CDC History of Tuberculosis Control - Medical and Public Health ...

ended and outbreaks of MDR TB in hospitals,
prisons, and other institutions were underway.
The following articles by the lead staff of
DTBE’s branches and programs will provide a
more current perspective on division activities.
CDC Funding for TB Prevention and
Control
by Patricia Simone, MD
Chief, Field Services Branch, DTBE
and Paul Poppe
Deputy Director, DTBE
Federal fiscal support for TB control began
with the passage of the Public Health Service
Act, which was created to assist states in
establishing and maintaining adequate measures
for the prevention and control of TB.
To enhance case-finding activities, the 1955
Appropriation Act (Public Law 83-472) directed
federal grants with local matching funds
to be used only for prevention and casefinding
activities. In 1961, Congress provided
for project grants that were to be used for
improving services to known TB patients
outside of hospitals, examination of contacts,
and diagnosis of suspects. In December 1963,
the Surgeon General’s task force issued a
report recommending a 10-year plan to enhance
the federal role in national TB control
through increased grants for services for
unhospitalized cases and inactive cases, contact
investigations, school skin test screening, and
hospital radiograph screening programs. By
1967, there were 82 TB control programs in
the United States, with federal appropriations
of $3 million in formula grants and $14.95
million in TB project grants.
However, in 1966 the Public Health Services
Act was amended, changing project grants to
block grants. These new grants did not require
that any funds be used for TB control, and
many health departments eventually redistributed
the funds to other programs. While
categorical TB appropriations were restored in
1982, there were very modest amounts of
TB Control at the Millennium
46
federal funding (approximately $1 million to
$9 million per year) available for TB control
until fiscal year 1992.
Despite an overall decline in funds being spent
for TB control, the number of reported TB
cases continued to decline nationally through
1984. However, from 1985, the number of
cases began increasing and continued to rise
through 1992. Recognition of the outbreaks
of multidrug-resistant TB, the high mortality
associated with TB in HIV-infected persons,
and transmission to health-care workers
resulted in strong recommendations for enhanced
funding for TB prevention and control
programs and more stringent infection control
practices. In fiscal year 1992 the appropriation
was increased to $15 million from the previous
year’s funding of $9 million. It increased again
in 1993 to $73 million, when Congress appropriated
$34 million for the continuation and
expansion of the TB cooperative agreements
and $39.2 million in emergency funds for use
in the areas of the country most heavily
affected by the increased cases. Congress
appropriated yet another increase for categorical
TB grants in 1994, and the appropriation
for TB project grants was increased to over
$117 million. In addition, approximately $25
million in redirected HIV funds have been
available for TB control activities each year
since 1992, for a total of over $142 million in
funding for CDC for TB-related activities. As
a result of this infusion of funding, TB program
infrastructures have been rebuilt and the
results are evident with six consecutive annual
decreases in the number of reported TB cases
in the United States.
77
TB Funding History vs. Reported Tuberculosis Cases
1977 - 1998
In millions
$144
160
140
120
100
80
TB Cases
60
TB Funding
40
80
83
86
Year
89
92
95
98