To provide assistance to combat tuberculosis, malaria, and other infectious diseases, and for other purposes.

April 28, 2005

Mr. BROWNBACK (for himself, Ms. LANDRIEU, and Mr. INHOFE) introduced the following bill; which was read twice and referred to the Committee on Foreign Relations

To provide assistance to combat tuberculosis, malaria, and other infectious diseases, and for other purposes.

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 `Elimination of Neglected Diseases Act of 2005' or as the `END Act of 2005'.

SEC. 2. ENHANCED COORDINATION AND STRATEGIC PLANNING.

(a) MALARIA AND TB RESPONSE COORDINATORS- Section 1 of the State Department Basic Authorities Act of 1956 (22 U.S.C. 2651a) is amended--

(1) by redesignating subsection (g) as subsection (i); and

(2) by inserting after subsection (f) the following new subsections:

`(g) MALARIA RESPONSE COORDINATOR-

`(1) IN GENERAL- There shall be established within the Department of State a Coordinator of United States Government Activities to Combat Malaria Globally, who shall be appointed by the President (in this subsection referred to as the `Coordinator').

`(2) AUTHORITIES AND DUTIES; DEFINITION-

`(A) AUTHORITIES- The Coordinator, acting through such nongovernmental organizations (including faith-based and community-based organizations) and relevant executive branch agencies as may be necessary and appropriate to effect the purposes of this section, is authorized--

`(i) to operate internationally to carry out prevention, care, treatment, support, capacity development, and other activities for combatting malaria;

`(ii) to transfer and allocate funds for combatting malaria to relevant executive branch agencies in accordance with the strategy developed under section 2(b) of the END Act of 2005; and

`(iii) to provide grants to, and enter into contracts with, nongovernmental organizations (including faith-based and community-based organizations) for activities to combat malaria.

`(B) DUTIES-

`(i) IN GENERAL- The Coordinator shall have primary responsibility for the oversight and coordination of all resources and international activities of the United States Government to combat malaria, including all programs, projects, and activities of the United States Government related to malaria under the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7601 et seq.) or any amendment made by that Act.

`(ii) SPECIFIC DUTIES- The duties of the Coordinator shall specifically include the following:

`(I) Ensuring program and policy coordination related to malaria among the relevant executive branch agencies and nongovernmental organizations, including auditing, monitoring, and evaluation of all such programs.

`(II) Ensuring that each relevant executive branch agency undertakes programs primarily in those areas where the agency has the greatest expertise, technical capabilities, and potential for success in combatting malaria.

`(III) Avoiding duplication of efforts to combat malaria.

`(IV) Ensuring coordination of relevant executive branch agency activities in the field to combat malaria.

`(V) Pursuing coordination with other countries and international organizations to combat malaria.

`(VI) Resolving policy, program, and funding disputes among the relevant executive branch agencies related to activities to combat malaria.

`(VII) Directly approving all activities of the United States, including the provision of funding, related to combatting malaria.

`(VIII) Administering the Malaria Scientific Review Board established in subsection (g) of section 104C of the Foreign Assistance Act of 1961 (22 U.S.C. 2151b-4).

`(IX) Establishing due diligence criteria for all recipients of funds for malaria activities subject to the coordination and appropriate monitoring, evaluation, and audits carried out by the Coordinator necessary to assess the measurable outcomes of such activities.

`(X) Coordinating with the World Health Organization, the Global Fund to Fight AIDS, Tuberculosis and Malaria, the Department of

Health and Human Services (the Centers for Disease Control and Prevention and the National Institutes of Health), and other organizations with respect to the development and implementation of a comprehensive malaria control program.

`(C) RELEVANT EXECUTIVE BRANCH AGENCIES DEFINED- In this paragraph, the term `relevant executive branch agencies' means the Department of State, the United States Agency for International Development, the Department of Health and Human Services (including the Public Health Service), and any other department or agency of the United States that participates in international malaria activities pursuant to the authorities of such department or agency or this Act.

`(h) TB RESPONSE COORDINATOR-

`(1) IN GENERAL- There shall be established within the Department of State a Coordinator of United States Government Activities to Combat Tuberculosis Globally, who shall be appointed by the President (in this subsection referred to as the `Coordinator').

`(2) AUTHORITIES AND DUTIES; DEFINITION-

`(A) AUTHORITIES- The Coordinator, acting through such nongovernmental organizations (including faith-based and community-based organizations) and relevant executive branch agencies as may be necessary and appropriate to effect the purposes of this section, is authorized--

`(i) to operate internationally to carry out prevention, care, treatment, support, capacity development, and other activities for combatting tuberculosis;

`(ii) to transfer and allocate funds for combatting tuberculosis to relevant executive branch agencies in accordance with the strategy developed under section 2(c) of the END Act of 2005; and

`(iii) to provide grants to, and enter into contracts with, nongovernmental organizations (including faith-based and community-based organizations) to carry out activities to combat tuberculosis.

