis.
* * * * * * *
(e) Annual Report.--
(1) In general.--Not later than January 31 of each
year, the President shall submit to the Committee on
Foreign Relations of the Senate and the Committee on
International Relations of the House of Representatives
a report on the implementation of this section for the
prior fiscal year.
(2) Report elements.--Each report shall include--
(A) * * *
* * * * * * *
(C) a detailed assessment of the impact of
programs established pursuant to such sections,
including
(i)(I) the effectiveness of such
programs in reducing the spread of the
HIV infection, particularly in women
and girls, in reducing mother-to-child
transmission of the HIV infection, and
in reducing mortality rates from HIV/
AIDS; and
(II) the number of patients currently
receiving treatment for AIDS in each
country that receives assistance under
this Act.
(ii) the progress made toward
improving health care delivery systems
(including the training of adequate
numbers of staff) and infrastructure to
ensure increased access to care and
treatment;
(iii) with respect to tuberculosis,
the increase in the number of people
treated and the increase in number of
tuberculosis patients cured through
each program, project, or activity
receiving United States foreign
assistance for tuberculosis control
purposes including the percentage of
such United States foreign assistance
provided for diagnosis and treatment of
individuals with tuberculois in
countries with the highest burden of
tuberculosis, as determined by the
World Health Organization (WHO); and
* * * * * * *
SEC. 104B. ASSISTANCE TO COMBAT TUBERCULOSIS.
(a) Findings.--Congress makes the following findings:
* * * * * * *
[(b) Policy.--It is a major objective of the foreign
assistance program of the United States to control
tuberculosis, including the detection of at least 70 percent of
the cases of infectious tuberculosis, and the cure of at least
85 percent of the cases detected, not later than December 31,
2005, in those countries classified by the World Health
Organization as among the highest tuberculosis burden, and not
later than December 31, 2010, in all countries in which the
United States Agency for International Development has
established development programs.]
(b) Policy--It is a major objective of the foreign
assistance program of the United States to control
tuberculosis. In all countries in which the Government of the
United States has established development programs,
particularly in countries with the highest burden of
tuberculosis and other countries with high rates of
tuberculosis, the United States Government should prioritize
the achievement of the following goals by not later than
December 31, 2015:
(1) Reduce by half the tuberculosis death and disease
burden from the 1990 baseline.
(2) Sustain or exceed the detection of at least 70
percent of sputum smear-positive cases of tuberculosis
and the cure of at least 85 percent of those cases
detected.
(c) [Authorization.] Assistance Required.--To carry out
this section and consistent with section 104(c), the President
[is authorized to] shall furnish assistance, on such terms and
conditions as the President may determine, for the prevention,
treatment, control, and elimination of tuberculosis.
(d) Coordination.--In carrying out this section, the
President shall coordinate with the World Health Organization,
the Global Fund to Fight AIDS, Tuberculosis, and Malaria, and
other organizations with respect to the development and
implementation of a comprehensive tuberculosis control program.
[(e) Priority to DOTS Coverage.--In furnishing assistance
under subsection (c), the President shall give priority to
activities that increase Directly Observed Treatment Short-
course (DOTS) coverage and treatment of multi-drug resistant
tuberculosis where needed using DOTS-Plus, including funding
for the Global Tuberculosis Drug Facility, the Stop
Tuberculosis Partnership, and the Global Alliance for TB Drug
Development. In order to meet the requirement of the preceding
sentence, the President should ensure that not less than 75
percent of the amount made available to carry out this section
for a fiscal year should be expended for antituberculosis
drugs, supplies, direct patient services, and training in
diagnosis and treatment for Directly Observed Treatment Short-
course (DOTS) coverage and treatment of multi-drug resistant
tuberculosis using DOTS-Plus, including substantially increased
funding for the Global Tuberculosis Drug Facility.]
