107th Congress

Comprehensive Tuberculosis Elimination Act of 2001

H.R. 1167 and S. 1115; S. 2045

Background

Tuberculosis (TB), a chronic bacterial infection, causes more deaths worldwide than any other infectious disease. TB is spread through the air and usually infects the lungs. Nearly 2 billion people—including about 10 to 15 million people in the United States—are infected with the TB microorganism, Mycobacterium tuberculosis. Approximately 8 million new cases of TB are reported globally each year. Between 1985 and 1992, cases of TB in the United States increased by 20 percent, from 22,201 to 26,673. This reemergence of TB is closely related to the AIDS epidemic. A large part of the increase in TB cases is due to the growing number of persons who are infected with both HIV and M. tuberculosis. Although the number of active, reported TB cases in the United States declined to 16,377 in 2000, the National Institutes of Health (NIH) continues to maintain a strong TB research portfolio, which was valued at $87.3 million in fiscal year (FY) 2001.

A number of NIH Institutes fund TB research and related activities. The National Institute of Allergy and Infectious Diseases (NIAID) is the lead Institute for TB research at NIH. NIAID's research program encompasses studies on the pathogenesis, epidemiology, and natural history of TB, and basic and applied research to develop new ways to diagnose, treat, and prevent TB. The National Heart, Lung, and Blood Institute (NHLBI) is the second leading NIH Institute in TB research. Most NHLBI funding is directed at basic research on how M. tuberculosis affects the lungs and what can be done to prevent that damage. NHLBI also supports the Tuberculosis Academic Award (TBAA), which stimulates development of and improvement in the quality of medical curriculums, physician/patient/community education, and clinical practice for the prevention, management, and control of TB in the United States. The Fogarty International Center supports the Tuberculosis International Training and Research Program (TBITRP) in coordination with NIAID, the Centers for Disease Control and Prevention (CDC), and the U.S. Agency for International Development.

In 1991, a Federal TB task force was formed in response to the surge in TB cases. The task force comprises about 20 agencies, including NIH. It initially developed a report on controlling multi-drug-resistant TB and has since met quarterly to discuss the latest TB activities and research. The task force has been developing a Federal response to an Institute of Medicine report entitled "Ending Neglect: The Elimination of Tuberculosis in the United States."

For information on other tuberculosis legislation, see the article entitled "International Tuberculosis Control Act of 2002."

Provisions of the Legislation/Impact on NIH

H.R. 1167, the Comprehensive Tuberculosis Elimination Act of 2001, would have required the establishment of a Committee on Interagency Collaboration for Tuberculosis Elimination, the purpose of which would have been to advise the Secretary of Health and Human Services and other appropriate Federal officials on how best to coordinate Federal TB activities. NIH would have been a member of this committee, along with CDC, the Agency for Healthcare Research and Quality, and any other Federal agency that conducts TB activities. Instead of establishing an interagency committee, S. 1115 (the companion bill to H.R. 1167) would have modified the existing Advisory Council for the Elimination of Tuberculosis.

Section 301 of the legislation would have put in statute TBAA and created a new grant program entitled the Tuberculosis/Pulmonary Infection Awards. The purpose of the award would have been to support the career development of clinically trained professionals who are committed to research regarding pulmonary infections and TB by providing for supervised study and research. For each of these awards, H.R. 1167 would have authorized $5 million to be appropriated for NHLBI for FY 2002 and such sums as may be necessary for each of the FYs 2003 through 2006. S. 1115 would have authorized $10 million for the entire section, which included the awards and a directive to expand TB research. Section 302 would have required NIAID to conduct activities for the development of a TB vaccine in accordance with the Blueprint for Tuberculosis Vaccine Development. H.R. 1167 would have increased NIAID's authorization for TB research and research training to $240 million for FY 2002 and such sums as may be necessary for each of the FYs 2003 through 2006. S. 1115 would have authorized $136 million for FY 2003, $162 million for FY 2004, and such sums as may be necessary for each of the FYs 2005 through 2007. (The current law authorized $50 million for 1994 and such sums as may be necessary for each of the FYs 1995 through 1998.) Finally, Section 303 of H.R. 1167 would have put in statute FIC's TBITRP. S. 1115 contained this provision, but it would not have placed TBITRP in statute.

The legislation would have amended CDC's TB program in Section 317E of the Public Health Service Act. H.R. 1167 would have authorized $528 million for FY 2002 and such sums as may be necessary for each of the FYs 2003 through 2006. S. 1115 would have authorized $235 million for FY 2003 and such sums as may be necessary for each of the FYs 2004 through 2007.

Status and Outlook

H.R. 1167 was introduced by Representative Sherrod Brown (D-OH) on March 22, 2001, and was referred to the House Energy and Commerce Committee. Representative Brown is the ranking member of the House Energy and Commerce Subcommittee on Health.

S. 1115 was introduced by Senator Edward M. Kennedy (D-MA) on June 27, 2001, and was referred to the Senate Health, Education, Labor and Pensions (HELP) Committee. On June 19, 2002, the Senate HELP Committee marked up the bill and ordered it reported with an amendment in the nature of a substitute. On July 26, S. Report 107-227 was printed, and the bill was placed on the Senate Legislative Calendar under General Orders.

Although there was no further action on either of these bills, it is anticipated that similar legislation will be introduced in the 108th Congress.