[Congressional Record Volume 164, Number 119 (Monday, July 16, 2018)]
[Extensions of Remarks]
[Page E1016]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




               COMBATTING TUBERCULOSIS IN SOUTHERN AFRICA

                                 ______
                                 

                       HON. CHRISTOPHER H. SMITH

                             of new jersey

                    in the house of representatives

                         Monday, July 16, 2018

  Mr. SMITH of New Jersey. Mr. Speaker, I recently held a hearing 
addressing the persistent and too-often underestimated threat to global 
public health posed by tuberculosis. This brutal, contagious disease 
killed 1.7 million people in 2016, the most recent data available--
making it the deadliest infectious disease in the world--killing more 
than both HIV/AIDS and malaria combined.
  TB is devastating for many people globally, but it impacts the people 
of Africa--especially southern Africa--disproportionately.
  In 2016, 44 percent of all TB deaths occurred in the Africa region--
in spite of accounting for only 25 percent of all new TB cases. 
Africans die at a rate of 72 per 100,000 infected, compared with 35 per 
100,000 in Southeast Asia and 13 per 100,000 in the Eastern 
Mediterranean region. Those infected with HIV/AIDS are particularly 
vulnerable to TB, and nearly three-quarters of those co-infected with 
HIV and TB in 2016 lived in sub-Saharan Africa.
  Thankfully, most cases of TB are curable if patients are diagnosed 
and adhere to a proper treatment regimen. However, millions of newly 
infected people go undiagnosed and without treatment each year, and the 
global spread of Multiple Drug-Resistant (MDR) and Extensively Drug-
Resistant (XDR) TB, which emerges when patients receive inappropriate 
or incomplete treatment, poses an even greater and more costly threat. 
In 2016, roughly 490,000 people developed MDR-TB and an additional 
110,000 new cases were resistant to the most effective treatment.
  Not only is treating MDR and XDR TB a grueling process for the 
patient, it also costs far more to treat than the ``garden variety'' of 
the disease. One study by the Stop TB Partnership estimated that drug 
resistant TB could kill up to 2.5 million people annually and cost the 
global economy $16.7 trillion if left unchecked.
  The dangerous potential of a drug resistant TB outbreak is evident in 
the South African mining sector, where exposure to silica dust, 
crowded, poor living conditions and high HIV prevalence create an 
incubator for disease and heighten the risk of contracting TB. Further 
complicating the problem, approximately 40 percent of mine workers are 
migrants who frequently move across borders and don't receive 
consistent medical treatment from public health systems in the region 
that do not coordinate sufficiently. This further increases the risk of 
MDR and XDR TB infections.
  I am encouraged to see that the U.S. funding for combatting TB 
increased to $261 million in 2018, which is $20 million more than what 
was allocated in 2017 and more than $82 million higher than the 
Administration's request. This shows that my colleagues are taking this 
threat seriously, and I commend them.
  But we must not stop there, or become complacent.
  The WHO anticipates a $7.4 billion budget shortfall for the Global 
Plan to End TB if the international community does not significantly 
increase funding. We must encourage our international partners to step 
up to this challenge, and take the opportunity of the U.N. General 
Assembly High-Level Meeting on Ending TB this September to do so; but 
even more, we must explore more innovative and holistic approaches to 
eliminating this disease. We must work from a regional perspective and 
increase coordination among health systems; we must pay special 
attention to the mines in South Africa; we must redouble our efforts to 
diagnose and treat every person infected with TB; and we must pull out 
all the stops when it comes to preventing MDR and XDR TB infections.
  We also must encourage to World Health Organization to stop being 
overly bureaucratic when it comes to battling TB. There are bottlenecks 
in the WHO approval process for new treatments and new diagnostic tests 
which need to be fixed.
  I was eager to hear from our distinguished witnesses, who helped us 
understand where we are in this fight against TB and what more we must 
do to eliminate it once and for all.

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