The United States faces an outbreak of virulent, drug-resistant tuberculosis, yet TB disease fighters say government policy-makers "lack the political will" to move against the threat.
As The Washington Times reported last month, federal and state legislators have ignored repeated pleas for funding to fight the airborne disease. Instead they have cut funding for TB control, and TB programs are deteriorating just when specialists insist an expanded effort is needed.
"There is no question that our funding is insufficient. We can't do what needs to be done with the resources allocated," said Dr. Kenneth Castro, head of the nation's tuberculosis control program for the Centers for Disease Control and Prevention (CDC).
Fran DuMelle, the American Lung Association's deputy managing director, explains: "The U.S. Congress and many state governments are not convinced that tuberculosis is the problem that it is. The Congress sees TB as a non-issue - as a disease the country spent incredible amounts to contain, and did. The number of TB cases declined. Now legislators think there's no need for increased funds."
Adds Rep. Constance A. Morella, Maryland Republican: "There has been no realization that we have this new strain of tuberculosis [and] that it . . . is prevalent and infecting those in this country as well as people in other nations. There is no understanding that it is so much more cost-effective to pay for the treatments that will prevent it from spreading than it is to try and cure it when it spreads."
Mrs. Morella is one of a half-dozen legislators heeding the appeals of the nation's foremost authorities on tuberculosis. She said in an interview that "if left unchecked, the new strain of TB could kill 70 million people in the world and affect a billion more. It will kill more [people] this year than at any time in history." It is true that TB case rates in the United States have been declining. Last year, the national rate dropped to a record low of 6.8
cases per 100,000 persons.
But the lethal strains of multidrug-resistant TB, or "MDR-TB," have in just three years spread from 38 mostly undeveloped nations to more than 100 countries, including the United States and the countries of Western Europe.
The speed with which MDR-TB is spreading has stunned tuberculosis specialists. They had known for some time that drug-resistant TB was a threat.
Indeed, back in January 1992 the CDC reacted to early signs that multidrug-resistant TB was emerging as a serious problem. The agency assembled experts, created a task force and developed a "national action plan" to combat the menace.
The CDC issued five major reports on the problem and outlined a complex anti-TB strategy. It called for collaboration among various federal and state agencies, intense drug research, development of a workable vaccine and much more.
The agency requested $500 million to "eliminate" the disease - meaning to reduce the number of cases to one in a population of 1 million persons. It received $100 million.
For 2000, the TB control budget has been raised to $128 million, a fraction of what medical authorities say is now needed simply to fend off an MDR-TB epidemic.
Doctors say the United States can anticipate an epidemic for several reasons. Foremost is the fact that TB, in all its forms, spreads easily on the breeze of a TB victim's cough.
Then too, hundreds of thousands of immigrants and millions of visitors annually enter the United States from countries where drug- resistant TB proliferates. An unknown number of such persons carry the infection.
What's more, "ordinary" TB and drug-resistant TB commonly are found among those with the human immunodeficiency virus (HIV), which causes AIDS. TB-infected AIDS victims are spreading TB.
Given proper chemotherapy for nine months to a year, "ordinary TB" can be cured 90 percent of the time. …