`(B) DUTIES-

`(i) IN GENERAL- The Coordinator shall have primary responsibility for the oversight and coordination of all resources and international activities of the United States Government to combat tuberculosis, including all programs, projects, and activities of the United States Government related to tuberculosis under the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7601 et seq.) or any amendment made by that Act.

`(ii) SPECIFIC DUTIES- The duties of the Coordinator shall specifically include the following:

`(I) Ensuring program and policy coordination related to tuberculosis among the relevant executive branch agencies and nongovernmental organizations, including auditing, monitoring, and evaluation of all such programs.

`(II) Ensuring that each relevant executive branch agency undertakes programs primarily in those areas where the agency has the greatest expertise, technical capabilities, and potential for success in combatting tuberculosis.

`(III) Avoiding duplication of efforts to combat tuberculosis.

`(IV) Ensuring coordination of relevant executive branch agency activities in the field to combat tuberculosis.

`(V) Pursuing coordination with other countries and international organizations to combat tuberculosis.

`(VI) Resolving policy, program, and funding disputes among the relevant executive branch agencies related to activities to combat tuberculosis.

`(VII) Directly approving all activities of the United States, including the provision of funding, related to combatting tuberculosis.

`(VIII) Establishing due diligence criteria for all recipients of funds for tuberculosis activities subject to the coordination and appropriate monitoring, evaluation, and audits carried out by the Coordinator necessary to assess the measurable outcomes of such activities.

`(C) RELEVANT EXECUTIVE BRANCH AGENCIES DEFINED- In this paragraph, the term `relevant executive branch agencies' means the Department of State, the United States Agency for International Development, the Department of Health and Human Services (including the Public Health Service), and any other department or agency of the United States that participates in international tuberculosis activities pursuant to the authorities of such department or agency or this Act.

`(3) AUTHORITY TO SERVE IN MULTIPLE CAPACITIES- An individual may serve as the Coordinator of United States Government Activities to Combat HIV/AIDS Globally, the Coordinator of United States Government Activities to Combat Malaria Globally, and the Coordinator of United States Government Activities to Combat Tuberculosis Globally.'.

(b) STRATEGY FOR MALARIA-

(1) REQUIREMENT- Not later than 6 months after the date of enactment of this Act, the Secretary of State and the Secretary of Health and Human Services shall develop a comprehensive, integrated, five-year strategy to set priorities for the use of United States assistance for programs to combat malaria in foreign countries. If elements are included in or excluded from the strategy that conflict with recommendations of the Malaria Scientific Review Board, the Secretary of State and the Secretary of Health and Human Services shall provide a justification to Congress for such inclusion or exclusion.

(2) OBJECTIVE- The objective of the strategy required by paragraph (1) shall be to reduce the rate of infection of malaria in each community in a foreign country where the United States provides assistance to combat malaria.

(3) ELEMENTS- The strategy required by paragraph (1) shall--

(A) assign priorities for the provision of assistance to combat malaria for each agency or department of the United States that provides such assistance that are consistent with the mission and expertise of such agency or department;

(B) evaluate each program to combat malaria that receives assistance from the United States to determine if such program is consistent with such priorities and to modify or terminate any inconsistent program;

(C) identify priority regions and countries where bilateral efforts will have the greatest impact and best complement multilateral efforts and bilateral programs of other donors;

(D) describe procedures to employ measurable outcome indicators to assess the effectiveness of a program to combat malaria that receives assistance from the United States, including a program that is intended to build capacity or provide technical assistance;

(E) propose methods to eliminate duplication of effort of programs to combat malaria that receives assistance from the United States;

(F) propose activities to combat malaria to be assigned to each such agency or department of the United States based on the clinical and scientific expertise and technical capability of such agency or department to carry out such activities;

(G) estimate the resources required by each such agency or department to carry out the strategy required by paragraph (1), including requests for funding to be made for these purposes by the President to Congress; and

(H) ensure that each such program is coordinated and consistent with the activities of other donors to combat malaria, including such activities of the Global Fund to Fight AIDS, Tuberculosis and Malaria established pursuant to Article 80 of the Swiss Civil Code.

(4) CONSULTATION- The Coordinator of United States Government Activities to Combat Malaria Globally shall consult with the Malaria Scientific Review Board established in subsection (g) of section 104C of the Foreign Assistance Act of 1961 (22 U.S.C. 2151b-4), as added by section 3(b), in developing the elements for the strategy related to combatting malaria.

(5) REPORT- Not later than 180 days after the date of the enactment of this Act, the Coordinator of United States Government Activities to Combat Malaria Globally shall submit to Congress a report setting forth the strategy required by paragraph (1).

(c) STRATEGY FOR TUBERCULOSIS-

(1) REQUIREMENT- The Coordinator of United States Government Activities to Combat Tuberculosis Globally shall develop a comprehensive, integrated, five-year strategy to set priorities for the use of United States assistance for programs to combat tuberculosis in foreign countries.

(2) OBJECTIVE- The objective of the strategy required by paragraph (1) shall be to reduce the rate of infection of tuberculosis in each community in a foreign country where the United States provides assistance to combat tuberculosis.

