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Week Ending November 9, 2007

H.R.1567 To amend the Foreign Assistance Act of 1961 to provide increased assistance for the prevention, treatment, and control of tuberculosis, and for other purposes.

The President is authorized under the Foreign Assistance Act of 1961 to furnish assistance for tuberculosis prevention, treatment and elimination in poor foreign countries. This bill requires the President to take that action.

TB, the bill explains, is ‘one of the infectious causes of death to adults worldwide, killing 1.6 million per year—one person every 20 seconds.’ One third of the world is infected and 8.8 million develop active TB each year. 22 countries account for 80% of the problem and China and India represent 36% of all new TB cases each year. The challenge to health organizations is that the disease has developed strains that are resistant to multi-drug treatment (MDR-TB) and extensive drug treatment (XDR-TB). XDR-TB is merging with the HIV epidemic.

50% of TB cases in the US are attributed to foreign-born individuals due to the increase in international travel, commerce and migration. The strategy, then, is to control the disease in developing countries. Recent investments in that strategy have shown that treating the disease abroad is significantly less expensive, and so more cost effective, than treating it in the US. The treatment of choice is called Directly Observed treatment Short-course, or DOTS.

To solve the problem, the bill explains, six steps are needed: Pursuing high-quality expansion and enhancement of DOTS, implementing TB and HIV collaborative activities, contributing to the strength of health systems, engaging health care providers, empowering individuals with TB and their communities and enabling promotion of research to develop new diagnostics, drugs, vaccines and program-based operational research relating to TB.

The solutions combined are evident in the ‘Global Plan to Stop TB 2006-2015’ through which complete treatment costs as little as $16.00. The Global plan aims to cut TB in half by 2015 and to sustain or exceed the detection of at least 70% of sputum smear-positive cases of TB and the cure of at least 85% of the detected cases.

$15 million per year would go to the Global TB Drug Facility through the World Health Organization. Increased funds to WHO are authorized. Additional funds to the US Center for Disease Control and Prevention are also authorized.

Sponsor:  Rep. Elliot Engel (D-NY-17^th)

Vote: Passed House by voice vote November 5, 2007

Cost to the taxpayers: $400 million appropriated to the President for FY 2008 and up to $550 million for 2009. $70 million in 2008 and up to $100 million in 2009 to the CDC. “CBO estimates that implementing the bill would cost $93 million in 2008 and about $900 million over the 2008-2012 period.”

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MORE INFORMATION

SECTION-BY-SECTION ANALYSIS AND DISCUSSION

Section 1. Short Title.

This section states that this Act may be cited as the `Stop Tuberculosis (TB) Now Act of 2007.'

Section 2. Findings.

This section presents a number of findings that stress the urgency of new initiatives to combat the global spread of tuberculosis. The findings note that tuberculosis represents one of the greatest causes of deaths among adults worldwide and is a leading killer of women of reproductive age. The findings also note the virulent new form of XDR-TB that came to our attention when the disease began to surge throughout South Africa. The Committee is concerned that this strain of TB could undo all of the achievements gained to date in lives saved through treatment and care programs funded by the PEPFAR.

This section also highlights the DOTS (Directly Observed Treatment Short-Course) program that has been determined to be one of the most cost-effective and patient-friendly ways to treat TB in poor countries. DOTS is part of the new Stop TB Strategy developed by the WHO.

Section 3. Assistance to Combat Tuberculosis.

This section establishes as a U.S. policy objective the control of tuberculosis, particularly in countries where the United States has established development programs, and should achieve the following, no later than December 31, 2015--

Ìreduce by half the tuberculosis death and disease burden from the 1990 baseline; and

Ìsustain or exceed the detection of at last 70 percent of sputum smear-positive cases of tuberculosis and the cure of at least 85 percent of those cases detected.

This section also requires assistance to adhere to the Stop TB Strategy, including expansion of DOTS.

In addition, this section authorizes not less than $15,000,000 to the Global Tuberculosis Drug Facility. It further authorizes through USAID up to $330,000,000 for Fiscal Year 2008 and up to $450,000,000 for fiscal year 2009 to support the WHO and the Stop Tuberculosis Partnership to improve the capacity of countries with high rates of tuberculosis to implement the Stop TB Strategy. This section also authorizes an appropriation of up to $70,000,000 for fiscal year 2008 and up to $100,000,000 for fiscal year 2009 to carry out global TB activities through the CDC. The appropriations shall remain available until expended.

The Committee expects USAID and the CDC to ensure fully that all such TB funding increases authorized under this section or endorsed by the House in an amendment to the FY 2008 Foreign Operations bill in June 2007 are expended in a transparent and efficient manner. All U.S. funded anti-TB programs should be results-driven and should expand upon or complement, but not duplicate, other international and indigenous efforts. The Committee further asserts that the Stop Tuberculosis Partnership, a multilateral effort which is to receive increased funding pursuant to this section, also must be held to the highest standard of transparency in terms of planning, procurement and implementation. The Committee intends to conduct rigorous oversight of these programs as they expand and develop over the next two years. This Section also requires an annual report that includes the percentage of U.S. foreign assistance provided for diagnosis and treatment of individuals with tuberculosis in countries with the highest burden of tuberculosis, as determined by WHO.

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