[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3460 Referred in Senate (RFS)]

<DOC>
116th CONGRESS
  1st Session
                                H. R. 3460


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                            December 4, 2019

Received; read twice and referred to the Committee on Foreign Relations

_______________________________________________________________________

                                 AN ACT


 
To facilitate effective research on and treatment of neglected tropical 
          diseases through coordinated international efforts.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``End Neglected Tropical Diseases 
Act''.

SEC. 2. TABLE OF CONTENTS.

    The table of contents for this Act is as follows:

Sec. 1. Short title.
Sec. 2. Table of contents.
Sec. 3. Statement of policy.
Sec. 4. Findings.
Sec. 5. Definition.
Sec. 6. Rule of construction.
Sec. 7. Expansion of United States Agency for International Development 
                            Neglected Tropical Diseases Program.
Sec. 8. Actions by Department of State.
Sec. 9. Multilateral development and health institutions.

SEC. 3. STATEMENT OF POLICY.

    It is the policy of the United States to support a broad range of 
implementation and research and development activities that work toward 
the achievement of cost-effective and sustainable treatment, control, 
and, where possible, elimination of neglected tropical diseases for the 
economic and social well-being of all people.

SEC. 4. FINDINGS.

    Congress finds the following:
            (1) The World Health Organization (WHO) has identified 17 
        neglected tropical diseases (NTDs). Approximately 2 billion 
        people, almost one-third of the world's population, are at risk 
        of contracting an NTD, and more than 1.4 billion people are 
        currently afflicted with 1 or more NTDs.
            (2) In 2013, WHO adopted a comprehensive resolution on NTDs 
        recognizing that increased national and international 
        investments in prevention and control of neglected tropical 
        diseases have succeeded in improving health and social well-
        being in many countries.
            (3) NTDs have an enormous impact in terms of disease burden 
        and quality of life. NTDs cause the loss of up to 534,000 lives 
        and 57 million disability-adjusted life-years each year. NTDs 
        surpass both malaria and tuberculosis in causing greater loss 
        of life-years to disability and premature death. Many NTDs 
        cause disfigurement and disability, leading to stigma, social 
        discrimination, and societal marginalization.
            (4) NTDs create an economic burden of billions of dollars 
        through the loss of productivity and high costs of health care 
        required for treatment. People afflicted by NTDs are less 
        productive than their healthy counterparts. NTDs jeopardize the 
        ability of people to attend work and school, or to produce at 
        full capacity. For example, controlling one NTD, hookworm, in 
        children can result in a 43-percent increase in future wage 
        earnings.
            (5) The social, economic, and health burden of NTDs falls 
        primarily on low- and middle-income countries, where access to 
        safe water, sanitation, and health care is limited. At least 
        100 countries face 2 endemic NTD burdens, and 30 countries 
        carry 6 or more endemic NTDs.
            (6) NTDs are not confined to the developing world, however. 
        Several NTD outbreaks have been reported in the United States 
        and other developed countries, especially among the poor. In 
        the United States, NTDs disproportionately affect people living 
        in poverty, and especially minorities, including up to 2.8 
        million African Americans with toxocariasis and 300,000 or more 
        people, mostly Hispanic Americans, with Chagas disease.
            (7) Many NTDs can be controlled, prevented, and even 
        eliminated using low-cost, effective, and feasible solutions. 
        Understanding the economic burden of NTDs on productivity and 
        health care costs can help to assure governments and donors 
        that the resources directed toward NTDs represent a good 
        investment.
            (8) Research and development efforts are immediately needed 
        for all NTDs, especially those for which limited or no 
        treatment currently exists.
            (9) Critical to developing robust NTD control strategies 
        are epidemiological data that identify at-risk populations, 
        ensure appropriate treatment frequency, and inform decisions 
        about when treatment can be reduced or stopped.
            (10) Of the 14 most common NTDs, roughly 80 percent of 
        infections are caused by soil-transmitted helminths (STH) and 
        schistosomiasis. STH are a group of 3 parasitic worms 
        (roundworms, whipworms, and hookworms) that afflict more than 1 
        billion people worldwide, including 600 million school-age 
        children, of whom more than 300 million suffer from severe 
        morbidity. Schistosomiasis is another helminth infection 
        affecting at least 200 million people in developing countries, 
        but some estimates indicate that the true number of people 
        affected may be double or even triple that number.
            (11) The benefits of deworming are immediate and enduring. 
        A rigorous randomized controlled trial has shown school-based 
        deworming treatment to reduce school absenteeism by 25 percent. 
        School-based deworming also benefits young siblings and other 
        children who live nearby but are too young to be treated, 
        leading to large cognitive improvements equivalent to half a 
        year of schooling.

