Leadership Needed to End an Epidemic

It is time to look for leadership beyond Mr. Obama. So far, none of this year's presidential candidates have issued a proposal for keeping the public safe from dangerous outbreaks and epidemics like MDR-TB.
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Earlier this year, the Obama administration launched the National Action Plan for Combating Multidrug-Resistant Tuberculosis (MDR-TB). The nation's top public health officials--including the directors of the Centers for Disease Control and Prevention, the Global Health Bureau and the White House Office of Science and Technology Policy--each gave speeches urging swift action.

MDR-TB can't compete for headlines with the likes of Ebola or the Zika virus. But it is a crisis. Patients often spend months in mandatory isolation. They're given large quantities of antibiotics, with side effects including permanent deafness, liver and kidney damage, depression and psychosis. Without this treatment, people typically suffer a long and debilitating illness before dying.

TB is airborne, and any person sick with it is able to transmit the infection until they access effective treatment. About 480,000 people worldwide contracted MDR-TB in 2014. Three quarters of them never received a diagnosis, let alone treatment.

It doesn't take a health expert to see that addressing MDR-TB is one of the most important health security objectives of the Obama presidency.

And that is why it's flabbergasting that President Obama has recently asked Congress to gut the primary program executing the MDR-TB action plan. Mr. Obama's FY2017 budget request cuts support for the US Agency for International Development's TB team by $45 million--a 19 percent reduction from last year.

This can't stand. Congress should reject the President's proposal and fully fund the fight against TB and its drug-resistant forms.

Mr. Obama's budget calculus would be different if the fight against TB were already adequately funded--but it's not. TB kills more people around the world each year than any other contagious disease. Yet for FY2017, Mr. Obama has requested $191 million for TB--compared with $745 for malaria and $4.3 billion for HIV and AIDS, two other important global health challenges.

It's exactly this half-cocked response to TB, on an international scale, which has allowed drug-resistance to become a problem in the first place.

If not treated properly, standard TB readily develops into a drug-resistant form that can spread to others. Millions of patients have received inadequate treatment for normal, eminently curable TB, and now drug-resistant TB is epidemic globally.

Mr. Obama's request is unwise for several reasons. First, it will enable human tragedy. Second, it's bad economic policy, since MDR-TB is vastly more expensive to treat than standard TB. Suffering from an advanced form of drug-resistant TB in the United States leads to, by far, the highest hospital costs of any medical condition.

Congress will now decide whether to restore funding for TB. But even if Congress reverses Obama's cut and keeps the TB program's budget flat for another year, it will still leave the action plan a largely unfunded mandate.

It is time to look for leadership beyond Mr. Obama. So far, none of this year's presidential candidates have issued a proposal for keeping the public safe from dangerous outbreaks and epidemics like MDR-TB.

Presidential leadership is vital to stopping the spread of MDR-TB. In the 1990s, my first assignment as a health officer for the Centers for Disease Control and Prevention was to lead the response to an MDR-TB epidemic in New York City, which emerged after Congress had eliminated domestic TB funding from the federal budget. People died, many of the city's residents were in a panic, and the epidemic-response costs topped $1 billion--far more than it would have cost to prevent it in the first place.

Just today, the Centers for Disease Control and Prevention released new data showing that for the first time in 23 years, TB is on the rise again in the US. This development follows years in which Congress has failed to appropriate the full funding they themselves have authorized for domestic TB prevention and treatment.

To be sure, Congress is balancing many different funding priorities and looking to trim the budget where it can. But it should be a bipartisan priority to safeguard the public health by preventing the spread of a deadly airborne disease.

Congress must fully fund the fight against TB and MDR-TB, while we look ahead to leadership from a new president who will hopefully give this disease the priority it demands.

This post is part of the 'The Isolation of Airborne Cancer' series produced by The Huffington Post for World TB Day. This series will look at the devastating issues surrounding tuberculosis, the number one infectious killer. To follow the conversation on Twitter, view #WorldTBDay.