Text: Frist Introduces Bill to Help Countries Combat HIV/AIDS

18 June 2001

Text: Frist Introduces Bill to Help Countries Combat HIV/AIDS

S. 1032 would provide $200 million in FY-02 to battle diseases

A senator, who is also a doctor, has introduced legislation aimed to combat HIV/AIDS, tuberculosis, and malaria.

Senator Bill Frist (Republican of Tennessee) introduced S. 1032 to the Senate June 13. The bill's goal is to "expand assistance" to countries struggling with HIV/AIDS, malaria, and tuberculosis. It would provide $200 million in fiscal year 2002 to a global fund set up to fight the spread of those deadly diseases.

The proposed legislation would provide $500 million in fiscal year 2003.

Calling the worldwide HIV/AIDS epidemic "the most pressing moral, humanitarian and public health crisis of modern times," Frist said the challenge is one Americans cannot turn away from. "All America must rise to this historic challenge and join in sending a message of hope," the Tennessee lawmaker said.

"We must not turn away from the world-wide devastation of HIV/AIDS," Frist told Senate colleagues.

"Just consider this: right now, 36 million people are infected with HIV/AIDS a fatal infectious disease, mostly in developing countries. That number is more than the total combined populations of Virginia, Massachusetts, Tennessee, Maryland, Kentucky, Connecticut, New Mexico, Vermont and Nebraska," said the Tennessee Republican.

"As of today," he continued, "AIDS have orphaned 13 million children, more than the entire population of Illinois."

Frist, who is a surgeon, told fellow senators that more than 8 million people acquire tuberculosis each year, and "500 million more get malaria, both diseases that disproportionately affect the poorest countries."

Malaria, he noted, "still kills a child every 40 seconds. Remember the horrific links between HIV/AIDS, TB and malaria. If you have AIDS you are much more likely to contract TB, and TB has become the greatest killer of those with AIDS."

In a similar fashion, Frist explained, that if a person with HIV/AIDS contracts malaria, "that person is more likely to die. And infectious diseases such as these cause 25 percent of all the deaths in the world today."

In 2001, Frist said, the United States is spending more than "$460 million on international AIDS assistance alone, not including research."

That amounts to "approximately half of all the funds being spent on HIV/AIDS from all sources worldwide," he added.

The United States also spends more than $250 million on international TB and malaria programs, he said, "but we, and the rest of the world, must do more."

S. 1032, Frist said, authorizes $200 million for fiscal year 2002, and $500 million for fiscal year 2003 to be appropriated for payment to the global trust fund that was first proposed by United Nations Secretary General Kofi Annan in April of this year. That money, he emphasized, "will not substitute for, or reduce, resource levels otherwise appropriated for our excellent bilateral and multilateral HIV/AIDS, malaria and TB programs."

The global fund to be set up to combat HIV/AIDS would, according to the legislation, be "a public-private partnership that includes participation of, and seeks contributions from, governments, foundations, the private sector, civil society, the United Nations system, nongovernmental organizations, and other parties."

The fund would pursue what the authors of the legislation describe as "an integrated approach that includes the prevention of new infections and the treatment and care of infected individuals."

Frist, who serves on the Senate Budget Committee, Foreign Relations Committee, and the Health, Education, Labor and Pensions Committee, traveled to Africa while he was chairman of the Senate Subcommittee on Africa Affairs, and said the AIDS epidemic there "poses the single greatest policy challenge for Africa and to United States policy toward Africa."

S. 1032 was co-sponsored by three Democrats and two Republicans, including Senators John Kerry (Democrat of Massachusetts) and Jesse Helms (Republican of North Carolina).

President Bush announced in May that the United States would contribute $200 million to a global fund to fight the worldwide epidemic of HIV/AIDS.

S. 1032 was referred to the Senate Foreign Relations Committee.

The United Nations General Assembly will take up the issue of HIV/AIDS in a special session June 25-27.

The proposed legislation also provides for the reprogramming of fiscal year 2001 funds under the Global AIDS and Tuberculosis Relief Act of 2000 "until expended," and allows current fiscal year funds to be merged with fiscal year 2002 funds.