(3) ELEMENTS- The strategy required by paragraph (1) shall--

(A) assign priorities for the provision of assistance to combat tuberculosis for each agency or department of the United States that provides such assistance that are consistent with the mission and expertise of such agency or department;

(B) evaluate each program to combat tuberculosis that receives assistance from the United States to determine if such program is consistent with such priorities and to modify or terminate any inconsistent program;

(C) identify priority regions and countries where bilateral efforts will have the greatest impact and best complement multilateral efforts and bilateral programs of other donors;

(D) describe procedures to employ measurable outcome indicators to assess the effectiveness of a program to combat tuberculosis that receives assistance from the United States, including a program that is intended to build capacity or provide technical assistance;

(E) propose methods to eliminate duplication of effort of programs to combat tuberculosis that receives assistance from the United States;

(F) propose activities to combat tuberculosis to be assigned to each such agency or department of the United States based on the clinical and scientific expertise and technical capability of such agency or department to carry out such activities;

(G) estimate the resources required by each such agency or department to carry out the strategy required by paragraph (1), including requests for funding to be made for these purposes by the President to Congress; and

(H) ensure that each such program is coordinated and consistent with the activities of other donors to combat tuberculosis, including such activities of the Global Fund to Fight AIDS, Tuberculosis and Malaria established pursuant to Article 80 of the Swiss Civil Code.

(4) REPORT- Not later than 180 days after the date of the enactment of this Act, the Coordinator of United States Government Activities to Combat Tuberculosis Globally shall submit to Congress a report setting forth the strategy required by paragraph (1).

SEC. 3. ASSISTANCE TO COMBAT MALARIA.

(a) AWARD OF ASSISTANCE- Section 104C of the Foreign Assistance Act of 1961 (22 U.S.C. 2151b-4) is amended by adding at the end the following new subsections:

`(e) AWARD OF ASSISTANCE-

`(1) IN GENERAL- The President may not enter into any agreement with a person to procure assistance to combat malaria except as provided in this subsection, or as described in the strategy developed under section 2(b) of the END Act of 2005.

`(2) DEFINITIONS- In this subsection:

`(A) AGREEMENT- The term `agreement' means an agreement to procure assistance to combat malaria.

`(B) ASSISTANCE TO COMBAT MALARIA- The term `assistance to combat malaria' means any goods or services related to the treatment or prevention of malaria authorized to be provided under subsection (c).

`(C) ELIGIBLE ENTITY- The term `eligible entity' means any person that the President determines is eligible to enter into an agreement under this section.

`(D) MALARIA SCIENTIFIC REVIEW BOARD- The term `Malaria Scientific Review Board' means the Malaria Scientific Review Board established under subsection (g).

`(3) APPLICATION- An eligible entity seeking to enter into an agreement shall submit an application to the President at such time and in such manner as the President may require.

`(4) TERM OF AGREEMENT- The term of an agreement may not exceed 3 years and each agreement shall provide for the annual evaluation described in paragraph (8).

`(5) REVIEW PANELS-

`(A) AUTHORITY- The Administrator of the United States Agency for International Development is authorized to establish review panels as described in this subparagraph to review applications for assistance under this section.

`(B) MEMBERSHIP- A review panel shall be composed of individuals selected by the President after consideration of individuals recommended by the Malaria Scientific Review Board.

`(C) TERM OF SERVICE- The term of service for a member of a review panel may not exceed 1 year. An individual may serve for more than 1 term but such terms may not occur during consecutive years.

`(D) AVAILABILITY OF INFORMATION- A review panel shall make available--

`(i) to Congress, the transcript of any meeting of the review panel upon request; and

`(ii) to the public, a summary of the review and scores awarded by the review panel to each eligible entity who submitted an application under paragraph (3) upon request.

`(6) SELECTION CRITERIA-

`(A) HISTORY AND EXPERIENCE- During a fiscal year prior to 2009, the history and experience of an eligible entity in receiving funds from the United States Agency for International Development and carrying out programs with such funds may not be considered in awarding assistance under this section.

`(B) AVAILABILITY OF INFORMATION- An eligible entity may not be awarded assistance under this section unless such entity agrees to make available to the President for publication in the Federal Register and on the Internet the information that the President determines is appropriate.

`(7) ALLOCATION OF FUNDS- The President shall award agreements for a fiscal year in a manner so that amounts made available to the President for such agreements are allocated as follows:

`(A) Fifty percent of such amounts shall be used to provide commodities used to combat malaria, including pharmaceuticals, diagnostic equipment, and pesticides and pesticide application equipment for use with indoor residual spraying, of which--

`(i) 55 percent shall be used to provide commodities associated with indoor residual spraying; and

`(ii) not less than 10 percent shall be used to provide pharmaceuticals.

`(B) Not more than 10 percent may be used to carry out technical assistance activities.

`(C) Not more than 5 percent may be used by the United States for administration, travel, or other indirect or overhead costs.

