[Congressional Record (Bound Edition), Volume 153 (2007), Part 6]
[Extensions of Remarks]
[Pages 8509-8510]
[From the U.S. Government Publishing Office, www.gpo.gov]




                 THE GLOBAL THREAT OF DRUG-RESISTANT TB

                                 ______
                                 

                       HON. CHRISTOPHER H. SMITH

                             of new jersey

                    in the house of representatives

                        Thursday, March 29, 2007

  Mr. SMITH of New Jersey. Madam Speaker, last week the Subcommittee on 
Africa and Global Health held a hearing on the important and timely 
global health issue of drug-resistant tuberculosis. It is shocking that 
this disease which is curable continues to kill about 2 million people 
each year. Perhaps the reason for this apparent contradiction is that 
the vast majority of those who die from TB--98 percent--live in the 
developing world, and are from the poorest and most marginalized 
sectors of society. TB is particularly pernicious in that it targets 
young adults who are just starting to form their families and who are 
the producers and sustainers of their societies. The emergence in 
recent years of drug-resistant TB has raised the specter of higher 
death rates, more children who will lose their parents, and communities 
that will fall deeper into poverty and despair.

  Combined with the fact that TB is the leading cause of death of 
persons with HIV/AIDS, this disease is having a particularly 
devastating impact on Africa. However, it is important to note that no 
region--indeed no country, including our own--is immune from the 
effects of tuberculosis. We should all be alarmed that strains that are 
resistant to a single drug have been documented in every country 
surveyed by the World Health Organization. Given the ease with which TB 
can be spread, TB is truly a disease without borders, and it is in our 
national as well as humanitarian interest to seek its eradication.

  Therefore, it was highly appropriate that the subcommittee on global 
health commemorated World TB Day 2007 with the rest of the world, and 
raised our voices with that of others for an emergency response to this 
increasingly dangerous threat to global health. I agree with my 
colleagues here in Congress who are advocating for significantly more 
resources to be directed towards TB prevention, detection and 
treatment, and research for new drugs. In addition, the hearing 
provided us with the opportunity to examine the best means for 
directing our resources.

  The World Health Organization recently came out with an interesting 
study entitled:

[[Page 8510]]

``Appreciating Assets: The Contribution of Religion to Universal Access 
in Africa.'' The study was focused on the treatment of HIV/AIDS, and 
utilized Zambia and Lesotho as the two study sites, but the findings 
provide useful indications for addressing other health issues, 
including tuberculosis, throughout Africa. The study found that 
approximately 30-40 percent of national health services were provided 
by faith-based organizations. In some areas, those percentages went as 
high as 65-70 percent.

  The benefits of a faith-based infrastructure for addressing HIV/AIDS 
would seem to apply also to tuberculosis. For example, assisting and 
monitoring adherence to the drug regimen could be overseen by the 
volunteer community, as well as education of the general public. Since 
churches, mosques and synagogues are being encouraged to undertake HIV/
AIDS initiatives, TB can readily be included.

  It is well-known that the Global Fund is a major contributor to TB 
detection and treatment programs around the world. The United States 
has given over $2 billion to the Global Fund, or just over 30 percent 
of the Fund's revenues. I was disturbed to read reports earlier this 
month that the Global Fund has permanently terminated two grants to 
Uganda for malaria and tuberculosis. When I visited Uganda in January 
2006, a suspension of 5 Global Fund grants due to gross mismanagement 
had just been lifted and I was informed that the problems appeared to 
have been resolved. The fact that this now turns out not to have been 
the case, and that several other countries have also had Global Fund 
grants terminated, raises serious questions about how the Global Fund 
is operating.

  I know from my visits to Africa and from the numerous reports we 
receive in Congress how well our bilaterally-funded PEPFAR programs are 
performing. The information and accountability that Congress has come 
to take for granted through these bilateral programs are not available 
through the Global Fund. And yet many of the primary recipients of 
Global Fund grants are governments with a history of corruption and 
fraud, and/or limited capacity to properly manage large sums of money 
in their health sectors. One could argue that the absence in the Global 
Fund of a robust reporting and monitoring mechanism at both the primary 
and sub-recipient levels is an open invitation for waste in these 
countries, and a tragic loss of opportunity to save lives. The 
implementation of a system that provides accountability and 
transparency would seem vital to continued and expanded donor support 
of the Global Fund in the future.



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