SEC. 5. DEFINITION.

    In this Act, the term ``neglected tropical diseases'' or ``NTDs''--
            (1) means infections caused by pathogens, including 
        viruses, bacteria, protozoa, and helminths that 
        disproportionately impact individuals living in extreme 
        poverty, especially in developing countries; and
            (2) includes--
                    (A) Buruli ulcer (Mycobacterium Ulcerans 
                infection);
                    (B) Chagas disease;
                    (C) dengue or severe dengue fever;
                    (D) dracunculiasis (Guinea worm disease);
                    (E) echinococcosis;
                    (F) foodborne trematodiases;
                    (G) human African trypanosomiasis (sleeping 
                sickness);
                    (H) leishmaniasis;
                    (I) leprosy;
                    (J) lymphatic filariasis (elephantiasis);
                    (K) onchocerciasis (river blindness);
                    (L) scabies;
                    (M) schistosomiasis;
                    (N) soil-transmitted helminthiases (STH) 
                (roundworm, whipworm, and hookworm);
                    (O) taeniasis/cysticercosis;
                    (P) trachoma; and
                    (Q) yaws (endemic treponematoses).

SEC. 6. RULE OF CONSTRUCTION.

    Nothing in this Act shall be construed to increase authorizations 
of appropriations for the United States Agency for International 
Development.

SEC. 7. EXPANSION OF UNITED STATES AGENCY FOR INTERNATIONAL DEVELOPMENT 
              NEGLECTED TROPICAL DISEASES PROGRAM.

    (a) Findings.--Congress finds the following:
            (1) Since fiscal year 2006, the United States Government 
        has been an essential leader in global efforts to control seven 
        targeted neglected tropical diseases: lymphatic filariasis 
        (elephantiasis), onchocerciasis (river blindness), 
        schistosomiasis, soil-transmitted helminthiases (roundworm, 
        whipworm, and hookworm), and trachoma. Additional information 
        suggests that such efforts could also produce collateral 
        benefits for at least three other neglected tropical diseases: 
        foodborne trematodiases, scabies, and yaws (endemic 
        treponematoses).
            (2) The United States Government is a partner in the London 
        Declaration on Neglected Tropical Diseases (2012), which 
        represents a new, coordinated international push to accelerate 
        progress toward eliminating or controlling 10 NTDs by 2020.
            (3) While many of the most common NTDs have safe, easy to 
        use, and effective treatments, treatment options for the NTDs 
        with the highest death rates, including human African 
        trypanosomiasis (sleeping sickness), visceral leishmaniasis, 
        and Chagas disease, are extremely limited.
            (4) The United States Agency for International Development 
        (USAID) Neglected Tropical Diseases Program has made important 
        and substantial contributions to the global fight to control 
        and eliminate 5 of the most common NTDs. Leveraging more than 
        $15,700,000,000 in donated medicines, USAID has supported the 
        distribution of more than 1 billion treatments in 31 countries 
        across Africa, Asia, and Latin America and the Caribbean.
            (5) Since 2014, the USAID Neglected Tropical Diseases 
        Program has been investing in research and development for the 
        treatment of certain NTDs to ensure that promising new 
        breakthrough medicines can be rapidly evaluated, registered, 
        and made available to patients.
            (6) The USAID Neglected Tropical Diseases Program is a 
        clear example of a successful public-private partnership 
        between the Government and the private sector and should be 
        judiciously expanded, as practicable and appropriate.
    (b) Sense of Congress.--It is the sense of Congress that the USAID 
Neglected Tropical Diseases Program, as in effect on the date of the 
enactment of this Act, should--
            (1) provide integrated drug treatment packages to as many 
        individuals suffering from NTDs or at risk of acquiring NTDs, 
        including individuals displaced by manmade and natural 
        disasters, as logistically feasible;
            (2) better integrate NTD control and treatment tools and 
        approaches into complementary development and global health 
        programs by coordinating, to the extent practicable and 
        appropriate, across multiple sectors, including those relating 
        to HIV/AIDS, malaria, tuberculosis, education, nutrition, other 
        infectious diseases, maternal and child health, and water, 
        sanitation, and hygiene;
            (3) establish low-cost, high-impact community- and school-
        based NTD programs to reach large at-risk populations, 
        including school-age children, with integrated drug treatment 
        packages, as feasible;
            (4) as opportunities emerge and resources allow, engage in 
        research and development of new tools and approaches to reach 
        the goals relating to the elimination of NTDs as set forth by 
        the 2012 World Health Organization publication ``Accelerating 
        Work to Overcome the Global Impact of Neglected Tropical 
        Diseases: A Roadmap for Implementation'', including for Chagas 
        disease, Guinea worm, human African trypanosomiasis (sleeping 
        sickness), leprosy, and visceral leishmaniasis; and
            (5) monitor research on and developments in the prevention 
        and treatment of other NTDs so breakthroughs can be 
        incorporated into the USAID Neglected Tropical Diseases 
        Program, as practicable and appropriate.
    (c) Program Priorities.--The Administrator of USAID should 
incorporate the following priorities into the USAID Neglected Tropical 
Diseases Program (as in effect on the date of the enactment of this 
Act):
            (1) Planning for and conducting robust monitoring and 
        evaluation of program investments in order to accurately 
        measure impact, identify and share lessons learned, and inform 
        future NTD control and elimination strategies.
            (2) Coordinating program activities with complementary 
        USAID development and global health programs, including 
        programs relating to water, sanitation, and hygiene, food and 
        nutrition security, and education (both primary and secondary), 
        in order to advance the goals of the London Declaration on 
        Neglected Tropical Diseases (2012).
            (3) Including morbidity management in treatment plans for 
        high-burden NTDs.
            (4) Incorporating NTDs included in the Global Burden of 
        Disease Study 2010 into the program as opportunities emerge, to 
        the extent practicable and appropriate.
            (5) Continuing investments in the research and development 
        of new tools and approaches that complement existing research 
        investments and ensure that new discoveries make it through the 
        pipeline and become available to individuals who need them 
        most.