`(D) Not more than 5 percent may be used to carry out research, including basic research or operational research or vaccine and therapeutic research and development.

`(E) The remaining amounts should be used to--

`(i) support distribution of commodities purchased under subparagraph (A);

`(ii) support the commodity distribution efforts of the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria;

`(iii) provide rapid response to malaria epidemics that multilateral efforts may not be able to mobilize to address quickly; or

`(iv) carry out other activities with measurable impact on morbidity and mortality from malaria.

`(8) EVALUATION-

`(A) INDICATORS- At the end of each 1-year period during which an agreement is in effect, the President shall determine whether the assistance to combat malaria provided pursuant to the agreement has produced a significant decrease in the following indicators:

`(i) The rate of morbidity from malaria in each health district where such assistance is provided.

`(ii) The rate of mortality from malaria in each health district where such assistance is provided.

`(B) CONDUCT OF EVALUATION- An evaluation of the assistance to combat malaria under an agreement required by subparagraph (A) may be conducted by the eligible entity providing such assistance or by another person, as determined by the President.

`(C) HEALTH DISTRICT DEFINED- In this paragraph, the term `health district' means the jurisdiction which a program to combat malaria is operated, as designed by the host government.

`(9) CONTINUATION- The President may continue an agreement for an additional 1-year period if the assistance to combat malaria provided under the agreement has produced a significant decrease in the indicators described in clauses (i) and (ii) of paragraph (8)(A).

`(10) REVISION-

`(A) IN GENERAL- If an agreement is not continued under paragraph (9), the President may negotiate to revise the agreement so that the assistance to combat malaria provided under the modified agreement is likely to result in a significant decrease in the indicators described in clauses (i) and (ii) of paragraph (8)(A).

`(B) REPORT TO CONGRESS- If the President approves a revision of an agreement that at least 75 percent of the members of the Malaria Scientific Review Board have voted to recommend not to approve, the President shall submit to Congress a justification for such approval.

`(11) TERMINATION-

`(A) IN GENERAL- The President shall terminate an agreement if such agreement--

`(i) is not continued under paragraph (9) or revised under paragraph (10); or

`(ii) has been revised under paragraph (10) for 2 consecutive 1-year periods and is not continued under paragraph (9) at the end of the subsequent 1-year period.

`(B) REPORT TO CONGRESS- If the President fails to terminate an agreement that at least 75 percent of the members of the Malaria Scientific Review Board have voted to recommend to terminate, the President shall submit to Congress a justification for such failure.

`(12) INELIGIBILITY-

`(A) IN GENERAL- An eligible entity who entered into an agreement that is terminated under paragraph (11), and any subsidiary of such entity, may not submit an application for assistance under this section during the 18-month period beginning on the date such agreement is terminated.

`(B) RENEWED ELIGIBILITY- At the end of a 3-year period described in subparagraph (A), such entity may submit an application for eligibility to the President that includes a description of actions carried out by such entity to address the reasons that the agreement described in subparagraph (A) was terminated.

`(f) OTHER LIMITATIONS ON ASSISTANCE-

`(1) ASSISTANCE FOR MOSQUITO NETS-

`(A) IN GENERAL- The President may not provide direct or indirect assistance under this section for a project to provide mosquito nets unless such project will provide mosquito nets that are treated with a long-lasting insecticide.

`(B) EVALUATIONS- An eligible entity awarded assistance under this section to provide mosquito nets may not receive such assistance for a period of more than 24 months unless at the end of such period, such entity demonstrates that--

`(i) not less than 60 percent of the children under the age of 5 and of women who are pregnant in each location where such entity is providing the mosquito nets are using such nets; or

`(ii) not less than 80 percent of households in each such location are using such nets.

`(2) ASSISTANCE FOR PHARMACEUTICALS- The President may not provide assistance under this section for a project to provide a pharmaceutical that contains chloroquine or sulfadoxine pyrimethamine to combat malaria in a country if--

`(A) resistance rates to chloroquine or sulfadoxine pyrimethamine, as appropriate, in such country exceed 15 percent; or

`(B) no data are available for such country regarding the resistance rates to chloroquine or sulfadoxine pyrimethamine, as appropriate.

`(3) CLINICAL AND EPIDEMIOLOGICAL ACTIVITIES-

`(A) IN GENERAL- Notwithstanding any other provision of law, the President shall ensure that the Secretary of Health and Human Services, acting through the Director of the Centers for Disease Control and Prevention, administers any assistance provided under this section for--

`(i) clinical or epidemiological activities to combat malaria; and

`(ii) technical assistance, or other indirect support with respect to epidemiological surveillance, diagnosis, treatment, or management of malaria.

`(B) APPLICATION AND EVALUATION- An eligible entity who receives assistance described in subparagraph (A) shall apply for such funds as described in subsection (e) and activities carried out with such assistance shall be evaluated as described in paragraph (8) of such subsection.

