US leadership failing global TB control effort, says report

An elderly man infected with TB walks to the TB clinic in West Bengal, India. --Donna Todd

While high profile global health issues like AIDS and malaria garner more attention and funding, tuberculosis (TB) is increasingly becoming  a problem in places like India, and soon the US. A report published by the Center for Strategic and International Studies (CSIS) says that the US is failing to respond to the growing problem due to a “lack of visible high-level leadership” and not enough resources devoted to TB.

“The U.S. approach to global TB has been challenged by persistent shortcomings,” says the report. “One conspicuous weakness is a woefully inadequate pool of US agency resources allocated to control global TB.”

Report authors J. Stephen Morrison and Phillip Nieburg recommend that the United States appoint a US global TB coordinator, increase financial resources, lay out a clear vision for global TB control, and engage in high-level diplomatic engagement on TB. By enacting the four proposals, they believe the US can take a greater leadership role in controlling the worrying infection.

“TB is an unusual disease in that it is a somewhat quiet and indolent disease. It strikes US interests in an increasing way that we need to acknowledge,” said Morrison at a launch event yesterday for the report in Washington DC.

Since TB is spread from person to person through the air, its potential to rapidly spread across the globe is a major health concern. An estimated 8.6 million people developed TB in 2013 and another 1.3 million died because of the infection. The UN’s World Health Organization says that progress has been made on global TB control, but it has not been enough.

The 3 million new cases of TB that go undiagosed each year is alone reason for concern. The burden of new infections falls on Brazil, China, Russia, India and South Africa. The countries also known as the BRICS are home to some 80% of new infections in the 22 highest burden countries each year. More concerning is that three out of every five cases of multidrug resistant TB (MDR-TB) are in the BRICS.

Given how easily TB can spread and the emergence of drug resistant forms of TB, US public health leaders are concerned by the impact on the country. It is apparent that preventing a major outbreak in the US means taking a health interest in countries beyond US borders.

“Without reducing the global burden of TB and MDR-TB, we at the CDC recognize that reducing the US TB burden cannot come at the same time,” said Dr Thomas Kenyon, Director of the CDC Center for Global Health, at the event.

Achieving gains comes at a cost. The WHO estimates that as much as $2.3 billion is needed through 2015 to mount a full short-term response. Recent spending on TB by the US amounts to roughly $400 million between the budget for the United States Agency for International Development ($224-$256 million) and the President’s Emergency Play for AIDS Relief ($160 million). Morrison and Neiburg call on the US to meet the lofty goals set by the 2008 Lantos-Hyde TB legislation which called for $4 billion in TB funding over five years.

Establishing budgetary gains will require having someone in the current White House administration that can advocate for resources and help lead the US TB effort. Such a position already exists for malaria and HIV. Creating a Global TB Coordinator would both signal the commitment of the US and ensure that its TB control ambitions are met.

“Even without a large increase in resources in the near term, a U.S. Global TB Coordinator would provide visible TB leadership here and abroad, and a clear focal point for goals, programs, and funding streams across agencies,” says the report.

Guests at the CSIS-hosted event yesterday were in agreement that available resources are the greatest challenge to global TB control. The strategies that are working are unable to succeed at the level with which they can at current funding levels. The increase in TB-dedicated funding from the Global Fund to Fight AIDS, TB and Malaria from 17% of total program disbursements to 18% is a small step forward, but advocates say much ore needs to be done.

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Tom Murphy

Tom Murphy is a New Hampshire-based reporter for Humanosphere. Before joining Humanosphere, Tom founded and edited the aid blog A View From the Cave. His work has appeared in Foreign Policy, the Huffington Post, the Guardian, GlobalPost and Christian Science Monitor. He tweets at @viewfromthecave. Contact him at tmurphy[at]humanosphere.org.