March 2008: Write to your senators urging next U.S. global health bill includes strong TB controlThe United States Leadership Against HIV/AIDS, TB and Malaria Act of 2003 is now due for its next 5-year authorization. This is one of the most important foreign assistance bills the U.S. Congress will ever consider, and there is growing support that it should include a strong commitment to fight tuberculosis. On February 27, the House Committee on Foreign Affairs voted to approve its version of the bill, the Tom Lantos and Henry J. Hyde Global Leadership Against HIV/AIDS, Tuberculosis and Malaria Reauthorization Act of 2008 (H.R.5501). Soon after — most likely in early March — the full House will vote on the bill. The Senate is expected to begin consideration of the bill in March. It is critical that your senators hear from you to ensure that the next 5-year bill includes strong TB-HIV provisions and full funding for bilateral (country-to-country) TB programs and the Global Fund to Fight AIDS, TB and Malaria.
Global HIV/AIDS, Tuberculosis and Malaria Reauthorization Act of 2008In 2003, President Bush called for the creation of a five-year, $15 billion emergency plan to combat AIDS in 15 focus countries. This plan, known as the President’s Emergency Plan for AIDS Relief (PEPFAR), was the central component of the United States Leadership Against HIV/AIDS, TB and Malaria Act of 2003. Unfortunately, though a three-disease bill, it did not authorize specific funding to fight TB and malaria. Because of the 2003 bill’s focus on HIV/AIDS, it is usually referred to as PEPFAR, and the reauthorization as “PEPFAR II” or the “reauthorization of PEPFAR.” RESULTS is working to ensure that the 2008 bill:
Congress has indicated support that the reauthorization truly be a three-disease bill, a testament to the advocacy efforts by RESULTS and partners to raise political awareness for the need for urgent action to fight TB. We must now continue our work to ensure that the political will to include a comprehensive response to the global TB epidemic does not fade. Why $4 Billion for TB?$4 billion is the U.S. share of the global donor amount needed to fight TB. This figure is derived from the funding called for in the Global Plan to Stop TB and the WHO’s drug-resistant response plan. The U.S. contribution is calculated by taking the U.S. proportion of all donor (high-income country) GDP. The U.S. represents about one-third of all donor country GDP. This funding is urgently needed to detect and treat TB and respond to the growing threat of extensively drug-resistant TB. TB claims the lives of 1.6 million people annually and is the leading infectious killer of people living with HIV/AIDS. The deadly synergy between the two diseases — especially XDR-TB — threatens the progress made in the fight against HIV/AIDS. Investing in the fight against TB is both critical and cost-effective: a World Bank–sponsored analysis estimates a 9-to-1 return of investment in TB in Africa (The Economic Benefit of Global Investments in Tuberculosis Control). The Stop TB Now Act of 2007 should be included in the reauthorization to ensure that this three-disease bill incorporates strong commitments to fight TB. Inclusion will also ensure that the Stop TB Now Act is passed into law this year. Why $2 Billion in FY09 for the Global Fund?Since its inception in 2002, the Global Fund has saved over 2 million lives. It has programs in 136 countries, and provides 21 percent of all donor HIV/AIDS spending and two-thirds of donor financing for TB and malaria. As of December 2007:
The Global Fund continues to expand its funding of life-saving interventions. Projections of potential funding demands from poor country partners indicate the Global Fund will need an estimated $46 billion from 2009 to 2013. For the U.S. to maintain its one-third share of total contributions to the Global Fund, reauthorization should include $2 billion in FY09. New WHO Report Warns of the Spread of Drug-ResistanceIn February 2008, the World Health Organization (WHO) released a new drug-resistant TB report, the first since the detection of extensively drug-resistant TB (XDR-TB) two years ago. The report is the largest collection of data ever compiled on drug-resistance and covers over 80 countries. The report shows that the number of countries reporting at least one case of XDR-TB has increased significantly, and it is likely that XDR-TB is under-reported in Africa because most of the continent lacks the tools for rapid and accurate data collection and diagnosis of drug-resistant cases. Drug-resistant TB is man-made and arises in the context of poorly funded and administered TB programs. Multidrug-resistant TB (MDR-TB) is a form of TB that is resistant to two or more of the first-line, essential drugs used for TB treatment. XDR-TB is MDR-TB plus resistance to the most effective “reserve” drugs, which are called “second-line drugs.” Drug-resistance is difficult and expensive to detect and treat; however, a full course of drugs to treat standard TB costs only $20. While increased funding is needed to halt the continued emergence of XDR-TB, the most effective prevention of drug-resistance is the scale-up of basic TB control programs. Key findings and conclusions of the report include:
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