Tuberculosis, an airborne disease, is the biggest killer among infectious disease agents, killing 4,900 people each day — more than malaria and HIV combined. In 2019, 10 million people developed TB and 1.4 million died from it, including 208,000 people who were living with HIV. TB is economically devastating, and health care personnel are disproportionately at risk. TB is a leading cause of death among women of reproductive age in developing countries. The existing TB vaccine is only effective in children.
In 2015 the National Institutes of Health, Centers for Disease Control and Prevention , and U.S. Agency for International Development developed a National Action Plan for Combating Multidrug-Resistant Tuberculosis, 2015 – 2020 (National Action Plan), focusing on 10 priority countries and targeting treatment to 560,000 persons with MDR-TB. The plan warned that the United States “has a window of opportunity to ensure that accelerating progress towards a TB-free world is not imperiled by MDR-TB.” However, the Action Plan has not been fully funded and implemented and it must be updated to cover 2021-2026.
Bilateral assistance is essential for strengthening applications to the Global Fund to Fight AIDS, Tuberculosis and Malaria, facilitating grant implementation, and improving the management of drug-resistant TB cases. Through the Global Drug Facility, USAID resources lower the cost of medications and help countries avoid dangerous treatment interruptions. USAID’s TB program, along with the NIH and CDC, also supports research efforts, including development of new treatment regimens and rapid diagnostics, that must be urgently accelerated.
Take advantage of new TB technologies and USAID’s TB Local Organizations Network to reach those who are unreached and to put the TB effort back on track following COVID-19-related disruptions. Implementing TB prevention and finding active TB cases are resource- and labor-intensive; greater U.S. assistance can play a critical role in improving active-case approaches and expanding access to TB preventive therapy. Funding should be increased for USAID TB and to the CDC Center for Global Health TB program to double the U.S. contribution to the TB Global Drug Facility and enable expansion of U.S. assistance to a broader range of priority countries, including in the Western Hemisphere. U.S. contributions to the Global Fund, which has substantially expanded MDR-TB funding, should be increased.
Reauthorize the USAID TB program, last authorized in 2008, to provide updated performance and reporting requirements. Congress should require a comprehensive strategy to combat all forms of TB, while providing patient support, an aggressive research agenda and an independent evaluation of U.S. bilateral assistance for TB.
Require USAID to develop a new National Action Plan to Combat MDR-TB to build on the previous plan’s success in scaling up drug-resistant TB identification, treatment, prevention and research and development of new diagnostic, treatment and prevention tools in the U.S. and globally. A new MDR-TB Action Plan will provide the needed framework to accelerate these efforts.
Photo Credit: World Vision
Morobe families happy with improved immunization access Sophia at the outreach site. The outreaches also offer the chance to speak with health workers about the challenges of parenthood and receive guidance on how to take better care of children.
TB programs offer a high return on health investment — $56 for each dollar invested. U.S. funding and leadership makes an enormous difference: TB incidence in the 23 USAID TB priority countries has fallen by 29% since 2000 and TB mortality decreased by 47%.
A 2020 study by the CDC found that implementing effective global TB control efforts could save the U.S. not just thousands of lives, but billions of dollars. According to the study, effective global TB control could avert 40,000 new TB cases in the U.S. between 2020 and 2035, and reduce TB incidence by 43%, when compared with current global trends. 
Of particular concern is drug resistance. Treating MDR-TB involves 250 injections and 15,000 pills over a two-year period, along with side effects that often include permanent hearing loss. Even with the National Action Plan in place, USAID has reported to Congress that “additional resources will be required” to reach planned objectives. 
The rate of new TB cases is declining by about 2% a year, but this must accelerate to a 4%-5% decline per year by 2020 to reach the first World Health Organization End TB Strategy milestones.  Faster progress is possible due to recent advances in diagnosis and treatment, yet greater US resources are needed to catalyze progress, including on TB prevention.
USAID announced the Global Accelerator to End TB, which helps countries meet the commitments outlined in the U.N. Political Declaration on the Fight Against Tuberculosis. This initiative’s Local Organizations Network works directly with local entities, including faith-based and other community organizations, to provide accessible services in TB priority countries, and with more resources it could accept many more high-quality applications.
With increasing buy-in at the highest political levels of key countries, USAID and CDC support can do even more to strengthen national programs and leverage Global Fund grants. The United States now has an unprecedented opportunity to lead the world in ending the TB threat to global health security.
Many high-TB-burden countries have reported substantial reductions in the diagnosis of TB, even after the relaxation of COVID-19-related lockdowns, resulting in far fewer people starting treatment. Shortages of some medications and overtaxed personnel have made it difficult to maintain treatment for existing patients or provide preventive therapy. According to recent modeling, the world could see an additional 6.3 million cases of TB, and an additional 1.4 million TB deaths, between 2020 and 2025, setting the fight against TB back 10 years or more.
David Bryden, RESULTS, Co-Chair TB Roundtable, firstname.lastname@example.org
Nuala Moore, American Thoracic Society, Co-Chair TB Roundtable, email@example.com
HEADER PHOTO CREDIT: World Vision
Giving children the best possible start in life through Go-Baby-Go. 24-year-old Tamador bonds with her daughter, Amira.
“Global Tuberculosis Report 2019 Advocacy Toolkit,” WHO. https://www.who.int/tb/Advocacy-Toolkit-WHOGLOBALTUBERCULOSISREPORT.pdf?ua=1
 “Eliminating the Financial Hardship of TB via Universal Health Coverage and other Social Protection Measures,” WHO. http://bit.ly/2fyjyIp.
 “U.S. Global Health Budget Tracker & Resources,” Kaiser Family Foundation. http://bit.ly/2EVm7Wd.
 “Economic Cost of Non-Adherence to TB Medicines Resulting from Stock-Outs and Loss to Follow-Up in the Philippines,” USAID. http://bit.ly/2gOYMJl.
 “Ending the Tuberculosis Epidemic: Fiscal Year 2015,” USAID. http://bit.ly/2zlb02A.
 “Benefit and Costs of the Tuberculosis Targets for the Post 2015 Development Agenda,” Copenhagen Consensus Center. http://bit.ly/2gblNot.
 “National Action Plan for Combating Multidrug-Resistant Tuberculosis: Year Two Report,” USAID, 2018. http://bit.ly/2LADtpn.
 “Global Tuberculosis Report 2017,” WHO. http://bit.ly/2Datmrv.