LOS ANGELES, California — In December 2021, Senators Bob Menendez (D-N.J.) and Todd Young (R-Ind.) put forward the End Tuberculosis Now Act of 2021, a piece of bipartisan legislation to address the international tuberculosis issue through increased U.S. attention and action. While TB is not exclusively “a disease of the poor,” it disproportionately impacts the most impoverished communities throughout the world. The End TB Now Act promises to prioritize the treatment and prevention of TB in the most disadvantaged regions.
The Importance of the Act
The End TB Now Act of 2021, legislation to address the ongoing tuberculosis pandemic, came at a notable time in light of the COVID-19 pandemic. Both Menendez and Young point out how efforts to address COVID-19 not only interfered with progress in the fight against TB but also highlighted the way that the disease disproportionately impacts more vulnerable populations.
The senators emphasized that the spread of TB among these communities is increasing despite being a “preventable, treatable and curable disease.” The bill seeks to address the ongoing pandemic in this new light following the COVID-19 pandemic.
The bill focuses on authorizing international action and assistance on the part of the U.S. to address TB. More specifically, it includes taking steps to prevent, treat, manage and eradicate the disease, in addition to establishing goals for TB diagnosis, cure and prevention on a global scale.
The Global TB Burden
The World Health Organization (WHO) reports that TB is the “13th leading cause of death” worldwide, a statistic that underlines the need for action. As many as 1.6 million individuals died from TB in 2021 alone. Additionally, 98% of TB cases occur in low-and middle-income countries, yet TB programs in these nations suffer from significant underfunding. More specifically, in 2021, the majority of new cases came from the WHO South-East Asian Region. Many new cases also originated from the WHO African Region. Over the last several years, funding for prevention, diagnosis and treatment has continued to fall short of what is needed.
Support for the Bill
Many organizations and medical professionals responded positively to the introduction of the End TB Now Act of 2021 and echoed shared concerns over the ongoing pandemic. RESULTS, a non-partisan citizens’ advocacy organization, emphasized that the majority of TB cases occur in impoverished and marginalized communities and that it is poverty and a lack of treatment, not the disease itself, that leads to the increase in cases and death.
Kate O’Brien, from the organization We Are TB, shared a similar sentiment, stating in a press release that the act would help prioritize giving the necessary care to the people who need it. Public health expert Dr. Ersin Topcuoglu also recognized the reversal of progress in the fight against TB since COVID-19. “We welcome legislation to support interagency coordination, the creation of more streamlined TB programs, more funding and better detection and treatment for this age-old infectious disease killer,” he said on the Management Sciences for Health website.
The TB pandemic is not a new issue and efforts to eliminate the disease are ongoing. However, as efforts to fight the new pandemic of COVID-19 increased, work against TB decreased, as evidenced by detection efforts dropping and increasing cases and TB-related mortality. Human and medical resources went toward addressing the COVID-19 pandemic and healthcare systems faced increased pressure. The End TB Now Act seeks to not only undo the damage done to global TB progress but aggressively fight against it.
In the End TB Now Act, Menendez and Young stress that this ongoing TB pandemic is primarily an issue of poverty and health equity, rather than an issue of disease. Work to address COVID-19 has made this contrast stark, necessitating decisive and intentional U.S. action. RESULTS notes that through this lens, the bill’s goal of increasing U.S. action against TB is both economically logical and morally sound.
The link between poverty and tuberculosis is clear as the majority of cases and death occur in countries where poverty is prominent. The WHO states, “Poverty is a powerful determinant of tuberculosis.” The conditions that are common in poverty, such as poor living and working conditions, a lack of general health knowledge and limited access to health and medical care, to name a few, all translate to direct risk factors for the disease.
The End TB Now Act of 2021 aims to tackle the interconnected issue of poverty and TB by working to eliminate the conditions that allow TB to spread while diagnosing and treating the disease. The bill’s prioritization of TB in the most disadvantaged countries promises an effective and hopeful solution for the many impoverished people affected.
– Johanna Bunn