Health Care, Not Borders
June 14, 2007
David Gartner is the Policy Director for the Global AIDS Alliance.
The latest twist in the case of Andrew Speaker, the American lawyer now under quarantine because of his infection with drug resistant tuberculosis (TB), is that the border guard who let him back in the U.S. has retired. That's all well and good, but the reality that the spread of dangerous drug resistant tuberculosis can't be stopped at the border. By obsessing on how Speaker got back into the United States, we are missing an important opportunity to confront the real dangers that TB poses to America and the world.
Andrew Speaker is just one of the billions of people walking around in the world infected with tuberculosis. Even the dangerous strain of TB that Speaker contracted already existed in the United States before his return. Fully one-third of people on the planet carry TB in their bodies, and 1.6 million people die each year from the disease. It is one of the leading killers of people living with HIV.
Tuberculosis is an ancient killer which has become even more dangerous in recent years. Evidence of TB has been found in Eqyptian mummies dating back 4,000 years. One hundred and twenty-five years ago the bacterium that causes TB was identified and drugs to treat TB have been available for over 50 years. As TB survivor Archbishop Desmond Tutu wrote:
The latest and most lethal strain of TB, known as XDR-TB, was identified by the CDC in 2005. Although this strain is so far relatively rare, cases have been identified in 37 countries. In one rural South African hospital, 52 of 53 patients died from XDR-TB. In recent months XDR-TB has spread across South Africa and neighboring Mozambique recently declared a TB emergency. In Sub-Saharan Africa, there are only six labs that can test outside of South Africa, so XDR-TB is likely pervasive but unknown in many parts of the continent. As a result we suspect but can't confirm that XDR-TB is much more widely spread across Africa.
Tuberculosis is also undermining the response to HIV/AIDS. In the case of the South African hospital, all of the people tested who died from XDR-TB were also HIV positive. In Botswana, 70 percent of people who are diagnosed with TB also are infected with HIV. TB actually kills half of all people living with AIDS—many of whom could be kept alive for years with cheap TB treatment. In Southern Africa, XDR-TB is killing even those receiving powerful anti-retroviral AIDS therapy. America's vital investment in fighting AIDS is being seriously undermined by the failure to adequately treat the twin killer of TB.
Last year, with increased media coverage about the potential threat of Avian Flu, policymakers saw that borders wouldn't protect us against the spread of infectious diseases. The administration and Congress provided billions of dollars to develop new diagnostics and drugs and to strengthen global health infrastructure for Avian Flu. XDR-TB, which has already killed more people than avian flu, demands a similar response.
The first step we can take is to scale up the U.S. contribution to the Global Fund to Fight, AIDS, Tuberculosis and Malaria. The Global Fund currently provides two-thirds of all donor financing for TB and has transformed the reach of TB treatment around the world. It is funding crucial TB control programs in many countries, including in Asia, where many Americans travel and which send an increasing number of visitors to the U.S. In a recent letter authored by Senators Richard Durbin, D-Ill., and Senator Gordon Smith, D-Ore., 29 senators urged a U.S. contribution to the Global Fund of $1.3 Billion for the coming fiscal year. The administration and the Congress should also dramatically expand funding for to respond to XDR-TB and help to strengthen the health systems of the poorest nations.
Although TB has been around for millennia, this new dangerous strain is a product of decades of neglect of TB. Despite the fact that TB treatment can cost as little as $10 per patient, millions of people still don't have access to treatment. Since TB and other infectious diseases will not respect national boundaries, we must take up the global challenge of defeating these killers around the world.