National Action Plan for Combatting MDR-TB continues to be a work in progress

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First year report describes assessments of needs, strategies, opportunities

In December 2015, tuberculosis response advocates welcomed the release of a White House National Action Plan for Combating Multidrug-Resistant Tuberculosis with wary optimism. Promised months earlier as part of a broader administration initiative to tackle antimicrobial resistance, a set of specific goals to counter the growing threat of tuberculosis that does not respond to available medicines would, advocates hoped, inspire funding to support improved treatment and diagnoses of the disease. At the same time, advocates noted, without that funding, the plan would remain nothing more than a plan. They pointed to an earlier initiative with the same name, released by the U.S. Centers for Disease Control and Prevention in 1992 that, unsupported by federal dollars, had never materialized into action or results. And they pointed out that, released in the final week of 2015, the plan had arrived too late to achieve goals that it had set, and aimed to meet “by 2016.”

Representatives of USAID at an official launch of the plan a few weeks later countered these concerns by noting that the plan had been so long a work in progress following the March 2015 announcement of its imminent release, that some of the goals for 2016 had, in fact, already been met. And, with the announcement of  promising partnerships with Janssen, the pharmaceutical company producing the first new drug to combat drug-resistant tuberculosis in half a century, and with Cepheid, the maker of the GeneXpert test that rapidly detects drug-resistant TB, they highlighted approaches to supporting the plan that would lessen its dependence on federal funding.

A little more than a year later the release of a National Action Plan for Combating Multidrug-Resistant Tuberculosis Year One Report offers some validation of both views of the prospects of a plan that required, but did not receive, additional funding for tuberculosis research, development, programming and training. Two months after the release of the plan, in fact, the White House proposed a $45 million cut to funding for the USAID TB program. Congressional appropriators rejected that proposal, but kept funding for tuberculosis responses at the same level as before the plan’s inception. The report recounting what happened in the year that followed, produced by USAID, the National Institutes of Health, and the CDC outlines ongoing preparations to put the plan into action. It highlights progress already made. And it hails the boost that strategies in the plan’s will receive from the partnership with Janssen. In addition, it notes that World Health Organization guidelines for a shorter TB treatment regimen will help programs meet the plan’s goals of improved treatment completions and outcomes. It concludes that “All year one milestones were achieved.”  But while some of those milestones had already been achieved, as officials had noted upon the formal launch of the plan, others consisted of working with targeted countries to develop systems and strategies toward improved prevention, treatment, monitoring and surveillance. It remains to the next report, and to the funding provided in the coming budgets to support the plan, to see what is built on those foundations. In the meantime, while the Trump “America First” budget proposal outline for fiscal year 2018 released March 16 proposes cutting one fifth of the  National Institutes of Health budget, the administration’s request for cuts to the current fiscal year include cutting $1.2 billion from the current NIH budget, and shaving $44.6 million from the currently allotted amount for the USAID TB program.

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