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An Indian tubercolosis patient sits in a bed at a government hospital in Agartala on March 24 on World Tubercolosis Day. There is no vaccine for TB, although there are some in the pipeline, it requires funding. Public health nurses are at extreme risk for contracting the disease, and most states have cut their budgets for staffing public health nurses, e.g. Massachusetts used to have six public health nurses who could treat TB, it now only has one.
One in three people are infected with the Mycobacterium Tuberculosis, and 10 percent of those infected will become sick with Tuberculosis sometime in their lives. The rest have latent TB, and do not develop the disease. However, the disease can become active when the person’s immune system is compromised. That we currently have an epidemic of diabetes for instance, leaves us at risk for spiking a TB epidemic here in the United States. The year 2015 saw a 17 percent increase in Connecticut cases the first increase in 23 years. In the United States, TB treatment averages $17,000 per case, while treatment of multi-drug resistant TB (MDRTB) averages $282,000 — (XDR —extensively drug resistant) $482,000.
If you include productivity losses that number increase to $621,000. Clearly our state budgets would be overwhelmed by having to treat MDR TB here. It costs an average of $5,000 to treat MDRTB overseas, and $100-200 to treat drug-sensitive TB. It is imperative that we contain and overcome the plague abroad. There is no vaccine for TB, although there are some in the pipeline, it requires funding. Public health nurses are at extreme risk for contracting the disease, and most states have cut their budgets for staffing public health nurses, e.g. Massachusetts used to have six public health nurses who could treat TB, it now only has one.
Do not feel bad if you are one of many Americans who’ve been brainwashed to believe 10-25 percent of our budget goes to foreign aid, the fact is foreign aid is less than 1 percent of our budget. Do not feel bad if you’ve thought of foreign aid as charity or altruistic sacrifice, when indeed it is an important part of our defense, commerce, and keeping deadly pandemics off our shores. Thus, military leaders and secretaries of state often advocate for the foreign aid budget because greater health, primary education, and overcoming dire poverty, makes the recipient countries stronger allies. The U.S. Commerce department has historically written letters of support, as the development in these countries now has them make up 50 percent of our export trade. However, It is imperative that we awake from the myth, and understand the nature of foreign aid and the bipartisan strategy it has been to keep America strong, as the proposed 30 percent (!) cuts create an immediate risk of triggering an epidemic of tuberculosis in our country that we do not have the resources to handle.
About 4,900 people die from TB every day, and 25,000 people a day are sickened with it. Treatment for drug-responsive TB is a course of injections with the patient suffering nausea and pain. MDRTB can take one and a half to over two years of treatment and that kind of agonizing symptoms of the disease and the treatment, many patients are left with nerve damage.
Trump may be ignorant of the risk, but USAID and world leaders are not. TB has now surpassed AIDS as the leading infectious killer. Under U.S. leadership The United States has implemented the “National Action Plan for Combatting Drug-Resistant Tuberculosis,” and the global community has committed to end the TB epidemic by 2030. Three major innovations promise to turn the tide.
1. The first new antibiotic in 40 years has been introduced. Bedaquiline (aka BDQ) increases a person’s chance of survival from 50-80 percent.
2. A molecular diagnostic machine has been developed, called Expert that can accurately determine from a sample of sputum whether it is TB or multi-drug resistant TB, including in those who have HIV/ AIDS, and have the results within two hours, as opposed to the slow process of diagnosis that has historically sent people home to wait for results, having them spread the disease, and often the very poor don’t have means of returning for the results or treatment. People tested can be started on treatment immediately, reducing the spread of the disease to others, and increasing the chances of survival for the patient. This is a huge advance and USAID is helping countries buy the machine.
3. A smarter version of treatment now reduces the average course of treatment from two years to nine months.
The Plan cannot move forward without funding. Vaccines in the pipeline cannot get developed without funding. The United States will lose a fortune in monies, Americans will suffer and die, our health care costs will increase astronomically, our commerce will suffer, and we will weaken our allies, bringing the plague here, at a time we are already experiencing increases in the incidence of TB here. A “cut” is supposed to save us money, this is one that will overwhelm our resources.
We need to call our members of Congress, and ask them to fight any cuts to our foreign aid budget. Specifically, regarding TB, we need to ask our representatives to submit a formal appropriations request form for the USAID TB account to Representatives Mike Rogers and Nita Lowey, and Senators Lindsey Graham and Patrick Leahy, as chairs and ranking members of the respective State and Foreign Operations Subcommittee of Appropriations for $450 million for FY 2018 for our bilateral TB efforts, and a request for $1.475 billion for the Global Fund to Fight AIDS, Malaria, and TB. These amounts are in keeping with work that has been going on for decades, that is succeeding in our seeing results such as an end to death by AIDS and an end to in utero transmission of AIDS, and that are part of a strategy to rid the world of the TB pandemic by 2030.
Sandra Eagle of Stamford is a member of Results (results.org) an anti-poverty movement.