HEADLINE: HEARING OF THE AFRICA, GLOBAL HUMAN RIGHTS AND INTERNATIONAL OPERATIONS SUBCOMMITTEE OF THE HOUSE INTERNATIONAL RELATIONS COMMITTEE SUBJECT: MALARIA AND TUBERCULOSIS: IMPLEMENTING PROVEN TREATMENT AND ERADICATION METHODS
CHAIRED BY: REPRESENTATIVE CHRISTOPHER H. SMITH (R-NJ)
WITNESSES: MARK DYBUL, M.D., ASSISTANT U.S. GLOBAL AIDS COORDINATOR AND CHIEF MEDICAL OFFICER, OFFICE OF THE U.S. GLOBAL AIDS COORDINATOR, U.S. DEPARTMENT OF STATE; MICHAEL MILLER, DEPUTY ASSISTANT ADMINISTRATOR, BUREAU FOR GLOBAL HEALTH, U.S. AGENCY FOR INTERNATIONAL DEVELOPMENT;
WILLIAM MOELLER, PRESIDENT AND CEO, AMERICAN BIOTECH LABS; YOUSSOU N'DOUR, SENEGALESE JAZZ MUSICIAN, GOODWILL AMBASSADOR, ROLL BACK MALARIA PARTNERSHIP; PAUL NUNN, M.D., COORDINATOR, TB, HIV, AND DRUG RESISTANCE UNIT, WORLD HEALTH ORGANIZATION
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The Subcommittee will come to order. I am pleased to convene this hearing of the
Subcommittee on Africa, Global Human Rights and International Operations. Today we will be
examining the U.S. government's efforts to combat two killer diseases, Malaria and
Tuberculosis, which are ravaging the developing world.
The bad news is sobering. One-third of the world is infected with the TB bacterium, and
it is the leading cause of death for people with HIV/AIDS. There is a TB explosion in Africa
today due to the AIDS pandemic, and sub-Saharan Africa is staggering under the burden of the
highest TB rates in the world. Tuberculosis accelerates the progression of HIV, making people
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
Believe me, malaria is a dreadful disease. I saw my own father, a combat veteran who
contracted the disease in New Guinea during World War II, struggle under its effects for years.
The good news, however, is that both diseases are preventable and curable. "DOTS,"
which stands for "Directly Observed Treatment, Short-Course," is the WHO-recommended
strategy for the detection and cure of standard TB. Its key elements include political
commitment to detect, treat, and monitor infected individuals, which includes a standardized
treatment regimen of six to eight months. A six-month course of anti-TB drugs costs only $12
and can produce cure rates of up to 95% even in the poorest countries. But despite its low cost
and proven success, DOTS is reaching only slightly over one-third of people sick with infectious
Malaria, likewise, is inexpensive and easy to treat, and can be controlled with proven
successful methods combining use of small, environmentally safe amounts of insecticide in
homes and buildings; distribution of insecticide-treated bed nets; treatment with drug regimens;
and focus on vulnerable populations, such as pregnant women.
Malaria has largely been eradicated in the developed world, and a few countries which
have employed this comprehensive eradication and treatment strategy have experienced quick,
dramatic reductions in infection rates. In Zambia's copperbelt, for instance, a privately-funded
malaria control program begun in 2000, which included insecticide spraying, saw a decline of
malaria cases of 50% in just one season. Today malaria cases are down 80%, and the number of
deaths down even further with the introduction of newer and better drugs. Malaria has been
largely eradicated in northern regions of South Africa, thanks to a similar campaign funded by
South African private donors and the Global Fund.
The purpose of this hearing today is to examine our own foreign assistance efforts to
eradicate these two scourges and mitigate the suffering and deaths of millions of women and
children. And frankly, I am concerned. In the seven years since the UN Roll Back Malaria
Partnership first set its goal to halve malaria rates, rates have instead increased steadily by ten
percent. As the rates of HIV/AIDS have grown, TB rates are skyrocketing. The U.S. and global
response to HIV/AIDS is heartening, but not enough attention is being paid to addressing TB and
The President's Emergency Plan for AIDS Relief approved by the 108th Congress
included authorization for the U.S. government to treat those infected with malaria and TB.
However, other than those also infected with HIV, none of these funds has been spent for
treatment of a single person infected with malaria or tuberculosis.
USAID's Child Survival and Health programs spend approximately $80 million
respectively for malaria and TB programs annually. For FY 06, the Administration is requesting
$139 million, a decrease of $30 million over the previous year's level, primarily to strengthen
TB and malaria prevention and control programs at the country level. Budget request documents
state that malaria treatment programs will focus on expanding access to insecticide treated bed
nets, intermittent treatment for pregnant women, and the roll-out of new combination drug
therapies. TB programs which expand and strengthen the DOTS strategy at the country-level are
the focus of USAID's tuberculosis program.
My response to these proposed programs is that it appears we are doing more of the same
- at even reduced funding levels. But more of the same is not going to roll back malaria, or stop
the escalating rates of TB. In our HIV/AIDS strategy, we spend approximately one-third of
funds for treatment programs. Why are we spending only seven percent of our malaria program
funds on direct interventions, when so many lives could be saved by getting the right drugs and
the right tools to the most vulnerable?
I look forward to the testimonies of our expert witnesses both from the government and
from the private sector. I hope to hear good news stories of how we are strategically targeting
areas where we can have an impact; how we are documenting that our dollars are producing real
results; and how we are saving lives.
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