SenateS. 4751119th Congress
End Tuberculosis Now Act of 2026
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[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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