Following is the text of the June 13 speech of Senator Frist introducing S. 1032 and the text of S. 1032):

(begin text of June 13 speech of Senator Frist introducing S. 1032)

FRIST (for himself, Mr. KERRY, Mr. HELMS, Mr. LEAHY, Mr. DURBIN, and Mr. CHAFEE):

S. 1032. A bill to expand assistance to countries seriously affected by HIV/AIDS, malaria, and tuberculosis; to the Committee on Foreign Relations.

Mr. FRIST. Mr. President, I have spoken several times over the last few months on what many consider to be the most pressing moral, humanitarian and public health crisis of modern times, the worldwide epidemic of HIV/AIDS. I have previously gone into great detail about the impact of the disease on families, communities, economies, and regional stability.

Sometimes we feel overwhelmed by the enormity of insolvable problems. We become inured to the tragedy, and look for problems we can more easily solve. But we must not turn away from the worldwide devastation of HIV/AIDS. Just consider this: right now, 36 million people are infected with HIV/AIDS a fatal infectious disease, mostly in developing countries. That number is more than the total combined populations of Virginia, Massachusetts, Tennessee, Maryland, Kentucky, Connecticut, New Mexico, Vermont and Nebraska. As of today, AIDS have orphaned 13 million children, more than the entire population of Illinois.

Compounding this burden, over 8 million people acquire tuberculosis each year, and 500 million more get malaria, both diseases that disproportionately affect the poorest countries. Frequently forgotten, malaria still kills a child every 40 seconds. Remember the horrific links between HIV/AIDS, TB and malaria. If you have AIDS you are much more likely to contract TB, and TB has become the greatest killer of those with AIDS. Similarly, if a person with HIV/AIDS contracts malaria, that person is more likely to die. And infectious diseases such as these cause 25 percent of all the deaths in the world today. But as Americans, we have many reasons to be proud of our response to the challenges.

The U.S. has been a leader in the global battles against AIDS, malaria and TB. This year, we are spending over $460 million on international AIDS assistance alone, not including research. This is approximately half of all the funds being spent on HIV/AIDS from all sources worldwide. In addition, we spend over $250 million on international TB and malaria programs. But we, and the rest of the world, must do more. The U.N. estimates that for basic HIV/AIDS prevention, treatment and care programs in Africa alone, over $3 billion will be required, and at least $5 billion needed if specific anti-AIDS drugs are more widely used.

In Abuja, Nigeria, on April 26, U.N. Secretary General Kofi Annan called for a global ``war chest'' to combat HIV/AIDS, malaria and TB. Few thought that his call would so quickly be answered.

On May 11, just 2 weeks later, Senator LEAHY and I joined Secretary General Kofi Annan and Nigerian President Obasanjo as President Bush announced his intent to contribute $200 million as seed money for a new global fund designed to provide grants for prevention, infrastructure development, care and treatment for AIDS, malaria and TB. And this is to be over and above our already substantial bilateral commitments.

Uniquely, it will be financed jointly by governments and the private sector, and will focus on integrated approaches to turning back, and eventually conquering these scourges. While emphasizing prevention, this new initiative will also seek to develop health infrastructures so necessary to deliver services. Importantly, it will also support science-based care and treatment programs, including provision of drugs, and support for those, such as orphans, who are affected by disease, not just infected by it.

And because of recent action by the pharmaceutical companies to slash prices of AIDS drugs in Africa, for the first time in history, the drugs that revolutionized AIDS care and treatment in the U.S. can become part of a comprehensive prevention and care strategy in many more countries. This global fund is a new idea, it isn't a U.S. fund, or a U.N. fund, or a World Bank fund. However, it builds on last year's landmark work and legislation spearheaded by Congressman JIM LEACH, Congresswoman BARBARA LEE, and Senator JOHN KERRY to establish a multilateral funding mechanism for HIV/AIDS.

