TB scare breathes new life into public health legislation

Last week’s headlines about a U.S. citizen who exposed other airline passengers to a dangerous form of tuberculosis has sparked a flurry of activity on Capitol Hill, as members hope to use the increased attention to win additional TB funding.

Sen. Sherrod Brown (D-Ohio) yesterday introduced legislation to allocate $300 million for domestic TB prevention, diagnosis and treatment. Meanwhile, supporters of legislation intended to control TB internationally are using the news to gain sponsors for their measures.

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“It’s possible to eradicate TB in the United States,” Brown said at a press conference. But, he added, “As long as TB is a health threat globally, it’s a health threat locally.”

“People on the Hill see this as an opportunity,” said Joanne Carter of Results, a nonprofit advocacy group that has worked for years to increase U.S. spending on TB.

“We’ve known what the issues are, but we didn’t have political support,” she said. “Now, maybe we do.”

Brown suggested that the incident involving Atlanta attorney Andrew Speaker, who traveled from the United States to Europe and back with a rare form of tuberculosis known as extensively drug-resistant, or XDR-TB, would lend momentum to his legislation.

“The unfortunate situation of Andrew Speaker brought the whole TB issue more in focus in the new Congress,” Brown said. Senate Health, Education, Labor and Pensions Committee Chairman Edward Kennedy (D-Mass.) and Sen. Kay Bailey Hutchison (R-Texas) cosponsored Brown’s bill.

An aide to Rep. Eliot Engel (D-N.Y.), a key sponsor of a House TB bill, said he would seek to move the legislation as early as possible this year to take advantage of the increased attention. Previously, many thought the bill would move next year at the earliest.

Engel will also offer testimony today to the House Homeland Security Committee, which is holding a hearing on the “poorly coordinated federal response” to last week’s incident. A U.S. border guard allowed Speaker to reenter the country even though he saw that the Department of Homeland Security had placed Speaker’s name on a watch list at the behest of the Centers for Disease Control and Prevention (CDC).

“Tuberculosis is airborne so when one can access nearly any part of the globe in a day or two, there are sure to be more instances such as this,” Engel said in his prepared testimony.

Engel said the federal response must address the problem at its root in Africa and other places with high levels of HIV/AIDS, a disease strongly linked to TB infections and fatalities. Engel also highlighted international prevention as a homeland security issue, noting that the World Health Organization has estimated that 27,000 people contracted XDR-TB last year.

Engel’s bill emphasizes that more than half of tuberculosis cases in the U.S. come from foreign-born individuals, and increases in global travel and trade make it even more important to control the disease in foreign countries.

The Senate appropriations subcommittee that funds the CDC and the National Institutes of Health (NIH) also is to hold a hearing today. Julie Gerberding, the director of the CDC, and Anthony Fauci, the director of the NIH’s National Institute of Allergy and Infectious Diseases, are among those scheduled to testify.

Engel’s bill would authorize $330 million in fiscal 2008 and $450 million in fiscal 2009 on anti-TB activities. Another $170 million would be authorized over two years for carrying out global TB activities at the CDC.

Meanwhile, Brown’s bill would establish increased TB-program funding for the CDC, the NIH, and state and local public health agencies. In particular, the bill would direct dollars toward research into new treatments, diagnostics and vaccines for TB and expand the CDC’s authority to respond to foreign outbreaks, among other provisions.

These bills would authorize a huge increase from current federal funding, according to Carter. The U.S. currently spends less than $100 million on global TB prevention, and was spending less than a million dollars as recently as 1997, she said. Brown said that domestic TB spending currently stands at $130 million a year.

American Public Health Association Executive Director Georges Benjamin said that cutbacks in domestic anti-TB spending from the mid-1980s to the early 1990s created the atmosphere for the drug-resistant strains to emerge. “This country in the early 1990s pretty much forgot about tuberculosis,” Brown said.

Desiree Filippone, vice president of international government affairs at Eli Lilly, said tuberculosis hasn’t got the attention of HIV/AIDS and malaria even though about 2 million people die of TB every year.

 “Tuberculosis is kind of like the stepchild in the corner,” said Filippone. Because it is considered to be an old disease from the last century, she said, many believe it is no longer a risk. “These bills that are out there hopefully will get a lot of momentum from this.”

Benjamin agreed, noting, “We have not, in my view, recognized the threat [of drug-resistant TB].”
XDR-TB and another form of multi-drug-resistant TB (MDR-TB) — which is also rare but more responsive to treatment — emerged as a result of inadequate treatment of standard TB, according to physician and lung-disease expert Alfred Munzer of Washington Adventist Hospital. Speaking at Brown’s press conference, Munzer called these dangerous strains “manmade.”

Harvard Medical School professor Jim Kim also spoke at the press conference, noting that as of Monday, cases of XDR-TB had been identified in 38 countries, including in each Group of Eight developed nation. Forty-nine cases of XDR-TB were reported in the United States between 1993 and 2006, according to the CDC. 450,000 new cases of MDR-TB are diagnosed worldwide each year, Kim said.

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