When House Appropriations Committee members in 2014 asked then USAID Administrator Raj Shah how the U.S. could combat tuberculosis globally with 19 percent less money, he said not to worry. The Global Fund to Fight AIDS, TB and Malaria, and the President’s Emergency Plan for AIDS Relief would fill the gap, he said.
Two years later, the World Health Organization has declared TB to be the world’s biggest infectious disease killer, and the White House has released a National Action Plan to Combat Multidrug-Resistant TB with a goal of initiating treatment in half the multi-drug resistant TB patients in the ten highest burden countries by 2020.
But not much else has changed.
This week during a House Appropriations State and Foreign Operations Subcommittee hearing on the USAID budget, Rep. C.A. Dutch Ruppersberger of Maryland asked new USAID Administrator Gayle Smith how her agency plans on implementing the MDR-TB plan with a budget of $191 million – a 19 percent cut from current funding levels. Rep. Ruppersberger, who said drug-resistant TB is a threat to global health security, told Smith about a young child being treated for extensively drug resistant TB at Johns Hopkins University in his district – one of three XDR-TB cases in the U.S. currently.
Her answer? Cuts to the USAID TB program would be made up by additional resources from the Global Fund and PEPFAR. She also said the National Action Plan was a call to middle income countries to increase their domestic TB funding.
“We think if we marry it to the Global Fund and PEPFAR and can press middle income countries, we can move the ball forward,” Smith said.
Tuberculosis advocates, however, are not buying that argument.
They point out that only a small fraction of PEPFAR funding goes towards addressing TB-HIV coinfection, and with the PEPFAR budget flat-funded for the past few years, no additional funds are coming.
Smith said middle income countries like South Africa and Brazil are increasing their domestic TB spending, and countries like Russia need to do more.
But among middle income countries only South Africa and India receive USAID funding for TB, says David Bryden of RESULTS, adding that most countries that receive USAID TB funding are low income countries. In fact, eight of the highest TB-burden countries are classified as low income countries: Afghanistan, Cambodia, the Democratic Republic of Congo, Ethiopia, Mozambique, Tanzania, Zimbabwe, and Uganda. These countries face a financing gap of $6.8 billion over the next five years to deal with their TB burden. While these countries make up just five percent of the world’s population, they face 17 percent of global TB deaths.
In addition, the Global Fund heavily relies on the technical assistance USAID provides to countries to help them implement Global Fund grants, including building laboratory capacity and functioning supply chains, Bryden says. The Global Fund also relies on USAID to finance the Global Drug Facility, which helps lower the costs of drugs for drug-resistant TB, he notes.
“A cut to USAID TB would actually harm the Fund’s work and undermine the U.S. investment in the Fund,” he said.
While the Obama Administration has proposed cuts to the USAID TB program for the past five years, Congress has always reversed the cuts. This time, however, advocates argue that a reversal of cuts is not enough: new funds are needed to implement the National Action Plan to Combat MDR-TB, or else TB will remain the world’s biggest infectious disease killer.