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

critical steps needed. However, we later
realized that we talked about the plan only
within the “TB family” and with our peers.
We were not successful enough in getting
influential leaders and policy and opinion
makers to commit their organizations to full
shared ownership and thus, the necessary
advocacy to fully implement the Strategic Plan
at federal, state, and local levels.
Decision point: November 1991. The rise in
TB cases, and the emergence of multidrugresistant
TB (MDR TB). A small group of us
met with Dr. Roper (then CDC Director) to
discuss a plan of action. It was decided a
federal TB Task Force would be created to
bring together all HHS/PHS agencies (and a
few others) to develop a coordinated response
to the MDR TB outbreaks. The Task Force
was created and moved quickly, and in
January 1992 brought together more than 400
experts to develop the National Action Plan to
Combat Multidrug-Resistant Tuberculosis
(published in April 1992). The Action Plan
called for a total federal TB budget of
$610,280,000, of which CDC’s need was
$484,000,000. Along with many of our
partners, we were successful in getting federal
appropriations increased. We were successful
in getting enough resources to meet our
immediate needs, but not enough to allow the
success of our 1989-stated mission of
elimination. We had reached out to some new
partners in the Task Force and through the
National Coalition to Eliminate TB, but again,
after the crisis was over, we had not built
enough effective community partnerships or
new and long-lasting coalitions to help achieve
the level of resources needed. Also, while we
were in the process of obtaining increased
federal funding, we saw many state or local
areas reduce the amount of local resources
going into TB control efforts. In 1990 the
Public Health Foundation reported that 13%
of TB funds at the state and local levels were
federal dollars. In 1998, however, the National
TB Controllers Association reported that 42%
of budgets were now composed of federal
Notable Events in TB Control
73
dollars. We succeeded in making state and
local programs too dependent upon federal
dollars; this is a concern known all too well by
those of us who remember the overnight
elimination of categorical federal TB funds in
1972.
Decision point: March 1998. I had the
opportunity to participate in an ad hoc
committee of the Global Tuberculosis
Programme of WHO, convened in London, to
evaluate TB control in the 22 countries that
represent 80% of the global TB burden. The
committee concurred that most of these 22
countries would not meet their Year 2000
goals. The committee also outlined what was
believed to be shared constraints to progress.
These included 1) weak political will and
commitment towards TB control efforts;
2) lack of adequate funding; 3) inability to hire
and keep trained staff; 4) organizational and
management issues, such as health sector
reform, public and private sector interactions
(or lack thereof), and integration and
decentralization issues; 5) an inadequate supply
of quality TB drugs; and 6) lack of adequate
understanding of the magnitude of the
problem and of the possibility of successful
interventions. I believe all but item number 5
are also continuing threats to our national,
state, and local TB programs.
You and I stand at some unique moments of
decision in 2000. If each of us does not act
effectively, we will have missed some
opportunities to move the fight against TB
into the final rounds. Some of the decision
moments at hand:
• The National Academy of Science’s
Institute of Medicine (IOM) will issue a
report on TB control in the United
States. How will you and I use the
results to evaluate and strengthen our
programs? How will you use the IOM
report and local data to secure adequate
political will at your state or local level
to secure necessary resources?