The Role of the US in the Global Fight Against Tuberculosis

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SEATTLE, Washington — What do Tina Turner, Ringo Starr and Nelson Mandela all have in common? Each of these icons has crossed paths with one of history’s deadliest diseases: tuberculosis. The commonality between these three, while grim, reflects how shockingly pervasive tuberculosis has been throughout history. The World Health Organization lists tuberculosis as one of the world’s top 10 killers. Furthermore, it states that the rise of antibiotic resistance amplifies the disease’s already imposing threat. Over the past two decades, the United States has sharply ramped up its efforts in the global fight against tuberculosis. As a result, the world has seen a significant drop in the incidence of the disease. The battle rages on, however, and many experts remain concerned about the future of the fight against the world’s number one infectious disease.

The United States’ Efforts and Impact

While tuberculosis dates back as far as the 1800s, the World Health Organization did not list the disease as a global health emergency until 1993. The United States Agency for International Development (USAID) did not introduce its official program to fight and control the spread of the disease until 1998; however, the program’s creation significantly advanced the global fight against tuberculosis.

U.S. funding to fight against the disease increased from $64 million in 2001 to $321 million in 2020, and the investment continues to show impressive returns. Efforts under this program span across more than 50 countries, including at least 20 of the countries that carry the heaviest rates of the disease. The rates of incidence have decreased by 27%, and mortality has decreased by 44% “in USAID-supported countries.” On the ground, this aid manifests itself in the form of medicines, treatment programs, testing materials and widespread data collection efforts.

Additionally, the U.S. government invested more than 60% of the global public sector spending into tuberculosis research and development in 2018. This has played a crucial role in the laboratories working against tuberculosis. These advancements, while sizable, represent only a portion of the United Nations’ Sustainable Development Goal to end tuberculosis by 2030. The ambitious plan seeks to expand access to testing, medicine and treatment to 40 million people by 2022, but it will require increased investment. Given the successes to date and the timely threat of antibiotic resistance, such an investment is well worth the cost.

Progress Still To Be Made

While U.S. investment and aid have amounted to immense strides in the global fight against tuberculosis, the battle remains far from finished. Though rates of incidence and mortality fell sharply in response to increased efforts against tuberculosis, there were a reported 10 million new active cases in 2018 alone, leaving plenty of room for improvement.

The World Health Organization estimates a $1.3 billion annual shortage in tuberculosis-related funding relative to the global demand for testing and treatment in 2018. Therefore, approximately 3.6 million people lacked access to treatment worldwide. Additionally, all but three U.N. countries fell short of their established tuberculosis funding targets with respect to research and development. The U.S. provided only 84% of its stated goal, leaving a shortage of more than $70 million.

Under threat of antibiotic resistance, investment in research is crucial to defeating tuberculosis by 2030. However, the current U.S. administration has proposed a significant cut to tuberculosis funding for 2021. Additionally, during the COVID-19 crisis, the U.S. has halted funding to the World Health Organization altogether. The position of the U.S. in the global fight against tuberculosis is currently under significant pressure despite the successes of the previous two decades. The U.N.’s plan to end the disease may be compromised if such cuts to funding persist.

Looking Forward

While the U.S. efforts have won incredibly significant ground against tuberculosis over the past 20 years, the future of the battle appears unstable. The uncertainty of funding interrupts the U.N.’s targets to beat tuberculosis. Furthermore, the COVID-19 crisis sharply divides the amount of effort and resources allocated specifically to ending the disease. It is not too late, however, to stay the course and increase efforts against tuberculosis. By maintaining and making use of health infrastructure created to cope with COVID-19 and urging U.S. leaders to preserve the funding allocated to the disease, the global fight to end tuberculosis can stay on track. It is certain that an opportunity to stop the world’s deadliest infectious disease hinges on U.S. policy decisions in the near future.

James Ring
Photo: Flickr

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