S. 4751

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 4751 Introduced in Senate (IS)]

<DOC>

119th CONGRESS
2d Session
S. 4751

To prevent, treat, and cure tuberculosis globally.

_______________________________________________________________________

IN THE SENATE OF THE UNITED STATES

June 11, 2026

Mr. Young (for himself and Mrs. Shaheen) introduced the following bill; 
which was read twice and referred to the Committee on Foreign Relations

_______________________________________________________________________

A BILL

To prevent, treat, and cure tuberculosis globally.

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 Tuberculosis Now Act of 2026''.

SEC. 2. ASSISTANCE TO COMBAT TUBERCULOSIS.

(a) In General.--Section 104B of the Foreign Assistance Act of 1961 
(22 U.S.C. 2151b-3) is amended to read as follows:

``SEC. 104B. ASSISTANCE TO COMBAT TUBERCULOSIS.

``(a) Findings.--Congress finds the following:
``(1) The international spread of tuberculosis (referred to 
in this section as `TB') and the deadly impact of TB's 
continued existence constitute a continuing challenge.
``(2) Additional tools and resources are required to 
effectively diagnose, prevent, and treat TB.
``(3) Effectively resourced TB programs can serve as a 
critical platform for preventing and responding to future 
infectious airborne and respiratory disease pandemics.
``(4) The America First Global Health Strategy sets out 
ambitious goals to address TB that are aligned with global 
goals to reduce incidences and mortality rates of TB.
``(b) Policy.--
``(1) Major objectives regarding tuberculosis.--It is a 
major objective of the foreign assistance program of the United 
States to help end the TB public health emergency through 
accelerated actions--
``(A) to support the diagnosis and treatment of all 
adults and children with all forms of TB; and
``(B) to prevent new TB infections from occurring.
``(2) Other policies regarding tuberculosis.--It is the 
policy of the United States, in countries in which the United 
States has established a foreign assistance program under this 
Act, particularly in countries with the highest rates of TB and 
other countries with high rates of infection and transmission 
of TB--
``(A) to reduce mortality, incidence, and health 
costs caused by TB, including by providing support 
for--
``(i) developing and using innovative new 
technologies and therapies (including molecular 
diagnostics) to increase active case finding 
and rapidly diagnose and treat children and 
adults with all forms of TB (including latent 
TB), alleviate suffering, and ensure TB 
treatment and preventative therapy completion;
``(ii) expanding diagnosis and treatment 
for individuals with all forms of TB (including 
children) and expanding prophylaxis treatment 
to at-risk individuals (including children), 
household contacts, individuals with latent TB, 
and individuals living with HIV;
``(iii) ensuring high-quality TB care by 
closing gaps in care cascades, implementing 
continuous quality improvement at all levels of 
care, and providing related patient support;
``(iv) sustainable procurement of TB 
commodities to avoid interruptions in supply; 
and
``(v) avoiding the procurement of TB 
commodities of unknown quality and the payment 
of excessive TB commodity costs; and
``(B) to ensure, to the greatest extent 
practicable, that United States funding supports 
activities that simultaneously emphasize--
``(i) the development of comprehensive 
person-centered programs, including diagnosis, 
treatment, and prevention strategies to ensure 
that--
``(I) all individuals sick with TB 
receive quality diagnosis and treatment 
through active case finding; and
``(II) individuals at high risk for 
TB infection are identified and treated 
with prophylaxis treatment in a timely 
manner;
``(ii) robust TB infection control 
practices are implemented in all congregate 
settings, including hospitals and prisons;
``(iii) the deployment of diagnostic and 
treatment capacity--
``(I) in areas with the highest TB 
burdens; and
``(II) for highly at-risk and 
impoverished populations, including for 
patient support;
``(iv) program monitoring and evaluation 
based on critical TB indicators, including 
indicators relating to infection control, the 
numbers of patients accessing TB treatment and 
patient support, and prophylaxis treatment for 
those at risk, including all close contacts, 
and treatment outcomes for all forms of TB;
``(v) training and engagement of health 
care workers on the use of new diagnostic tools 
and therapies as they become available, and 
increased support for training frontline health 
care workers to support expanded TB active case 
finding, contact tracing, and patient support;
``(vi) coordination with domestic agencies 
and organizations to support an aggressive 
research agenda to develop vaccines as well as 
new tools to diagnose, treat, and prevent TB 
globally;
``(vii) linkages with the private sector 
