[Congressional Record Volume 146, Number 73 (Tuesday, June 13, 2000)]
[House]
[Pages H4224-H4225]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




          STOP TB NOW ACT FOR EFFECTIVE TUBERCULOSIS TREATMENT

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 19, 1999, the gentleman from Ohio (Mr. Brown) is recognized 
during morning hour debates for 5 minutes.
  Mr. BROWN of Ohio. Mr. Speaker, tuberculosis is the greatest 
infectious killer of adults worldwide. It is the biggest killer of 
young women. tuberculosis kills 2 million people each year, 1 percent 
around the world every 15 seconds. Tuberculosis hit an all-time high in 
1999 with 8 million new cases, 95 percent of them in the developing 
world.
  We have a small window of opportunity during which stopping 
tuberculosis is very cost-effective. The costs of Directly Observed 
Treatment, Short Course, so-called DOTS, can be as little as $20, that 
is $20 to save a life. If we wait, if we go too slowly, so much drug-
resistant TB will emerge that it will cost billions of dollars to 
control with little guarantee of success. Multi-drug resistant TB is 
more than 100 times more expensive to cure than nondrug resistant TB.
  I have introduced the Stop TB Now Act with the gentlewoman from 
Maryland (Mrs. Morella) in an effort to control tuberculosis. The bill 
authorizes $100 million to USAID for tuberculosis control in high 
incidence countries, mostly using the Directly Observed Treatment, 
Short Course, so-called DOTS. It calls on USAID to collaborate its 
efforts with CDC, the World Health Organization, the National 
Institutes of Health and other organizations with tuberculosis 
expertise. The measure provides funding for combating Multi-Drug 
Resistant TB, which is spreading at an alarming rate.
  Multi-drug resistant TB has been identified on every continent. 
According to the World Health Organization, multi-drug resistant 
tuberculosis ultimately threatens to return TB control to the 
preantibiotic era where no cure for TB was available. An effective DOTS 
cure program can prevent the development of multi-drug resistant 
tuberculosis.

[[Page H4225]]

  A recent World Health Organization study in India found in areas 
where effective TB treatment was implemented, the death rate from 
tuberculosis fell by more than 85 percent. TB accounts for one-third of 
AIDS deaths worldwide and up to 40 percent of AIDS deaths in Asia and 
in Africa. Eleven million people are currently affected with TB around 
the world and with HIV. The good news is that TB treatment is equally 
effective in HIV positive and HIV negative people. So if we want to 
improve the health of people with HIV, we must address the issue of 
tuberculosis.
  WHO estimates that one-third of the world's population is infected 
with the bacteria that causes tuberculosis; two billion, two billion 
people. An estimated 8 million people develop active tuberculosis each 
year, and roughly 15 million people in the United States are infected 
with tuberculosis.
  The threat TB poses for Americans derives from the global spread of 
tuberculosis and the emergence and spread of strains of tuberculosis 
that are multi-drug resistant.
  Up to 50 million people worldwide may be infected with drug-resistant 
tuberculosis. Incidence is particularly high in selected regions and 
populations such as Russian prisons where an estimated 5 percent of 
prisoners have active multi-drug resistant TB. In the U.S., TB 
treatment, normally about $2,000 per patient, skyrockets to as much as 
$250,000 per patient, as it did in New York City in the early 1990s 
when we had to treat multi-drug resistant tuberculosis. Treatment may 
not even be successful. MDR drug-resistant TB kills more than half 
those infected, even in the United States and in other industrialized 
nations, and it is a virtual death sentence in the developing world.
  The President recently visited India. I contacted him before that 
trip to discuss our bill. India has more tuberculosis cases than 
anywhere else in the world. Their situation illustrates the urgency of 
this issue. Two million people in India develop TB every year, and 
nearly 500,000 die from it each year. More than 1,000 Indians a day die 
from this infectious disease. The disease has become a major barrier to 
social and economic development, costing the Indian economy $2 billion 
a year. Three hundred thousand children are forced to leave school in 
India each year because their parents have tuberculosis, and more than 
100,000 women with TB are rejected by their families due to social 
stigma.
  India has undertaken an aggressive campaign to control tuberculosis, 
but they also need western help. Not surprisingly, the statistics on 
access to TB treatment worldwide are pretty grim. Fewer than 1 in 5 of 
those with TB are receiving DOTS treatment. Based on World Bank 
estimates, DOTS treatment is one of the most cost-effective health 
interventions available, costing the developing world as little as $20 
to save a life. DOTS can produce cure rates of 85, 90, even 95 percent, 
even in the poorest countries.
  Mr. Speaker, Gro Bruntland, the Director of WHO, has said that TB is 
not a medical issue, but a political issue. We have an opportunity to 
save millions of lives now and prevent millions of needless deaths in 
the future.

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