A key component of the Global Fund will be the full participation of the private sector, including business, NGOs, foundations and individual citizens. The problem is so large that governments cannot do the work alone. Non-governmental organizations, both faith-based and secular will be critical in the delivery of prevention and care services and to quickly converting good intentions into practical programs on the ground. And use of the funds will be closely monitored to ensure that good public health and science drive the programs and intellectual property rights are protected.

The legislation Senators KERRY, HELMS, LEAHY, DURBIN, and I are introducing today authorizes $200 million for fiscal year 2002, and $500 million for fiscal year 2003 to be appropriated for payment to the global trust fund. It will not substitute for, or reduce, resource levels otherwise appropriated for our excellent bilateral and multilateral HIV/AIDS, malaria and TB programs. This will be money well spent, it will save lives, and just as important, it will provide hope to the millions of people around the world who can do so much if given the prospect of a healthy future for themselves and their children.

Since the President was the first to announce our participation in the Global Fund for HIV/AIDS and Other Infectious Diseases, others have stepped up. France announced an initial contribution of $128 million, the United Kingdom has promised $106 million, and Japan is considering a significant commitment in the near future. Of particular interest, Winterthur-Credit Swisse has just announced a $1 million contribution, and others in the global business community are expected to follow. Other companies and foundations are considering financial or in-kind contributions.

Kofi Annan himself has offered $100,000 of his own money for the fund. I have also been told by U.N. Staff in New York that they have received many calls from private citizens asking how they can contribute. One gentleman from Virginia wants to send a check for $600. I have been assured that he and others like him will not have long to wait. A tax-exempt account for donations and toll-free number for information are being created as I speak. I understand that negotiations are underway with United Way to see if it can use its vast outreach to encourage donations. This is terrific news.

Every American, and others throughout the world, should join this fight against the diseases that have too long threatened our children, destroyed families, and undermined economic development of dozens of nations. This is not just government's fight. It is all of our responsibility to conquer HIV/AIDS, malaria and TB and consign them to the waste-bin of history.

Last week I had the opportunity of meeting with a remarkable woman from Atlanta who contracted HIV/AIDS at age 16. Denise Stokes has struggled with the virus for 15 years. She described what it was like spending time in hospital intensive care units and what it was like to not have access to available drugs. She prayed that some day there would be a cure and watched, from the depth of her illness, as policymakers seemed unable to grapple with the public health and personal tragedy that was AIDS. She is now sharing her experiences with churches, college students, community and professional organizations--challenging us to follow her example--to embrace our moral obligation to reach out beyond our selves, our communities and beyond our own country borders to fully battle the infectious diseases that are destroying so many lives on our planet. Denise Stokes' message is one of rising to a challenge, and bringing hope to the sick and their loved ones. All America must rise to this historic challenge and join in sending a message of hope.

(begin text of S. 1032)

International Infectious Diseases Control Act of 2001 (Introduced in the Senate)

S 1032 IS

107th CONGRESS

1st Session

S. 1032

To expanded assistance to countries seriously affected by HIV/AIDS, malaria, and tuberculosis.

IN THE SENATE OF THE UNITED STATES

June 13, 2001

Mr. FRIST (for himself, Mr. KERRY, Mr. HELMS, Mr. LEAHY, Mr. DURBIN, and Mr. CHAFEE) introduced the following bill; which was read twice and referred to the Committee on Foreign Relations

A BILL

To expanded assistance to countries seriously affected by HIV/AIDS, malaria, and tuberculosis.

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 `International Infectious Diseases Control Act of 2001'.

SEC. 2. DEFINITIONS.

In this Act:

(1) AIDS- The term `AIDS' means the acquired immune deficiency syndrome.

(2) EXECUTIVE AGENCY- The term `Executive agency' has the meaning given the term in section 105 of title 5, United States Code.

(3) GLOBAL FUND- The term `global fund' means the global fund to fight HIV/AIDS, malaria, and tuberculosis established consistent with section 4.

(4) HIV- The term `HIV' means the human immunodeficiency virus, the pathogen that causes AIDS.

