This year’s TB budget contains modest hike
This year’s TB budget contains modest hike
Some money designated for low-incidence states
Congress handed TB control programs a present — albeit a very small one — within the 2002 budget: an increase of 4.9% over last year’s budget. That works out to about $5 million more than last year’s budget.
"We don’t want to sound ungrateful, but it would have actually been easier in some ways to have gotten no increase at all," says Ken Castro, MD, director of the Division of TB Elimination at the Centers for Disease Control and Prevention in Atlanta. With so small an increase, the challenge is to find a way to keep the extra resources from being soaked up drop by precious drop before the money gets a chance to produce any substantial results, he says. "I’m not at all inclined to divide this money up 68 different ways," he adds. "Our challenge here is to bite off some good-sized chunks of problems we can actually do something about."
Funding lags behind cost-of-living increases
The total for TB funds in this fiscal year’s CDC budget is $132.8 million. Even with this year’s and last year’s increases, federal funding hasn’t kept pace with cost-of-living increases for the last eight years, Castro says. Extra money approved for bioterrorism preparedness, if appropriated, might push the federal agency’s overall budget as high as $7.5 billion. (Last year’s overall budget at the agency was just $5 billion.) But Castro sounds only mildly optimistic when he says he hopes TB controllers will see "some secondary gains" from the bioterrorism funding package.
President Bush’s proposed budget for fiscal year 2003 holds disappointments for the TB community. That budget shows flat funding for the National Center for HIV, STD, and TB Prevention, and about $700,000 less for the CDC as a whole. Analysts at the American Lung Association say Congress will probably add money later, but it would have been much better to have a higher starting place.
By the end of last month, both the TB experts at the CDC and members of the National TB Controllers Association were in agreement over how the current fiscal year’s increase should be spent. Some will probably go to provide extra help for low-incidence states. It also seems certain that some of the money will be spent at the CDC’s newly formed epidemiology consortium, where the money ran out before seven of 22 sites could get properly funded. Finally, it was expected that a modest grant would go to the National Coalition to Eliminate Tuberculosis.
Low-incidence states, where trends toward decreasing case rates have tended to stagnate, may get some help in acquiring more technical expertise for the few cases they do see, as well as the capacity to absorb and deal with unexpected surges, Castro says. There will be also be more support for doing molecular fingerprinting. Prohibitively expensive in high-incidence locales, using that particular tool makes sense "if there are just 20 cases a year," Castro adds. Contact investigations would be another good place to put the extra money, he says, especially for investigations involving pediatric cases.
A bill sponsored by U.S. Reps. Sherrod Brown (D-OH) and Connie Morella (R-NJ) had sought an extra $400 million for TB control, based on needs assessed by the National Academy of Science’s Institutes of Medicine. Though the bill hasn’t yet achieved its goal, the Brown-Morella bill "can continue to serve as an advocacy tool," says Joanne Carter, legislative director of the grass-roots citizens’ advocacy group RESULTS in Washington, DC. "We’re in the second year of the two-year congressional cycle, so we can still use this bill, and we can collect more co-sponsors for it." The bill already has strong bipartisan support, with nearly 100 cosponsors, she adds.
On the international front, a bill awaiting President Bush’s signature would award $75 million in TB funding to USAID, Carter notes. "That’s up from $60 million last year," she points out. And the global fund established to fight TB, HIV, and malaria should collect between $250 million and $300 million — a good start, but far short of the billion dollars the fund needed to get from the U.S.
"My fear was that [the events of Sept. 11] would distract everyone and suck attention away from ongoing problems like TB," Carter notes. "But now more than ever, I think people are seeing links between TB and the rest of the world."
At a recent RESULTS press conference, Carter says she was worried that all the questions would be about military issues. "Instead, everyone was asking about women’s health care in Afghanistan and other medical problems. We need to keep working to make sure people know about these issues, because they do have a natural constituency."
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