on--
``(I) research and development of a 
vaccine, and on new tools for diagnosis 
and treatment of TB;
``(II) improving current tools for 
diagnosis and treatment of TB, 
including telehealth solutions for 
prevention and treatment;
``(III) training healthcare 
professionals on the use of the newest 
and most effective diagnostic and 
therapeutic tools; and
``(IV) transparency and 
accountability;
``(viii) the reduction of barriers to 
treatment and diagnosis costs, including 
through--
``(I) training health workers to 
ensure integration into country's wider 
healthcare system;
``(II) requiring that all relevant 
grants and funding agreements include 
access and affordability provisions;
``(III) supporting campaigns for TB 
patients regarding local TB care for 
prevention, diagnosis, and treatment;
``(IV) monitoring cost barriers to 
accessing TB care for prevention, 
diagnosis, and treatment; and
``(V) increasing support for 
patient-led and community-led TB 
outreach efforts;
``(ix) support for local and country-level, 
sustainable accountability mechanisms to 
measure local progress and ensure commitments 
made by governments and relevant stakeholders 
are met; and
``(x) support for the inclusion of TB 
diagnosis, treatment, and prevention activities 
into primary health care, as appropriate.
``(c) Authorization.--
``(1) In general.--The President is authorized to furnish 
assistance, on such terms and conditions as the President may 
determine necessary to carry out this section, for the 
prevention, treatment, control, and elimination of TB.
``(2) Priority for assistance.--In furnishing assistance 
under paragraph (1), the President shall prioritize--
``(A) building and strengthening TB programs--
``(i) to increase the diagnosis and 
treatment of individuals who are sick with TB; 
and
``(ii) to ensure that such individuals have 
access to quality diagnosis and treatment;
``(B) direct, high-quality care for all forms of 
TB, including diagnosis, coordination of active case 
finding, treatment of all forms of TB disease and 
infection, patient support, and TB prevention;
``(C) treating individuals co-infected with HIV, 
other immune compromising co-morbidities, and other 
high-risk individuals with TB who may be at risk of 
stigma;
``(D) strengthening the capacity of health systems 
to detect, prevent, and treat TB, including MDR-TB and 
XDR-TB;
``(E) researching and developing innovative 
diagnostics, drug therapies, and vaccines, and program-
based research;
``(F) ensure integration of lab systems for 
molecular diagnostic networks for monitoring and 
response for productive use of laboratory capacities 
and healthcare facilities;
``(G) supporting the procurement of cost-effective 
and quality TB diagnostics and treatments, including 
annual support for the Global Drug Facility, and 
assisting local country capacity building and 
sustainability to control all forms of TB; and
``(H) ensuring TB programs can serve as key 
platforms for supporting national respiratory pandemic 
response with respect to existing and new infectious 
respiratory diseases.
``(d) Establishment of Goals.--The President, in consultation with 
the appropriate congressional committees and in pursuit of the policies 
described in subsection (a), shall establish goals to--
``(1) detect, cure, and prevent all forms of TB globally 
during the period beginning on January 1, 2027, and ending on 
December 31, 2030, specifically by working to--
``(A) reduce, by 2030--
``(i) the TB incidence rate by 80 percent 
(from 2015 levels); and
``(ii) the TB mortality rate by 90 (from 
2015 levels) percent;
``(B) ensure that--
``(i) 90 percent of incident TB cases are 
diagnosed and initiated on treatment;
``(ii) 90 percent of incident drug 
resistant-TB cases are diagnosed and initiated 
on treatment; and
``(iii) there is 90 percent treatment 
success rate for drug sensitive-TB and drug 
resistant-TB; and
``(C) provide TB preventive treatment to 30,000,000 
individuals; and
``(2) update the National Action Plan for Combating 
Multidrug-Resistant Tuberculosis.
``(e) Coordination.--
``(1) In general.--The President shall consult, as 
appropriate, with partner nations and relevant international 
organizations, nongovernmental organizations, and the private 
sector with respect to the development and implementation of a 
coordinated and complementary United States global TB response 
program.
``(2) Bilateral assistance.--In providing bilateral 
assistance under this section, the President, acting through 
the Secretary of State, shall--
``(A) catalyze support for research and development 
of new tools to prevent, diagnose, treat, and control 
TB worldwide, particularly to reduce the incidence of, 
and mortality from, all forms of drug-resistant TB;
``(B) consider the incidence of TB infections when 
determining assistance priorities to countries and 
regions;
``(C) ensure United States programs and activities 