(5) HIV/AIDS- The term `HIV/AIDS' means, with respect to an individual, an individual who is infected with HIV or living with AIDS.

(6) SECRETARY GENERAL- The term `Secretary General' means the Secretary General of the United Nations.

(7) WORLD BANK- The term `World Bank' means the International Bank for Reconstruction and Development.

SEC. 3. FINDINGS.

Congress makes the following findings:

(1) HIV/AIDS, tuberculosis, and malaria disproportionately affect the world's poorest countries and together will cost the lives of 6,000,000 people this year alone.

(2) According to the Joint United Nations Programme on HIV/AIDS (UNAIDS), more than 58,000,000 people worldwide have already been infected with HIV/AIDS, a fatal disease that is devastating the health, economies, and social structures in dozens of countries in Africa, and increasingly in Asia, the Caribbean, and Eastern Europe.

(3) AIDS has wiped out decades of progress in improving the lives of families in the developing world. As the leading cause of death in Africa, AIDS has killed 17,000,000 and will claim the lives of one quarter of the population, mostly productive adults, in the next decade. In addition, 13,000,000 children have been orphaned by AIDS--a number that will rise to 40,000,000 by 2010.

(4) The World Health Organization (WHO) estimates that 8,000,000 people each year become sick with tuberculosis, one of the most dangerous contagious diseases, easily transmitted through the air from those infected. Globally, tuberculosis kills at least 2,000,000 each year, is the leading killer of women between 15 and 44 years old, and is the most common cause of death in Africa in those with HIV/AIDS.

(5) More than 40 percent of tuberculosis cases in the United States result from importation of tuberculosis from foreign-borne persons. Multidrug-resistant tuberculosis spreads because of inadequate control programs and inappropriate use of anti-tuberculosis drugs--mostly in the developing world. Without a concerted international effort to increase the implementation of WHO-approved control strategies, the United States risks importation of this particularly dangerous form of tuberculosis.

(6) Malaria is a third disease that saps the social and economic strength tropical developing countries. Malaria affects more than 500,000,000 people each year and undermines not only the health and productivity of the world's poorest countries; malaria kills at least 1,000,000 each year, about 3,000 each day. In Africa, malaria kills a child every 40 seconds.

(7) Beyond the human toll, the economic impact of AIDS, malaria, and tuberculosis on regional economies is severe. According to UNAIDS, HIV/AIDS alone will reduce gross domestic product (GDP) of South Africa by 17 percent, or $22,000,000,000 over the next 10 years, and WHO estimates that sub-Saharan Africa's GDP would be 32 percent, or $100,000,000,000 higher now if malaria had been conquered 35 years ago. The current short term economic loss and direct cost of malaria is estimated to be up to $12,000,000,000 each year.

(8) The UNAIDS program estimates it will cost $3,000,000,000 for basic AIDS prevention and care services in sub-Saharan Africa alone, and at least $2,000,000,000 more if anti-retroviral drugs are provided widely. But in Africa, only $500,000,000 is currently available from all donors, lending agencies, and African governments themselves.

(9) For tuberculosis control, WHO estimates that a total of $1,000,000,000 per year will be necessary to effectively fight the tuberculosis epidemic, which will be spent to identify at least 70 percent of the cases and curing 85 percent of them. WHO indicates that an increase of $400,000,000 per year could make this goal a reality.

(10) The Secretary General of the United Nations, Kofi Annan, has called for a global fund to halt and reverse the spread of HIV/AIDS, malaria, and tuberculosis. The Secretary General proposed a multibillion dollar `war chest' financed jointly by donor governments and private contributors and, equally important, called on leaders from developing nations to give a much higher priority in their budgets to development of comprehensive health systems.

(11) The Secretary General has outlined the following five objectives for the fight against AIDS:

(A) To ensure that people everywhere know what to do to prevent infection.

(B) To prevent the transmission from mother to child.

(D) To provide care to those affected by AIDS, especially orphans.

(E) To deliver scientific breakthroughs, especially vaccines.