(b) MALARIA SCIENTIFIC REVIEW BOARD- Section 104C of the Foreign Assistance Act of 1961 (22 U.S.C. 2151b-4), as amended by subsection (a), is further amended by adding at the end the following new subsection:

`(g) MALARIA SCIENTIFIC REVIEW BOARD-

`(1) ESTABLISHMENT- There is established the Malaria Scientific Review Board (in this subsection referred to as the `Board'). The Board shall be administered by the Coordinator of United States Government Activities to Combat Malaria Globally established under section 1(g) of the State Department Basic Authorities Act of 1956.

`(2) MEMBERSHIP- The Board shall be composed of not less than 12 members as follows:

`(A) The Director of the National Institutes of Health of the Department of Health and Human Services or the designee of such Director.

`(B) The Secretary of Defense or the designee of such Secretary.

`(C) The Director of the Centers for Disease Control and Prevention of the Department of Health and Human Services or the designee of such Director.

`(D) The Director of the Office of Global Health Affairs of the Department of Health and Human Services or the designee of such Director.

`(E) The Coordinator of United States Government Activities to Combat HIV/AIDS Globally appointed under section 1(f) of the State Department Basic Authorities Act of 1956 (22 U.S.C. 2651a(f)) or the designee of such Coordinator.

`(F) The Administrator of the United States Agency for International Development, or the designee of such Administrator.

`(G) Not less than 6 individuals selected by the Coordinator of the United States Government Archives to Combat HIV/AIDS Globally who are not employees of the United States, including experts from countries with high rates of malaria prevalence.

`(3) QUALIFICATIONS- A member of the Board other than a member described in paragraph (2)(D), shall have a doctoral degree in an appropriate field of medicine or biomedical science.

`(4) CHAIR- The Chair of the Board shall rotate on an annual basis among the Board members referred to in subparagraphs (A), (B), and (C) of paragraph (2).

`(5) DUTIES- The Board shall--

`(A) review any solicitation made by the United States to procure goods or services related to the prevention or treatment of malaria;

`(B) recommend individuals to serve on a review panel described in subsection (e)(5);

`(C) review an evaluation made under subsection (e)(8);

`(D) vote on whether to recommend to terminate an agreement referred to in subsection (e)(1) at the end of each 1-year period that such agreement is in effect;

`(E) vote on whether to recommend to approve proposed modifications to such an agreement if such agreement will be revised under subsection (e)(10); and

`(F) consult with the Coordinator of the United States Government Archives to Combat HIV/AIDS Globally regarding the development of the strategy required by section 2(b) of the Elimination of Neglected Diseases Act of 2005.

`(6) PERSONNEL MATTERS-

`(A) COMPENSATION OF MEMBERS- Each member of the Board who is not an officer or employee of the Federal Government shall be compensated at a rate equal to the daily equivalent of the annual rate of basic pay prescribed for level IV of the Executive Schedule under section 5315 of title 5, United States Code, for each day (including travel time) during which such member is engaged in the performance of the duties of the Board. All members of the Board who are officers or employees of the United States shall serve without compensation in addition to that received for their services as officers or employees of the United States.

`(B) TRAVEL EXPENSES- The members of the Board shall be allowed travel expenses, including per diem in lieu of subsistence, at rates authorized for employees of agencies under subchapter I of chapter 57 of title 5, United States Code, while away from their homes or regular places of business in the performance of services for the Board.

`(C) STAFF-

`(i) IN GENERAL- The Chair of the Board may, without regard to the civil service laws and regulations, appoint and terminate an executive director and such other additional personnel as may be necessary to enable the Board to perform its duties. The employment of an executive director shall be subject to confirmation by the Board.

`(ii) COMPENSATION- The Chair of the Board may fix the compensation of the executive director and other personnel without regard to chapter 51 and subchapter III of chapter 53 of title 5, United

States Code, relating to classification of positions and General Schedule pay rates, except that the rate of pay for the executive director and other personnel may not exceed the rate payable for level V of the Executive Schedule under section 5316 of such title.

`(D) DETAIL OF GOVERNMENT EMPLOYEES- Any Federal Government employee may be detailed to the Board without reimbursement, and such detail shall be without interruption or loss of civil service status or privilege.

`(E) PROCUREMENT OF TEMPORARY AND INTERMITTENT SERVICES- The Chair of the Board may procure temporary and intermittent services under section 3109(b) of title 5, United States Code, at rates for individuals which do not exceed the daily equivalent of the annual rate of basic pay prescribed for level V of the Executive Schedule under section 5316 of such title.'.

(c) REPEAL OF AUTHORITY TO COORDINATE- Section 104C of the Foreign Assistance Act of 1961 (22 U.S.C. 2151b-4), as amended by subsections (a) and (b), is further amended by striking subsection (d).

SEC. 4. ASSISTANCE TO COMBAT TUBERCULOSIS.