focus on finding individuals with active TB and provide 
cost-effective and quality diagnosis and treatment, 
including through sustainable digital health solutions, 
and reaching individuals at high risk with prophylaxis 
treatment; and
``(D) ensure coordination among relevant Federal 
departments and agencies that engage in international 
activities relating to TB--
``(i) to ensure accountability and 
transparency;
``(ii) to reduce duplication of efforts; 
and
``(iii) to ensure appropriate incorporation 
and coordination of TB prevention, diagnosis, 
and treatment into other United States-
supported health programs.
``(f) Assistance for Tuberculosis Partnerships.--The President, 
acting through the Secretary of State, is authorized--
``(1) to provide resources to monitor and disseminate 
epidemiological information about tuberculosis, drug resistant 
TB, MDR-TB, and XDR-TB;
``(2) to provide resources directly to countries with high 
rates of TB--
``(A) to directly improve the capacity of such 
countries to prevent, diagnose, and treat TB on a local 
level; and
``(B) to develop and implement the national 
strategies and plans of such countries to control TB 
and eliminate MDR-TB and XDR-TB using the goals 
described in subsection (d)(1);
``(3) to leverage the contributions of donors to facilitate 
the activities described in paragraphs (1) and (2) while 
increasing the capacity of the United States to monitor and 
disseminate relevant information; and
``(4) to utilize longstanding United States partnerships 
and resources to address TB domestically and internationally.
``(g) Reports.--
``(1) Annual report on activities regarding tuberculosis.--
Not later than December 15 of each year until the earlier of 
the date on which the goals specified in subsection (d)(1) are 
met or December 31, 2032, the President shall submit a report 
to the appropriate congressional committees that describes 
United States foreign assistance to control TB and the impact 
of such assistance, including--
``(A) the number of individuals with active TB that 
were diagnosed and treated, including the rate of 
treatment completion and the number of individuals 
receiving patient support;
``(B) the number of individuals with MDR-TB and 
XDR-TB that were diagnosed and treated, including the 
rate of treatment completion, in countries receiving 
bilateral foreign assistance from the United States for 
programs to control TB;
``(C) the number of individuals trained by the 
United States Government in TB surveillance and 
control;
``(D) the number of individuals with active TB 
identified as a result of engagement with the private 
sector and other nongovernmental partners in countries 
receiving United States bilateral foreign assistance 
for TB control programs;
``(E) a description of the amount of funds 
provided, activities carried out, and any collaboration 
and coordination of United States anti-TB efforts with 
partner nations and relevant international 
organizations, nongovernmental organizations, and the 
private sector, including the amount of funding 
provided to such entities;
``(F) a description of the collaboration and 
coordination between the relevant Federal departments 
and agencies, including the Centers for Disease Control 
and Prevention and the Office of the Global AIDS 
Coordinator, to combat TB and, as appropriate, include 
treatment of TB in primary care;
``(G) the constraints on implementation of programs 
posed by health workforce shortages, health system 
limitations, barriers to digital health implementation, 
other challenges to successful implementation, and 
strategies to address such constraints, including local 
commitments to sustain TB control efforts;
``(H) a breakdown of expenditures for patient care 
supporting TB diagnosis, treatment, and prevention, 
including procurement of drugs and other TB 
commodities, drug management, training in diagnosis and 
treatment, health systems strengthening that directly 
impacts the provision of TB prevention, diagnosis, 
treatment, and research; and
``(I) for each country and each project site 
receiving bilateral United States assistance for the 
purpose of TB prevention, treatment, and control--
``(i) the number of individuals screened 
for TB disease (including screenings utilizing 
quality new rapid diagnostic tests) and the 
number evaluated for TB infection using active 
case finding outside of health facilities;
``(ii) the number of individuals with 
active TB disease that were diagnosed 
(including diagnoses made through using quality 
new rapid diagnostic tests) and treated with 
safe and effective oral regimens, including the 
rate of treatment completion and the number 
receiving patient support;
``(iii) the number of adults and children, 
including individuals with HIV and close 
contacts, who are evaluated for TB infection, 
the number of adults and children started on 
treatment for TB infection, and the number of 
adults and children completing such treatment, 
