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U.S. TB Control: From Confidence to Crisis

TAGline Fall 2013

Funding cuts and shifting budgetary priorities threaten tuberculosis gains

By Coco Jervis

The United States is losing ground in its fight against the tuberculosis (TB) epidemic within its own borders. Sequestration and shifting priorities of Congress and the Obama administration have led to a waning of political support and resources for domestic and global TB programs. More than 10,000 people are diagnosed with active TB disease every year in the United States, and an estimated nine to 14 million American residents are currently living with latent TB infection. Perceived low prevalence, coupled with a lack of political vigilance and declining federal and state resources for TB control and elimination, has set the stage for a dangerous and costly resurgence of domestic TB.

Complacency, divestment, and resurgence are a recurring pattern. Funding for TB control and elimination efforts declined precipitously throughout the 1970s and early 1980s, leading to a deadly explosion of active and drug-resistant TB—particularly in New York City—in the early 1990s. More than 20 years later, funding for our domestic TB response has been further slashed due to shifting priorities and sequestration-related cuts. As a result, the prevention and control infrastructure on state and local levels has fallen into neglect, setting the stage for a grave and costly domestic resurgence of TB. Currently, many resource-strapped domestic TB program managers struggle to provide basic diagnostic, treatment, contact-tracing, and ancillary services to patients.

Treatment of active, drug-sensitive TB in the United States can cost between $11,000 and $27,000 per patient; treatment for multidrug-resistant TB costs taxpayers upwards of $500,000 per patient. Compounding these exorbitant costs, many TB programs have recently experienced difficulty accessing drugs to treat latent and active TB either because of nationwide shortages or because the necessary drugs are too expensive. The strain on state and local TB programs will undoubtedly heighten with the rollout of health care reform and the influx of new insured and uninsured TB patients that will be in need of care.

Sequestration is devastating our domestic TB research progress as well. The Centers for Disease Control and Prevention’s (CDC’s) Division of TB Elimination (DTBE) has been forced to make some difficult funding cuts to its Tuberculosis Trials Consortium (TBTC), the leading TB clinical research collaborative in the world. Despite its already negligible budget, the TBTC has conducted critical research that could spur the development of shorter, better-tolerated treatment strategies for curing and preventing the spread of TB. The TBTC has pioneered clinical research that has led to shortening active, drug-sensitive TB treatment from six months to just three or four months. A shorter, safer, better-tolerated regimen would be transformative. Shaving even two months off TB’s long treatment course would mean one-third fewer patients on treatment at any given time, saving millions in treatment costs each year in the United States alone. But sequestration-related cuts are jeopardizing the launch of important late-stage clinical research for a new treatment regimen.

TAG has been aggressive in its response to these cuts. In July, TAG launched the Save the TBTC campaign aimed at mobilizing the domestic TB research and activist community to reach out to their members of congress to educate them about the importance of the TBTC’s work and the need to reinvest in the DTBE’s TB control and elimination activities. TAG is also working in coalition to reintroduce an ambitious Comprehensive TB Elimination Act that is sunsetting this year. TAG has also been working closely with the congressional TB Elimination Caucus, the CDC, and the FDA to address the ongoing TB drug shortage crisis.

Reaching zero TB deaths, zero new infections, and zero suffering and stigma in the United States is achievable with political will and a sustained commitment of resources to our TB control programs. Additionally, in order to achieve total TB elimination, both here and abroad, it will be necessary to accelerate the research and development of new diagnostics, drugs, prevention, and treatment, and to improve strategies to reach underserved populations. We must remain vigilant in our advocacy in order to ensure that TB remains in the spotlight.