(a) PRIORITY FOR DOTS COVERAGE- Section 104B(e) of the Foreign Assistance Act of 1961 (22 U.S.C. 2151b-3(e)) is amended by striking the second sentence and inserting `In order to meet the requirement of the preceding sentence, the President shall ensure that not less than 75 percent of the amount made available to carry out this section for a fiscal year is expended for antituberculosis drugs, diagnostic supplies, other commodities, direct patient services, and support and training of frontline health workers who are responsible for direct contact with patients and the immediate supervisors of such workers in diagnosis and treatment for Directly Observed Treatment Short-course (DOTS) coverage and treatment of multi-drug resistant tuberculosis using DOTS-Plus. Such amount may be used to procure pharmaceuticals through the multilateral procurement mechanism known as the Global Tuberculosis Drug Facility.'.

(b) AWARD OF ASSISTANCE- Section 104B of the Foreign Assistance Act of 1961 (22 U.S.C. 2151b-3) is amended--

(1) by redesignating subsection (f) as subsection (h); and

(2) inserting after subsection (e) the following new subsections:

`(f) AWARD OF ASSISTANCE-

`(1) IN GENERAL- The President may not enter into any agreement with a person to procure assistance to combat tuberculosis except as provided in this subsection.

`(2) DEFINITIONS- In this subsection:

`(A) AGREEMENT- The term `agreement' means an agreement to procure assistance to combat tuberculosis.

`(B) ASSISTANCE TO COMBAT TUBERCULOSIS- The term `assistance to combat tuberculosis' means any goods or services related to the treatment of tuberculosis authorized to be provided under subsection (c).

`(C) ELIGIBLE ENTITY- The term `eligible entity' means any person that the President determines is eligible to enter into an agreement under this section.

`(3) APPLICATION- An eligible entity seeking to enter into an agreement shall submit an application to the President at such time and in such manner as the President may require.

`(4) ALLOCATION OF FUNDS- The President shall ensure agreements are awarded in a manner so that of amounts made available to the President for such agreements for a fiscal year--

`(A) not less than 75 percent of such amounts shall be used to provide direct tuberculosis diagnosis and treatment services in the 22 countries that have the highest prevalence or incidence rates of tuberculosis, with an emphasis on providing such services to individuals in regions of such countries that do not have adequate medical services; and

`(B) not less than 25 percent of the amounts allocated under subparagraph (A) for a fiscal year shall be used to provide antituberculosis medications.

`(5) AVAILABILITY OF INFORMATION- An eligible entity may not be awarded assistance under this subsection unless such entity agrees to make available to the President for publication in the Federal Register and on the Internet the information that the President determines is appropriate.

`(6) EVALUATION-

`(A) INDICATORS- At the end of each 1-year period that an agreement is in effect, the President shall determine whether the assistance to combat tuberculosis provided pursuant to the agreement has produced a significant increase in the following indicators:

`(i) The rate at which individuals who have tuberculosis are accurately diagnosed.

`(ii) The number of tuberculosis patients who complete DOTS.

`(iii) The percentage of tuberculosis patients who begin DOTS that complete such treatment.

`(iv) The percentage of tuberculosis patients who are tested for the human immunodeficiency virus (HIV) infection, if appropriate considering the HIV prevalence rates among individuals infected with tuberculosis.

`(v) The percentage of patients who test positive for HIV infection who are referred successfully to HIV care or treatment, if appropriate considering the HIV prevalence rates among individuals infected with tuberculosis.

`(B) CONDUCT OF EVALUATION- An evaluation of the assistance to combat malaria

under an agreement required by subparagraph (A) may be conducted by the eligible entity providing such assistance or by another person, including an entity of a government, as determined by the President.

`(7) CONTINUATION- The President may continue an agreement for additional 1-year periods if the assistance to combat tuberculosis provided pursuant to the agreement has produced a significant increase in the indicators described in clauses (i) through (v) of paragraph (6)(A).

`(8) REVISION- If an agreement is not continued under paragraph (7), the President may negotiate to revise the agreement so that the assistance to combat tuberculosis provided under the modified agreement is likely to result in a significant increase in the indicators described in clauses (i) through (v) of paragraph (6)(A).

`(9) TERMINATION- The President shall terminate an agreement if such agreement--

`(A) is not continued under paragraph (7) or revised under paragraph (8); or

`(B) has been revised under paragraph (8) for a 1-year period and is not continued under paragraph (7) at the end of the subsequent 1-year period.

`(g) CLINICAL AND EPIDEMIOLOGICAL ACTIVITIES-

`(1) IN GENERAL- Notwithstanding any other provision of law, the President shall ensure that the Secretary of Health and Human Services, acting through the Director of the Centers for Disease Control and Prevention, administers any assistance provided under this section for--

`(A) clinical or epidemiological activities to combat tuberculosis; and

`(B) technical assistance, or other indirect support with respect to epidemiological surveillance, diagnosis, treatment, or management of tuberculosis.

`(2) APPLICATION AND EVALUATION- An eligible entity who receives assistance described in paragraph (1) shall apply for such funds as described in subsection (f) and activities carried out with such assistance shall be evaluated as described in paragraph (6) of such subsection.'.

SEC. 5. OTHER INFECTIOUS DISEASES.