disaggregated by sex and, if possible, income 
or wealth quintile;
``(iv) the establishment of effective TB 
infection control in all relevant congregant 
settings, including hospitals, clinics, and 
prisons;
``(v) a description of progress in 
implementing measures to reduce TB incidence, 
including actions--
``(I) to expand active case finding 
and contact tracing to reach vulnerable 
groups; and
``(II) to expand TB prophylaxis 
treatment, engagement of the private 
sector, and diagnostic capacity;
``(vi) a description of progress to expand 
diagnosis, prevention, and treatment for all 
forms of TB, including in pregnant women, 
children, and individuals and groups at greater 
risk of TB, including migrants, prisoners, 
miners, and individuals exposed to silica, 
disaggregated by sex;
``(vii) the rate of successful completion 
of TB treatment for adults and children, 
disaggregated by sex, and the number of 
individuals receiving support for treatment 
completion;
``(viii) the number of individuals, 
disaggregated by sex, receiving treatment for 
MDR-TB, including the proportion of those 
individuals who are being treated with safer 
and more effective oral regimens, and any 
factors impeding the scale up of treatment, and 
a description of progress to expand community-
based MDR-TB care;
``(ix) a description of TB commodity 
procurement challenges, including shortages, 
stockouts, or failed tenders for TB drugs or 
other TB commodities;
``(x) the proportion of health facilities 
with specimen referral linkages to quality 
diagnostic networks, including established 
testing sites and reference labs, to ensure 
maximum access and referral for second-line 
drug resistance testing, and a description of 
the turnaround time for test results;
``(xi) the number of individuals trained by 
the United States Government and its 
implementing partners to deliver high-quality 
TB diagnostic, preventative, monitoring, 
treatment, and care;
``(xii) a description of how supported 
activities are coordinated with--
``(I) country national TB plans and 
strategies; and
``(II) TB control efforts supported 
by the Global Fund to Fight AIDS, 
Tuberculosis, and Malaria, and other 
international assistance programs and 
funds, including in the areas of 
program development and implementation;
``(xiii) for the first 3 years of the 
report required under this paragraph, a 
description of the progress in recovering from 
the negative impact of COVID-19 on TB, 
including--
``(I) whether there has been the 
development and implementation of a 
comprehensive plan to recover TB 
activities from diversion of resources;
``(II) the continued use of 
bidirectional TB-COVID testing; and
``(III) progress on increased 
diagnosis and treatment of active TB; 
and
``(xiv) for each country receiving United 
States bilateral assistance for the purpose of 
TB prevention, treatment, and control, the 
United States will track country government co-
investment in TB prevention, treatment, and 
control.
``(2) Annual report on tuberculosis research and 
development.--The President, acting through the Secretary of 
State, and in coordination with the heads of other relevant 
Federal departments and agencies, shall, not later than 1 year 
after the date of the enactment of the End Tuberculosis Now Act 
of 2026, and annually thereafter until December 31, 2032, 
submit a report to the appropriate congressional committees 
that--
``(A) describes the current progress and challenges 
to the development of new tools for TB prevention, 
treatment, and control;
``(B) identifies critical gaps and emerging 
priorities for research and development, including 
rapid and point-of-care diagnostics, shortened 
treatments and prevention methods, telehealth solutions 
for prevention and treatment, and vaccines; and
``(C) describes research investments by type, 
funded entities, and level of investment.
``(3) Evaluation report.--Not later than 4 years after the 
date of the enactment of the End Tuberculosis Now Act of 2026, 
the Comptroller General of the United States shall submit a 
report to the appropriate congressional committees that 
evaluates the performance and impact of programs supported by 
United States bilateral assistance funding on the prevention, 
diagnosis, treatment, and care of TB, including recommendations 
for improving such programs.
``(h) Definitions.--In this section:
``(1) Appropriate congressional committees.--The term 
`appropriate congressional committees' means--
``(A) the Committee on Foreign Relations of the 
Senate; and
``(B) the Committee on Foreign Affairs of the House 
of Representatives.
``(2) MDR-TB.--The term `MDR-TB' means multi-drug-resistant 
tuberculosis.
``(3) XDR-TB.--The term `XDR-TB' means extensively drug-
resistant tuberculosis.''.
(b) Sunset.--The amendment made by subsection (a) shall cease to 
have any force or effect beginning on January 1, 2033.
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