SEC. 8. ACTIONS BY DEPARTMENT OF STATE.

    (a) Office of the Global AIDS Coordinator.--It is the sense of 
Congress that the Coordinator of United States Government Activities to 
Combat HIV/AIDS Globally should fully consider evolving research on the 
impact of NTDs on efforts to control HIV/AIDS when making future 
programming decisions, as necessary and appropriate.
    (b) Global Programming.--
            (1) In general.--The Secretary of State should encourage 
        the Global Fund to take into consideration evolving research on 
        the impact of NTDs on efforts to control HIV/AIDS when making 
        programming decisions, particularly with regard to female 
        genital schistosomiasis, which studies suggest may be one of 
        the most significant cofactors in the AIDS epidemic in Africa, 
        as necessary and appropriate.
            (2) Global fund.--In this subsection, the term ``Global 
        Fund'' means the public-private partnership known as the Global 
        Fund to Fight AIDS, Tuberculosis and Malaria established 
        pursuant to Article 80 of the Swiss Civil Code.
    (c) G-20 Countries.--The Secretary of State, acting through the 
Office of Global Health Diplomacy, should encourage G-20 countries to 
significantly increase their role in the control and elimination of 
NTDs.

SEC. 9. MULTILATERAL DEVELOPMENT AND HEALTH INSTITUTIONS.

    (a) Congressional Finding.--Congress finds that the treatment of 
NTDs, including community- and school-based deworming programs, can be 
a highly cost-effective intervention, and schools can serve as an 
effective delivery mechanism for reaching large numbers of children 
with safe treatment for soil-transmitted helminthiases (roundworm, 
whipworm, and hookworm) in particular.
    (b) United Nations.--The President should direct the United States 
permanent representative to the United Nations to use the voice, vote, 
and influence of the United States to urge the World Health 
Organization and the United Nations Development Programme to--
            (1) ensure the dissemination of best practices and 
        programming on NTDs to governments and make data accessible to 
        practitioners in an open and timely fashion;
            (2) highlight impacts of community- and school-based 
        deworming programs on children's health and education, 
        emphasizing the cost-effectiveness of such programs;
            (3) encourage governments to implement deworming campaigns 
        at the national level;
            (4) consider the designation of a portion of grant funds of 
        the institutions to deworming initiatives and cross-sectoral 
        collaboration with water, sanitation, and hygiene efforts and 
        nutrition or education programming, as practicable and 
        appropriate;
            (5) encourage accurate monitoring and evaluation of NTD 
        programs, including deworming programs; and
            (6) engage governments in cross-border initiatives for the 
        treatment, control, prevention, and elimination of NTDs, and 
        assist in developing transnational agreements, when and where 
        necessary.

            Passed the House of Representatives December 3, 2019.

            Attest:

                                             CHERYL L. JOHNSON,

                                                                 Clerk.