Tuberculosis (TB), an airborne disease, is the single biggest killer of all the infectious disease agents, killing 4,900 people each day, more than HIV. In 2015 there were 10.4 million new cases, and 11% were among people living with HIV. TB is frequently economically devastating for individuals and families, and health care personnel are disproportionately at risk. The existing TB vaccine has very limited efficacy.
In 2015 there were an estimated 580,000 new cases of drug-resistant TB, which kills about 250,000 people a year. However, less than one-quarter of people with drug-resistant TB are ever treated. The global response to drug-resistant TB must be scaled up using the latest cost-saving innovations.
Tuberculosis knows no borders. In the U.S., TB is found in every state, with nearly 10,000 cases a year, and 13 million people have a latent TB infection. People with active TB can infect up to 10‑15 other people over the course of a year. Six hundred and twenty cases of multidrug-resistant TB (MDR-TB) occurred in the U.S. from 2009 to 2014, severely straining public health budgets, with treatment costs averaging $154,000 per person for MDR-TB and about $500,000 per person for extensively drug resistant TB (XDR-TB). Because of migration, business and family ties, and tourism, the U.S. cannot ignore the global epidemic and at the same time protect the health of people in the U.S.
In 2015, relevant U.S. agencies, including the U.S. Agency for International Development (USAID), Centers for Disease Control and Prevention (CDC), and National Institute for Health (NIH), developed a National Action Plan for Combating Multidrug-Resistant TB (National Action Plan), focusing on 10 priority countries and providing treatment to 560,000 persons with MDR-TB. The plan warned that “The Nation has a window of opportunity to ensure that accelerating progress towards a TB-free world is not imperiled by MDR-TB.” However, President Obama proposed a large cut in the funding required to implement the plan.
Bilateral assistance is critical because it supports countries in developing strong applications to The Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund); facilitates grant implementation; and improves the management of drug-resistant TB. USAID resources are bringing down the cost of TB medications through the Global Drug Facility and are helping countries avoid costly and dangerous treatment interruption. USAID’s TB program, along with CDC and NIH, also supports research that must urgently be accelerated.