(12) Prevention of new infections is key, although treatment and care for those infected by HIV/AIDS is an increasingly critical component of the global response. Improving health systems, providing home-based care, treating AIDS-associated diseases like tuberculosis, providing for family support and orphan care, and making anti-retroviral drugs against HIV available will reduce social and economic damage to families and communities.

(13) Responding to the call from the Secretary General, the African heads of state meeting at the African Summit on HIV/AIDS, tuberculosis, and other infectious diseases in Abuja, Nigeria, April 25-27, committed to increasing to at least 15 percent the proportion of their budgets allocated to the health sector.

(14) Expanded United States financial support for new broad based international partnerships to control HIV/AIDS, malaria, and tuberculosis can help leverage substantial increases in global commitments to narrow the gap between need and currently available resources.

(15) The World Bank and WHO have demonstrated that investment in global public health activities to reduce HIV/AIDS, malaria, and tuberculosis not only is a humanitarian imperative, it also helps bolster the economic and social development necessary to build political and trade alliances. Further, containment of international disease threats has beneficial ramifications for Americans who are increasingly susceptible to global infectious disease threats.

SEC. 4. PURPOSES.

The purposes of this Act are to provide for United States participation in a global effort to--

(1) mitigate the effects, and control the spread, of HIV/AIDS, malaria, and tuberculosis by supporting programs for the prevention of new infections and for the care and treatment of individuals infected with those diseases in countries seriously affected, especially programs that provide care for children orphaned by the HIV/AIDS epidemic; and

(2) provide the resources and leadership to control AIDS, malaria, and tuberculosis through support of programs that emphasize--

(A) a science-based integrated approach that includes prevention of new infections and the treatment and care of infected individuals;

(B) public-private partnerships; and

SEC. 5. GLOBAL FUND TO FIGHT HIV/AIDS, MALARIA, AND TUBERCULOSIS.

(a) EFFORTS TO REACH AGREEMENT FOR ESTABLISHMENT OF GLOBAL FUND-

(1) IN GENERAL- The President, in consultation with the Secretary General and the heads of relevant Executive agencies, shall work with foreign governments, the United Nations and its relevant specialized agencies, the World Bank, and the private sector to reach an agreement for the establishment of a global fund to fight HIV/AIDS, malaria, and tuberculosis, to carry out the purposes of section 4 (1) and (2).

(2) DELEGATION OF AUTHORITY- The President shall exercise the authority of this subsection through the Secretary of State and the Secretary of Health and Human Services, except that, with respect to the World Bank, the President shall exercise such authority through the Secretary of the Treasury.

(b) DESCRIPTION OF GLOBAL FUND- The global fund should--

(1) be a public-private partnership that includes participation of, and seeks contributions from, governments, foundations, the private sector, civil society, the United Nations system, nongovernmental organizations, and other parties;

(2) pursue an integrated approach that includes the prevention of new infections and the treatment and care of infected individuals;

(3) focus on promotion of `best practices' in the prevention of new infections by funding a core group of programs that have been proven effective and then funding additional programs;

(4) promote scientific and medical accountability by requiring proposals to be reviewed and approved by medical and public health experts; and

(5) respect intellectual property rights as an important incentive in the development of new drugs.

(1) BOARD OF TRUSTEES- The global fund should be governed by a board of trustees, which should be composed of representatives of donors, recipients of funding, multilateral agencies, and such other parties as may be authorized by the agreement establishing the global fund.

(2) TECHNICAL ADVISORY GROUP- The board of trustees of the global fund should establish a technical advisory group, consisting of persons with demonstrated knowledge and experience in the fields of public health, epidemiology, health care delivery, health economics, and biomedical research, to advise the board of trustees with respect to funding proposals and other matters.

(3) SECRETARIAT AND OTHER BODIES- Other bodies, such as a small secretariat, should be established to support the work of the board of trustees of the global fund.

