The American Society for Microbiology (ASM) is writing concerning the need to provide additional, new budgetary resources for efforts to diagnose, treat and control the spread of tuberculosis. As you know, there is a growing concern about the development and spread of multi-drug and extensively drug resistant tuberculosis (MDR/XDR TB), forms of the disease which are expensive to treat and can be fatal. Tuberculosis annually kills about 2 million people worldwide and is the leading cause of death by a single infectious agent. Health officials estimate that one in every ten new TB infections worldwide is caused by some drug resistant form of Mycobacterium tuberculosis (M. tb). With one third of the world’s population infected with tuberculosis, we must now recognize the grim possibility of widespread untreatable tuberculosis.
The ASM strongly recommends that Congress provide additional funding to enable the United States to confront MDR/XDR TB globally with adequate public health infrastructure and new science based tools for improved diagnosis, treatment and prevention. The lack of rapid diagnostic tests and low toxicity, short course drugs cripples effective case management of TB in local settings. After more than a century of laboratory TB diagnostics, microscopic examination of sputum is still the only widely available diagnostic tool in developing countries, but its sensitivity is 40 to 60 percent in the field and as low as 20 percent if there is HIV coinfection. Culture and sensitivity testing are needed and are currently not used at the time of diagnosis. Current drug treatments are lengthy and complex, further complicated by HIV/AIDS and multi drug resistance. Drug research goals include novel treatments that cure within 1 to 2 months or less, are effective against MDR TB and latent TB infections, are compatible with antiretrovirals, affordable and easily used in the field.
Aggressive public health programs and biomedical research in the United States are globally relevant to addressing the new force of tuberculosis. Biomedical research is key to understanding tuberculosis and to developing improved diagnostics and new drugs. The National Institute of Allergy and Infectious Diseases (NIAID) has developed a research agenda for MDR/XDR TB, which was released in early June, and builds on the foundation of ongoing NIAID TB research. For the first time in 40 years, a group of promising new drugs is entering clinical trials.
The Administration has proposed no funding increases for TB programs in FY 2008. The ASM recommends that an additional $300 million be provided in new funding for TB efforts for the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC), which would include an additional $150 million for the NIH and $150 million for the CDC. The ASM urges Congress to pay attention to the emerging health threat of drug resistant TB and provide necessary funding increases in this critical area.
Thank you for your support on behalf of public health and biomedical research. The ASM appreciates your interest and commitment to science and health.
Diane E. Griffin, M.D., Ph.D.
Ruth L. Berkelman, M.D.
Chair, Public and Scientific Affairs Board
Gail H. Cassell, Ph.D.
Chair, Committee on Biomedical Research