Opening Statement

Multidrug Resistant Tuberculosis: Assessing the U.S. Response to an Emerging Global

Threat

February 27, 2008

Mr. Donald M. Payne

Thank you for joining us at this afternoon’s hearing to discuss the global threat posed by the spread of multiple drug- resistant and extensively drug-resistant tuberculosis, and the United States policy response. 

I held a similar hearing last year on World TB day during which we explored the spread of TB, and what it might take to eradicate it.  At that time, we focused on the tragic outbreak that occurred in KwaZulu Natal, South Africa in 2006 in which extensively drug-resistant tuberculosis, or XDR-TB, killed 52 of 53 people who contracted it.

At that time I voiced my concern that both multi drug-resistant TB, which is commonly known as MDR-TB, and the more deadly XDR-TB could undermine the gains that we are making in both TB and HIV/AIDS treatment programs. 

Nearly a year later, WHOs’ 2008 Tuberculosis drug resistance report shows that we have true cause for concern.  MDR-TB is on the rise, especially in Eastern Europe.  In four countries in the region the incidence of MDR-TB was 15% or higher among new TB cases.  In Estonia, MDR-TB represented 13.3% of new infections.  An astonishing 24% of those MDR-TB infections were the deadly XDR strain.  

What I find even more troubling about the report is the lack of information about what is happening related to MDR-TB in Africa.  Only six African countries were able to provide data for the survey—Cote D’Ivoire, Senegal, Rwanda, Ethiopia, Madagascar and Tanzania. 

While the infection rates in those countries are relatively low— Rwanda, which reported that 3.9% of new TB cases were MDR-TB, had the highest incidence— the absence of data is alarming.

We know that there have been cases of MDR and XDR-TB in both Botswana and South Africa.  What this surveillance report does not tell us is the extent of the problem in the sub-region. 

Part of the challenge with collecting data, which you pointed out last year in your testimony Dr. Raviglione [ruh VEE LEE own ee], is that in all of Africa, there are only 25 labs which have the capacity to detect MDR-TB.  And 19 of those are in South Africa.

Without labs, trained personnel, and equipment, an outbreak in any country in Africa could kill hundreds of people before containment.  It is imperative that we respond appropriately. 

The cure for non drug-resistant TB costs less than $20.  The cost of treating MDR and XDR—where it is available-- can be tens of thousands of dollars.  Low and middle- income countries do not have the resources to treat drug-resistant TB.  That is why it is imperative to expand control programs for regular TB. 

I have just come from a markup of the reauthorization of the President’s Emergency Plan for AIDS Relief.  To my dismay, one of my republican colleagues suggested that spending $50 billion over five years to fund AIDS, TB and Malaria programs abroad was a waste of money. 

Clearly that is not the case.  Treating TB abroad helps keep the homeland safe.  If we do not support universal access to treatment on a global scale, we become vulnerable to an outbreak of MDR and XDR-TB right here in the United States. 

That fact became painfully evident last May, when Atlanta resident Andrew Speaker made a tour through Europe and returned to the United States through Canada while infected with MDR-TB.

Fortunately no one was infected by Mr. Speaker.  However next time we may not be so lucky. 

There are steps that we can and should take to respond to MDR-TB, such as providing the equipment necessary to rapidly diagnose MDR-TB to countries that cannot afford it themselves.  And we can help improve drug supply for treatment and improve the laboratory capacity in low and middle income countries to gather better data.

I am happy to report that the Foreign Affairs Committee approved the reauthorization bill, despite the misgivings of my colleague.  The bill contains an authorization for $4 billion over five years to treat TB.  If appropriated, and I plan to do my part to see that they are, these funds could provide a significant amount of money for all of the aforementioned activities. 

I hope that in the limited time we have available today our witnesses will address what we have accomplished relative to addressing MDR and XDR-TB, especially in Sub-Saharan Africa, and what the Administration plans do to help stop TB over the coming fiscal year.  If we fail to do so not only do we risk the investments we are making in both TB and AIDS treatment overseas, we risk an epidemic here at home. 

With that I will turn to Mr. Smith for his opening remarks.