Tuberculosis: International Efforts and Issues for Congress Page: 2 of 21
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Tuberculosis: International Efforts and Issues for
Infectious diseases are estimated to cause more than 25% of all deaths around
the world. A number of infectious disease outbreaks over the past decade, such as
H5N1 avian influenza and severe acute respiratory syndrome (SARS), have
heightened concerns about how infectious diseases might threaten global security.
International air travel and trade have complicated efforts to detect and contain
infectious diseases. People could cross borders carrying a highly contagious disease
before an infectious agent causes symptoms.
Debate ensued about countries' ability to contain diseases after a man known
to be carrying a form of drug-resistant tuberculosis (TB) crossed a number of
international borders unabated. The World Health Organization (WHO) estimates
that someone contracts TB every second and that about one-third of all people in the
world carry TB; most of these cases, however, are latent. In 2005, 8.8 million people
contracted the disease globally, of whom 1.6 million died (an average of 4,400 daily
deaths). About 84% of all cases in the world were found in 22 countries. Among the
15 countries with the highest estimated TB incidence rates, 12 are in Africa.
In 2005, TB prevalence rose only in sub-Saharan Africa and eastern Europe.
WHO attributes a number of factors to this increase, including weak health systems,
low-quality health care, minimal access to health facilities, insufficient staffing and
little human resource development, ill-equipped and substandard laboratories, and
limited coordination of TB and human immunodeficiency virus/acquired
immunodeficiency syndrome (HIV/AIDS) programs.
In FY2008, Congress voted to fund U.S. global TB operations at unprecedented
levels. The House FY2008 Foreign Operations Appropriations (H.R. 2764) provided
$313.5 million for international TB programs and $300 million for a U.S.
contribution to the Global Fund to Fight HIV/AIDS, TB, and Malaria (Global Fund).
The Senate version of H.R. 2764 included $200 million for U.S. global TB efforts
and $340 million for a U.S. contribution to the Global Fund. Both houses included
$300 million in FY2008 Labor, HHS, and Education Appropriations (H.R. 3043 and
S. 1710) for a U.S. contribution to the Global Fund. S. Rept.110-107 of S. 1710 also
suggested that $10 million more than CDC's FY2007 operating plan for TB be
provided to improve CDC's efforts to prevent TB and its progression into XDR-TB.
No appropriations bills that include funds for TB efforts have been enacted.
The House Foreign Affairs and Senate Foreign Relations Committees passed
companion TB bills, Stop TB Now Act (S. 968 and H.R. 1567) to support global TB
efforts and authorize $330 million in FY2008 and $450 million in FY2009. They also
authorized $70 million and $100 million for anti-TB programs at the U.S. Centers for
Disease Control and Prevention (CDC) in FY2008 and FY2009, respectively.
Although Congress voted to increase support for global TB efforts, some Members
expressed concern that the additional funds might be provided at the expense of other
global health programs. This report discusses some key issues Congress might
consider as debate ensues about the proper level and use of global TB funds.
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Tuberculosis: International Efforts and Issues for Congress, report, October 26, 2007; Washington D.C.. (digital.library.unt.edu/ark:/67531/metadc816412/m1/2/: accessed January 18, 2018), University of North Texas Libraries, Digital Library, digital.library.unt.edu; crediting UNT Libraries Government Documents Department.