Hearing: The Global Threat of Drug-Resistant TB: A Call to Action for World TB Day
Opening Statement
Mr. Donald M. Payne
March 21, 2007
Good afternoon and thank you all for joining us at the second hearing of the Subcommittee on Africa and Global Health in the 110th Congress. The purpose of this hearing is to bring attention to emergence of drug-resistant tuberculosis and call for U.S. action to address it as we approach World TB Day, which is March 24.
I am honored to be joined today by Ranking Member Chris Smith, our new Vice-Chair Diane Watson of California, and our other distinguished colleagues on the Africa and Global Health Subcommittee.
Tuberculosis a highly contagious disease easily spread from person to person through the air. According to World Health Organization estimates, someone is infected with the organism that develops into TB every second. An infected person may not develop full blown TB, but in 2004, of the 9 million who were newly infected, 2 million died. The good news is that it is entirely curable. However, the treatment requires patients to be on a drug regimen for 6 months. If they do not complete the regimen, or if they complete it, but take an incorrect number of pills during the treatment, the infection can develop into what is known as multi-drug resistant or "MDR" TB. MDR-TB is not responsive to either of the two first-line TB drugs, and the treatments that are available take longer and are more expensive than regular TB medications. And last year the public became aware of an even greater threat: A new more dangerous MDR-TB strain, known as extremely drug resistant TB or XDR-TB, which is not only resistant to the two first-line drugs, but also to three of the six second-line drugs. XDR-TB has been identified in South Africa, and in countries that were part of the former Soviet Union, and six G8 countries including the United States.
MDR-TB is particularly lethal to those with immune-suppressed systems such as people infected with HIV. This is why drug-resistant tuberculosis threatens to undermine both the enormous progress and billions of dollars invested in AIDS treatment in southern Africa, as well as efforts on TB control worldwide.
XDR-TB and its deadly linkage with HIV first gained global recognition last August with reports of an outbreak in a hospital in South Africa where 52 of 53 patients with XDR-TB died-- half within a matter of 16 days. This tragedy serves as a sobering example of what may happen across Africa if we do not act to prevent another outbreak. Given XDR-TB's resistance to both the low-cost first line anti-TB drugs, and to several of the classes of second line drugs used, we are faced with a burgeoning epidemic-- driven by HIV infection-- that is lethal.
Since the initial outbreak, South African medical authorities have documented some 400 cases in dozens more hospitals in South Africa. What is troubling, however, is that no one knows for sure that these 400 cases represent the extent of the outbreak, because XDR-TB typically kills quickly, and doctors' ability to identify it is severely limited. Experts believe that XDR-TB has moved beyond South Africa into other countries in the sub-region where the capacity to identify it and control it is significantly weaker than in South Africa, and where high HIV rates will continue to drive the epidemic.
All of us here today must work together to take the necessary steps to enhance the medical establishment's ability to identify, treat and stop the spread of drug-resistant TB, primarily in Africa, and to head-off further incursion of XDR-TB into the United States.
Unfortunately, while we here in this room understand the gravity of this emergency, many of our colleagues still do not. Funding for international TB control has been flat-lined in recent years. And despite the emergence of XDR-TB, not a single dollar was provided to address the outbreak in the House Emergency Defense Supplemental bill for 2007. Waiting until fiscal year 2008 to provide resources to address this killer disease is a very serious mistake - one that may cost people their lives here and abroad.
I look forward to hearing proposals from our witnesses today regarding how the United States should respond to the emergence of XDR-TB, especially in southern Africa, and how we can work together to ensure that our response is commensurate in resources and speed with this crisis. I commend my colleague, Mr. Engel, for introducing H.R. 1567, the Stop TB Now Act of 2007 on March 19, which sets out the investment that our country must make in this effort. I am a cosponsor of the bill and will do all that I can to facilitate its passage here in the House. I also want to acknowledge that the Office of the Global AIDS Coordinator plans to spend $120 million on TB control this fiscal year. This is a step in the right direction, but much more remains to be done.
We must act quickly to support international efforts to find, control and treat XDR-TB, and to strengthen basic TB control programs. Failure to do so will result in a potentially devastating health catastrophe.
Today's proceedings will be a bit unusual. For reasons of protocol representatives from multilateral organizations cannot officially serve as witnesses, so we will begin with a briefing by Dr. Mario Raviglione, Director of the Stop TB Department at the World Health Organization. After hearing from him, we will officially bring the hearing to order and hear from our first panel.
Our witnesses for this hearing are an impressive group: Testifying on panel one is the Honorable Eliot Engel, of the 17th district of New York. Mr. Engle and I were in the same incoming Congressional class in 1988, and I have enjoyed working with him over the years. He serves as the distinguished Chairman of the Western Hemisphere Subcommittee, of which I am a member, and has worked extensively on halting the spread of HIV here in the United States. Mr. Engle is now expanding his efforts to help fight the spread of diseases globally.
Panel two will consist of the Honorable Mark Dybul, the U.S. Global AIDS Coordinator. Ambassador Dybul has been with the Office of the Global AIDS Coordinator almost since its inception, serving as Deputy to the first Coordinator, Ambassador Randall Tobias. Dr. Julie Gerberding, Director of the Centers for Disease Control and Prevention has a long career in the medical field. Dr. Gerberding is the first woman director of the CDC, and has extensive training and expertise in the area of infectious disease prevention. Dr. Kent Hill has been the Assistant Administrator of the Bureau for Global Health at the US Agency for International Development since 2005. Prior to that he was Assistant Administrator for Europe and Eurasia, an area of the world in which MDR-TB has become a serious threat.
Dr. Joia Mukherjee, Medical Director of Partners in Health, and Dr. Elena McEwan Senior Technical Adviser Catholic Relief Services will testify on our third panel. Since 1989, Dr. MOO CUR JEE has worked in the area of health care access and human rights all over the world including in Africa, Latin America and the United States and serves as a consultant to the WHO in the areas of HIV and MDR-TB. Dr. McEwan has extensive research and field experience dealing with TB. She worked for several years in Nicaragua training Ministry of Health Staff and Community health care workers in dealing with TB and other health issues.
Welcome to each of our witnesses, and our guests.
With that I turn to the distinguished Ranking Member, Mr. Smith for his opening statement.
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