(a) AUTHORITY TO PROVIDE ASSISTANCE- Section 104(c)(3) of the Foreign Assistance Act of 1961 (22 U.S.C. 2151b(c)(3)) is amended to read as follows:

`(3) ASSISTANCE FOR INFECTIOUS DISEASES-

`(A) FINDING- Congress finds that infectious diseases are responsible for the vast majority of morbidity and mortality in the developing world.

`(B) AUTHORITY TO PROVIDE ASSISTANCE- In addition to authorities to provide assistance to combat the acquired immune deficiency syndrome (AIDS), the human immunodeficiency virus (HIV), tuberculosis, and malaria in sections 104A, 104B, and 104C, the Administrator of the United States Agency for International Development is authorized to implement programs to prevent, treat, and control other infectious diseases, including leishmaniasis, African trypanosomiasis, Chagas' disease, shistosomiasis, meningitis group B, acute respiratory infections, infectious diarrhea, lymphatic filariasis, onchocerciasis, trachoma, and intestinal parasites in developing countries.

`(C) ALLOCATION OF FUNDS- The President shall ensure that of amounts made available for the assistance described in subparagraph (B) for a fiscal year--

`(i) not less than 50 percent of such amounts shall be used to provide direct immunization, prevention, diagnosis, prophylaxis, or treatment to patients; and

`(ii) not less than 60 percent of the amounts allocated under clause (i) for a fiscal year shall be used to provide medicines, vaccines, diagnostic equipment, micronutrient and oral rehydration combination supplements, and other commodities used in the delivery of immunization, prevention, diagnosis, prophylaxis, and treatment for patients.

`(D) AVAILABILITY OF INFORMATION- No individual or entity may not be awarded assistance to carry out a program under this paragraph unless such individual or entity agrees to make available to the President for publication in the Federal Register and on the Internet the information that the President determines is appropriate.

`(E) EVALUATION- A program carried out under subparagraph (B) shall be evaluated by the Administrator on an annual basis to determine if such program has resulted in a significant reduction in the rate of morbidity and in the rate of mortality attributed to an infectious disease in each location where the program was implemented.

`(F) REVISION- The Administrator shall revise a program carried out under subparagraph (B) that, at the end of a 1-year period, has not resulted in significant reduction in each of the rates referred to in subparagraph (E), so that the assistance provided under such modified program is likely to result in a significant decrease in each such rate.

`(G) CLINICAL AND EPIDEMIOLOGICAL ACTIVITIES-

`(i) IN GENERAL- Notwithstanding any other provision of law, the President shall ensure that the Secretary of Health and Human Services, acting through the Director of the Centers for Disease Control and Prevention, administers any assistance provided under this section for--

`(I) clinical or epidemiological activities to combat infectious diseases; and

`(II) technical assistance, or other indirect support with respect to epidemiological surveillance, diagnosis, treatment, or management of infectious diseases.

`(ii) EVALUATION- Any assistance described in clause (i) shall be evaluated at the end of each 1-year period as described in subparagraph (E).'.

(b) AUTHORIZATION OF APPROPRIATIONS- There are authorized to be appropriated to the President for each of the fiscal years 2006 through 2011 such sums as may be necessary to carry out section 104(c)(3) of the Foreign Assistance Act of 1961 (22 U.S.C. 2151b(c)(3)), as amended by subsection (a).

SEC. 6. ANNUAL REPORT ON HIV/AIDS, TUBERCULOSIS, AND MALARIA.

Section 104A(e)(2)(C)(iv) of the Foreign Assistance Act of 1961 (22 U.S.C. 2151b-2(e)(2)(C)(iv)) is amended to read as follows:

`(iv) with respect to malaria, the increase in the number of people treated and the increase in number of malaria patients cured, the number of people treated with artemesinin-based combination therapy or another therapy that is more effective than such combination therapy, the number of households that received indoor residual spraying to prevent transmission of malaria through each program, project, or activity receiving United States foreign assistance for malaria control purposes, and the progress in achieving reductions in morbidity and mortality through such programs, projects, or activities.'.

SEC. 7. AVAILABILITY OF INFORMATION ON EXPENDITURES.

Section 104(c) of the Foreign Assistance Act of 1961 (22 U.S.C. 2151b(c)) is amended by adding after paragraph (4) the following new paragraph:

`(5) AVAILABILITY OF INFORMATION-

`(A) REQUIREMENT FOR DATABASE- The President shall make publicly available through an Internet website a database of information regarding any activity carried out by the Agency, the Department of State, the Department of Health and Human Services, or the Department of Labor, or any assistance provided by the United States to a person, including an entity of a government, for the purpose of providing assistance to individuals in a foreign country related to any infectious disease, including--

`(i) the human immunodeficiency virus (HIV) and the acquired immune deficiency syndrome (AIDS);

`(ii) malaria;

`(iii) tuberculosis;

`(iv) diarrheal disease;

`(v) polio; and

`(vi) acute respiratory infection.

