Funds available from CDC will be scarce in future
TB association works at damage control
The Centers for Disease Control and Prevention's (CDC) Division of Tuberculosis Elimination plans to reduce awards to the states during fiscal year 1999 by $6 million, says Patricia Simone, MD, chief of the field services branch at the division.
TB health officials long have been concerned that success in reducing TB would result in decreased funding, thereby possibly sowing the seeds for a future epidemic.
While Congress has not made efforts yet to reduce funding directly, accounting changes at the CDC will slightly reduce future awards. More significantly, because unobligated funds have been accumulating at the CDC's division of TB elimination since 1995, there will be reductions in awards for 1999 and 2000, according to a letter sent to state TB controllers.
A CDC administrative charge, commonly referred to as the "tap," has been placed on cooperative agreement awards in the amount of 1.97% for FY 1998, increasing to 2% fewer dollars awarded to program areas in future years, says Kenneth Castro, MD, the division's director.
Funding: Use it or lose it
In a move to reduce and eventually eliminate the practice of using unobligated funds for program awards, the CDC will have to cut base awards by $6 million in FY 1999 and by the same amount in FY 2000, he explains.
"Congress has reduced appropriated funding levels for some other CDC programs with relatively large amounts of accumulated unobligated funds," he notes. "Therefore, we have been encouraging the cooperative agreement recipients to spend their funds efficiently."
The announcement was greeted with concern by TB controllers, says Bruce Davidson, MD, head of the Atlanta-based National Tuberculosis Controllers' Association (NTCA). "There is dismay both in states that weren't getting much money to begin with and in states that do but which have done a really great job wiping out their cases," he says.
To help allay anxiety, Simone has asked the NTCA to form a committee to come up with what Davidson calls "a flexible formula" for how awards should be trimmed.
"We're going to talk about how to maintain and improve domestic TB control," says Davidson. "We'll have to look at how to divvy up money in places that have been less than totally successful in their efforts. We'll suggest specific criteria, not just advise throwing money at problems since doing so doesn't ensure things will get better."
The NTCA committee has to develop a way to determine how much infrastructure is needed for a program to do its job. Often, that means TB control; in a few lucky spots, it could mean elimination, with efforts targeted at prevention. The proportion of foreign-born cases and other demographic features will all be considered, Davidson says.
The committee's first meeting was scheduled for May 27 and 28 in Atlanta. Jim Jones, TB controller for North Carolina, will serve as chairman for the proceedings.
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