(d) PROGRAM OBJECTIVES-

(1) GRANT AUTHORITY-

(A) IN GENERAL- In carrying out the purposes of section 4 (1) and (2), the global fund, acting through its board of trustees with guidance from the technical advisory group, should provide only grants, including grants for technical assistance to support measures to build local capacity in national and local government, civil society, and the private sector, with respect to the prevention of new infections and the care and treatment of individuals infected with disease.

(B) ELIGIBILITY FOR GRANTS- Governments and nongovernmental organizations shall be eligible to receive grants from the global fund. Emphasis should be given to facilitating the funding of nongovernmental organizations, including both faith-based and secular groups working in communities, except that national authorities should set the overall plan and agenda for dealing with public health and infectious diseases in their countries.

(2) ACTIVITIES SUPPORTED-

(A) IN GENERAL- Activities supported under paragraph (1) should include efforts to lead and implement effective and affordable HIV/AIDS, malaria, and tuberculosis programs, including programs focused on prevention and health education and treatment and care services, including access to affordable drugs.

(B) EMPHASIS ON STRONG POLITICAL LEADERSHIP- Emphasis should be given to ensuring strong political leadership in recipient countries, through the development and implementation of effective strategies against HIV/AIDS, tuberculosis, and malaria; development of well managed, transparently administered health systems; and monitoring and evaluation of programs supported by the global fund.

(C) INITIAL PRIORITY ON COMBATING HIV/AIDS- In view of the globalization of the AIDS epidemic, initial priority should be given to programs to combat HIV/AIDS. Such programs should include the promotion of `best practices' in the prevention of new infections, including education that emphasizes risk avoidance such as abstinence, measures to stop mother-to-child transmission, and efforts to provide for the support and education of AIDS orphans and the families, communities, and institutions most affected by HIV/AIDS.

(e) REPORTS TO CONGRESS-

(1) ANNUAL REPORTS BY THE PRESIDENT- Not later than one year after the date of the enactment of this Act, and annually thereafter for the duration of the global fund, the President shall submit to the appropriate committees of Congress a report on the global fund, including its structure, objectives, contributions, funded projects, and assessment of its effectiveness.

(2) APPROPRIATE COMMITTEES DEFINED- In paragraph (1), the term `appropriate committees of Congress' means the Committee on Foreign Relations and the Committee on Appropriations of the Senate and the Committee on International Relations and the Committee on Appropriations of the House of Representatives.

(f) UNITED STATES FINANCIAL PARTICIPATION-

(1) AUTHORIZATION OF APPROPRIATIONS- In addition to any other funds authorized for multilateral or bilateral programs related to HIV/AIDS, malaria, tuberculosis, or economic development, there is authorized to be appropriated to the Department of State $200,000,000 for fiscal year 2002 and $500,000,000 for fiscal year 2003 for payment to the global fund.

(2) REPROGRAMMING OF FISCAL YEAR 2001 FUNDS- Funds made available for fiscal year 2001 under section 141 of the Global AIDS and Tuberculosis Relief Act of 2000 (as in effect immediately before the date of enactment of this Act)--

(A) are authorized to remain available until expended; and

(B) shall be transferred to, merged with, and made available for the same purposes as, funds made available for fiscal year 2002 under paragraph (1).

(3) CERTIFICATION REQUIREMENT-

(A) IN GENERAL- Before the initial obligation or expenditure of funds appropriated under paragraph (1) or reprogrammed under paragraph (2), the President shall certify that adequate procedures and standards have been established to ensure accountability for and monitoring of the use of funds contributed to the global fund, including the cost of administering the global fund.

(B) TRANSMITTAL OF CERTIFICATION- The certification required by subparagraph (A), and the bases for that certification, shall be submitted by the President to Congress.

(4) STATUTORY CONSTRUCTION- Nothing in this Act may be construed to substitute for, or reduce resource levels otherwise appropriated by Congress for, bilateral and multilateral HIV/AIDS, malaria, and tuberculosis programs.

SEC. 6. REPEAL.

Subtitle B of title I of the Global AIDS and Tuberculosis Relief Act of 2000 (22 U.S.C. 6821 et seq.) is hereby repealed.2001-06-18

(end text of S. 1032)