`(B) INFORMATION REQUIRED- The information made available under subparagraph (A) for assistance provided by the United State to an eligible entity, including an entity of a government, shall include, for each grant of such assistance to such entity--

`(i) the name of such entity;

`(ii) the amount of assistance received;

`(iii) the text of any agreement entered into by the United States and such entity, including the budget proposed by such entity, the description of work to be performed, and any appropriate certifications;

`(iv) a description of the activities to be carried out using such assistance, including the location in which such activities will be carried out;

`(v) the name of any person who will be compensated by such entity to carry out an activity described under clause (iv);

`(vi) the schedule on which such assistance will be provided;

`(vii) progress reports on the carrying out of the activities described under clause (iv); and

`(viii) any reports or other products required to be produced by such entity under the agreement referred to in clause (iii).

`(C) SEARCH CAPABILITIES- The database developed under subparagraph (A) shall be capable of being searched on multiple criteria, including--

`(i) disease or program area;

`(ii) recipient of assistance;

`(iii) country assisted;

`(iv) solicitation number; or

`(v) the type of activity carried out with United States assistance.'.

SEC. 8. ASSISTANT SECRETARY FOR GLOBAL HEALTH.

(a) IN GENERAL- Part P of title III of the Public Health Service Act (42 U.S.C. 280g et seq.) is amended by adding at the end the following section:

`SEC. 399O. COORDINATION OF GLOBAL HEALTH ACTIVITIES.

`(a) ESTABLISHMENT OF POSITION OF ASSISTANT SECRETARY FOR GLOBAL HEALTH- There is established within the Department of Health and Human Services the

position of Assistant Secretary for Global Health, who shall direct the Office of Global Health Affairs within the Department. The President shall appoint an individual to serve in such position. Such Assistant Secretary shall report to the Secretary.

`(b) DUTIES- Subject to the authority of the Secretary, the Assistant Secretary for Global Health shall coordinate policies and activities of the Department that are international in nature, including international aspects of family and social policy, and in particular shall--

`(1) perform such interagency coordination responsibilities as the Secretary has with respect to international health, family, and social policy issues;

`(2) coordinate and lead on behalf of the Secretary--

`(A) activities of the Department pertaining to international and multilateral organizations; and

`(B) relationships between the Department and foreign governments with respect to health, family, and social policy;

`(3) represent the Department before other Federal agencies, before other governments, in international organizations, and with respect to private-sector entities on international health issues, refugee health issues, and international aspects of other departmental issues, including family and social policy;

`(4) provide policy guidance and coordination on refugee health policy issues, in collaboration with agencies of the Department and other Federal agencies;

`(5) coordinate technical and policy-related Federal input into refugee health issues; and

`(6) perform such other duties as the Secretary determines are appropriate.'.

(b) PAY- Section 5315 of title 5, United States Code, is amended by adding at the end the following:

`Assistant Secretary for Global Health, Department of Health and Human Services.'.

SEC. 9. LIMITATION ON COUNTRIES THAT IMPOSE IMPORT TARIFFS.

After the date that is 2 years after the date of the enactment of this Act, no agency or department of the United States may donate or otherwise supply medicines or medical devices, including insecticide treated nets, insecticides, and other essential consumables required for disease control to a foreign country if such country imposes import tariffs or other import duties on such medicines or medical devices.

SEC. 10. CONSTRUCTION.

(a) IN GENERAL- In order for the Department of Health and Human Services to carry out international health activities, including activities related to HIV/AIDS, other infectious disease, chronic disease, and environmental disease, the Secretary of Health and Human Services may exercise authority equivalent to that available to the Secretary of State in section 2(c) of the State Department Basic Authorities Act of 1956 (22 U.S.C. 2669(c)).

(b) RELATIONSHIP WITH DEPARTMENT OF STATE-

(1) CONSULTATION- The Secretary of Health and Human Services shall consult with the Secretary of State and relevant Chief of Mission to ensure that the authority provided in this section is exercised in a manner consistent with section 207 of the Foreign Service Act of 1980 (22 U.S.C. 3927) and other applicable statutes administered by the Department of State.

(2) REIMBURSEMENT- The Secretary of Health and Human Services is authorized to provide such funds by advance or reimbursement to the Secretary of State as may be necessary to pay the costs of acquisition, lease, alteration, renovation, and management of facilities outside of the United States for the use of the Department of Health and Human Services.

(3) COOPERATION- The Secretary of State shall cooperate fully with the Secretary of Health and Human Services to ensure that the Department of Health and Human Services has secure, safe, functional facilities that comply with applicable regulation governing location, setback, and other facilities requirements and serve the purposes established by this Act.

(c) RENOVATION OF FACILITIES- The Secretary of Health and Human Services is authorized, in consultation with the Secretary of State, through grant or cooperative agreement, to make available to public or nonprofit private institutions or agencies in participating foreign countries, funds to acquire, lease, alter, or renovate facilities in those countries as necessary to conduct programs of assistance for international health activities, including activities relating to HIV/AIDS, other infectious diseases, chronic diseases, and environmental diseases.

END