(e) Priority To Stop TB Strategy.--(1) Priority.--In
furnishing assistance under subsection (c), the President shall
give priority to--
(A) activities described in the Stop TB Strategy,
including expansion and enhancement of DOTS coverage,
treatment fro individuals infected with both
tuberculosis and HIV and treatment for individuals with
multi-drug resistant tuberculosis (MDR-TB),
strengthening of health systems, use of the
International Standards for Tuberculosis Care by all
providers, empowering individuals with tuberculosis,
and enabling and promoting research to develop new
diagnostics, drugs, and vaccines, and program-based
operational research relating to tuberculosis; and
(B) funding for the Global Tuberculosis Drug
Facility, the Stop Tuberculosis Partnership, and the
Global Alliance for TB Drug Development.
(2) Availability of amounts.--In order to meet the
requirements of paragraph (1), the President--
(A) shall ensure that not less than 75 percent of the
amount made available to carry out this section for a
fiscal year should be expended for anti-tuberculosis
drugs, supplies, direct patient services, and training
in diagnosis and treatment to implement the Stop TB
Strategy; and
(B) should ensure that not less than $15,000,000 of
the amount made available to carry out this section for
a fiscal year is used to make a contribution to the
Global Tuberculosis Drug Facility.
(f) Assistance for WHO and the Stop Tuberculosis
Partnership.--In carrying out this section, the President,
acting through the Administrator of the United States Agency
for International Development, is authorized to provide
increased resources to the World Health Organization (WHO) and
the Stop Tuberculosis Partnership to improve the capacity of
countries with high rates of tuberculosis and other affected
countries to implement the Stop TB Strategy and specific
strategies related to addressing extensively drug resistant
tuberculosis (XDR-TB).
[(f)] (g) Definitions.--In this section:
(1) DOTS.--The term ``DOTS'' or ``Directly Observed
Treatment Short-course'' means the World Health
Organization-recommended strategy for treating
tuberculosis, including low cost and effective
diagnosis, treatment, and monitoring of tuberculosis,
as well as a reliable drug supply, and a management
strategy for public health systems, with health system
strengthening, promotion of the use of the
International Standards for Tuberculosis Care by all
care providers, bacteriology under an external quality
assessment framework, short-course chemotherapy, and
sound reporting and recording systems.
(2) DOTS-plus.--The term ``DOTS-Plus'' means a
comprehensive tuberculosis management strategy that is
built upon and works as a supplement to the standard
DOTS strategy, and which takes into account specific
issues (such as use of second line anti-tuberculosis
drugs) that need to be addressed in areas where there
is high prevalence of multi-drug resistant
tuberculosis.
(3) Global alliance for tuberculosis drug
development.--The term ``Global Alliance for
Tuberculosis Drug Development'' means the public-
private partnership that brings together leaders in
health, science, philanthropy, and private industry to
devise new approaches to tuberculosis and to ensure
that new medications are available and affordable in
high tuberculosis burden countries and other affected
countries.
(4) Global tuberculosis drug facility.--The term
``Global Tuberculosis Drug Facility (GDF)'' means the
new initiative of the Stop Tuberculosis Partnership to
increase access to high-quality tuberculosis drugs to
facilitate DOTS expansion.
(5) Stop tuberculosis partnership.--The term ``Stop
Tuberculosis Partnership'' means the partnership of the
World Health Organization, donors including the United
States, high tuberculosis burden countries,
multilateral agencies, and nongovernmental and
technical agencies committed to short- and long-term
measures required to control and eventually eliminate
tuberculosis as a public health problem in the world.
(6) Stop TB Strategy.--The term ``Stop TB Strategy''
means the six-point strategy to reduce tuberculosis
developed by the World Health Organization. The
strategy is described in the Global Plan to Stop TB
2007-2016: Actions for Life, a comprehensive plan
developed by the Stop Tuberculosis Partnership that
sets out the actions necessary to achieve the
millennium development goal of cutting tuberculosis
deaths and disease burden in half by 2016.
* * * * * * *
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