A Strategic Approach to Global Tuberculosis: A report by Center for Strategic and International Studies

10 June 2014 - Washington D.C. / Geneva - A new report released by the Global Health Policy Center of the Washington-based Center for Strategic and International Studies, suggests a slew of recommendations for the U.S. government to beef up the fight against tuberculosis - including appointing a U.S. Global coordinator on TB, increasing resources for programs, and forging a high level diplomatic annual meet for TB.

Authored by J Stephen Morrison and Phillip Nieburg, the report: Strategic U.S. Leadership - Essential to Address the Global Tuberculosis Pandemic, is a part of the CSIS series on Tuberculosis.

The report identified four ways in which the evolution of the global TB pandemic threatens U.S. national interests. First, the threat of TB resurgence within the country’s borders, with nearly 9,945 TB cases reported in 2012. It notes that domestic cases of TB occur in people born in other countries. The report underscores "that eliminating TB in the United States and guarding effectively against the persistent threat of domestic TB resurgence are both processes that are inextricably linked to how well TB is addressed around the world."

The missed three million cases of people with TB each year and the bacterial resistance to anti-TB drugs are others factors that could threaten the U.S. national interests, the report said. "The ongoing spread of TB resulting from untreated or poorly treated TB cases imposes persistent disease and economic burdens upon many countries that are expected to be the cornerstones of future global growth and prosperity," it said.

The burden of TB among people living HIV (PLHIV) was also emphasized as a key factor. Although the U.S. government has invested over $50 billion in the President's Emergency Plan for AIDS Relief (PEPFAR) since 2003, supporting life-saving antiretroviral treatment for an estimated 6.7 million men, women, and children, TB remains the leading infectious killer especially in eastern and southern Africa - areas that have received the bulk of U.S. HIV/AIDS investments. The report noted that "achieving effective control of TB becomes even more critical for long-term success in keeping PLHIV alive in PEPFAR-supported countries. At present, only 3 percent of PEPFAR resources are being used to address TB issues."

Four recommendations for the U.S. administration flow from the report to elevate TB in political, budgetary, and strategic terms - as it did over the last decade with HIV/AIDS and malaria:

Appointing and empowering a U.S. Global TB Coordinator to advocate internally and with Congress for new resources; set clear priorities that can be achieved realistically with current constrained finances; devise a coherent U.S. approach that aligns resources with goals and that sets concrete targets for the years beyond 2015; and to ensure continued interagency cooperation within the U.S. government; and Represent the United States in the orchestration of global TB efforts.

Increasing global TB control resources and improve their use by increasing fiscal and personnel resources dedicated to Global TB including higher allocation for USAID and PEPFAR, and a suggestion for an external review of U.S. global TB programs.

Laying out a clear vision including building on the successes of controlling drug-sensitive TB, reduce the transmission and global burden of MDR-TB, improving the prevention, diagnosis, and control of TB in PLHIV and creating robust long-term research partnerships with key institutions in selected emerging economies.

It also recommended creating high-level diplomatic engagement on TB. United States must press for a new annual high-level diplomatic meeting on global TB that can signal that the TB pandemic has risen as a foreign policy and health priority. "Any fundamental, generational reshaping of the TB pandemic will rest on access to expanded resources across many institutions, higher levels of political will among diverse world leaders, and far better orchestration of global efforts through high-level political attention," it said.