On April 26, the House International Relations Subcommittee on Africa, Global Human Rights and International Operations heard testimony on efforts to combat malaria and tuberculosis (TB) worldwide.
Describing the scope of the problem, Chair Christopher Smith (R-NJ) said, “One third of the world is infected with TB bacterium, and it is the leading cause of death for people with HIV/AIDS…Similarly, malaria is the number one killer of children and pregnant women in Africa, and one of the top killers in Asia and South America. An estimated 600 million people contract malaria each year, resulting in between one and two million deaths, and almost 3,000 children die from the disease every day. Infection rates for malaria dwarf that of HIV/AIDS, and the vast majority of malaria patients are poor pregnant women and children under five years old, who die within days.” Noting that both diseases are treatable, Rep. Smith expressed his concern that, for FY2006, “the Administration is requesting $139 million, a decrease of $30 million over the previous year’s level, primarily to strengthen TB and malaria prevention control programs at the country level.”
Ranking Member Donald Payne (D-NJ) agreed. “There is a health emergency in Africa and parts of Asia, India in particular, and we have a responsibility as the U.S. to do more…Even if you take the amount in the Global Fund for TB and Malaria and add it to our bilateral programs, our FY 06 funding is down.” He also said the United States should pressure its allies to give more: “When Global Fund advocates say that we should be contributing more, the Administration’s response is that the United States would be able to pay more if other countries met their pledges, because of legislation requiring the U.S. contribution for fiscal years 2004 through 2008 not exceed 33 percent of contributions from all sources. But I think this is a situation where the U.S. should exert its influence over our friends and allies and urge them to step up their contributions.”
United States Agency for International Development (USAID) Deputy Assistant Administrator for Global Health Michael Miller stated that “TB and malaria are the highest priorities for USAID in our work in infectious diseases.” Mr. Miller said that DOTS (Directly Observed Treatment, Short-Course), a strategy recommended by the World Health Organization, “remains the cornerstone for effective TB control in all settings” and stressed the need to “ensure that all HIV-infected persons have access to prompt TB care.”
Asserting that “USAID has in place a comprehensive strategy to battle malaria, including prevention treatment, and malaria in pregnancy,” Mr. Miller highlighted the dangers for malaria in pregnant women: “Each year, more than 30 million African women become pregnant in malaria-endemic areas and are at risk for Plasmodium falciparum infection during pregnancy. Most women live in areas with year-round malaria transmission, where the infection during pregnancy leads to anemia in the mother and the presence of parasites in the placenta. The resulting impairment of fetal nutrition contributing to low birth weight (LBW) is the leading cause of young infant deaths and development in Africa. HIV infection diminishes even more a pregnant woman’s ability to control malaria infections.” He cited the provision of antimalarial drugs and ITNs (insecticide-treated mosquito nets) through antenatal clinics as the most effective means of helping rural women.
Roll Back Malaria Partnership Special Envoy and UNICEF Goodwill Ambassador Youssou N’Dour stated, “The Global Fund is the war chest in the fight against malaria, providing much of the financing needed to scale-up programs. But it cannot win this fight alone. Countries need help in choosing which tools to use and ensuring that they are purchased and distributed swiftly and effectively. This is the function of the Roll Back Malaria Partnership (RBM).” Mr. N’Dour said that RBM programs have streamlined the distribution of nets and the use of artemisinin-based combination therapies, which are more effective than chloroquine in fighting malaria. He urged Congress to contribute $1.1 billion to the Global Fund and $1.2 million more to RBM.
Confirming that “HIV is the biggest single challenge to TB control efforts” in Africa, World Health Organization Stop TB Coordinator Paul Nunn pointed out that TB is closely linked to poverty and war: “The low levels of economic performance in most African countries and the high levels of armed conflict and displacement of people create conditions of poor nutrition, crowding, and poor health service delivery that fuel transmission of the disease. In sub-Saharan Africa, it is estimated that only 53% of the population has access to health services.” Dr. Nunn outlined the key priorities for fighting TB, which include “raising the profile of TB on political and development agendas,” increased funding for TB control, more support for DOTS programs in sub-Saharan Africa, and “close collaboration” between national TB and HIV/AIDS programs.
