[Congressional Record Volume 161, Number 183 (Wednesday, December 16, 2015)]
[Extensions of Remarks]
[Page E1808]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




           DRUG RESISTANT TB: THE NEXT GLOBAL HEALTH CRISIS?

                                 ______
                                 

                       HON. CHRISTOPHER H. SMITH

                             of new jersey

                    in the house of representatives

                      Wednesday, December 16, 2015

  Mr. SMITH of New Jersey. Mr. Speaker, last week, I convened a hearing 
on an extremely urgent issue, focused on addressing what may very well 
be the next global health crisis: drug resistant tuberculosis.
   Just as Ebola surprised many at the ferocity with which it spread, 
all of us must be concerned that the world is not fully prepared to 
meet the threat from this highly contagious airborne disease which 
killed 1.5 million people last year alone. That translates to over 
4,000 people a day--4,000 lives that ended prematurely, including young 
children.
   The World Health Organization released its Global Tuberculosis 
report just over a month ago and appealed to the world to beef up 
efforts to combat TB, and yesterday, in Cape Town South Africa, the 
International Union Against Tuberculosis and Lung Disease concluded its 
annual meeting, having gathered experts in fighting TB from all over 
the world. These are positive signs, showing that the global health 
community continues to surge toward ending TB by 2035--or sooner.
   While most TB is curable if diagnosed and patients strictly adhere 
to a treatment regimen, some 6 million new cases of TB were reported to 
WHO in 2014. However it is likely that the number of people who 
contracted TB far exceeds this number--and may be as high as 9.6 
million people. These people need to be diagnosed with a diagnostic 
that is fast and reliable and able to detect drug resistances, and 
treated, so they can lead healthy productive lives.
   On a myriad of fronts there is reason for hope. For example the 
Expert MTB/RIF can diagnose TB and resistance to rifampicin within two 
hours, an amazing breakthrough. As CDC's Tom Friedman testified, this 
new diagnostic holds great promise. This new diagnostic holds great 
promise in enabling rapid detection of drug resistance, and the U.S. 
Government has led the global effort to scale up access to this test. 
The increase in the proportion of drug-resistant TB cases diagnosed and 
started on treatment over the past several years is largely 
attributable to the scale-up of this test.
   Yet the tragic fact remains that some 480,000 new cases of hard-to-
treat cases of multidrug resistant TB--a disease which often hits the 
poorest of the poor--are estimated to have occurred in 2014, yet only 
about 25 per cent of these, or 123,000 cases were detected and 
reported, leaving a whopping 75 percent undetected and untreated.
   Given the ease at which TB can spread through the air--especially 
through coughing--and the fact that people with weakened immune systems 
are more susceptible, one can see how left untreated MDR TB and its 
even more pernicious cousin, XDR or Extensively Drug Resistant TB can 
be catastrophic to individuals and wreak havoc on public health and 
public health systems.
   To illustrate how fragile health systems can be overwhelmed, a 
course of treatment for normal, drug susceptible TB costs roughly 
between $100 and $500, depending on the country. For MDR TB, the cost 
is roughly between $5,000 and $10,000 per patient.
   To respond fully to the TB crisis, the WHO estimates that some $8 
billion per year is needed. Unfortunately, there is a global budget 
shortfall of about $1.4 billion. We need to lead not only in terms of 
providing funding, but also in terms of encouraging others--other 
countries, but also the private sector and foundations--in meeting this 
need by closing this gap.
   Now is the time for a significantly enhanced response. A sustained 
focus on tuberculosis prevention today will save lives and money 
tomorrow, helping people the world over as well as protecting the 
homeland from what otherwise could become a global pandemic.
   Our 3 witnesses from the hearing are extraordinary leaders in the 
health field and experts on TB. They--like many on subcommittee--
believe we can at least mitigate TB in the short term and eliminate 
this deadly infectious disease by 2035, just as we have successfully 
fought polio. It takes political will, however, and an investment of 
resources that will pay dividends for healthier people in the long run.
   The subcommittee will continue to work hard on combatting TB, along 
with members of the House Tuberculosis Elimination Caucus, whose co-
chair is my good friend from New York, Ranking Member Eliot Engel, who 
joined the hearing last week. We also had some very outstanding leaders 
in the global fight against TB who briefed us and gave testimony at the 
hearing.

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