New plan for elimination urges global perspective
No country’s an island, especially with TB
The United States shouldn’t throw in the towel and abandon efforts at TB elimination, says a new update of the national strategic plan to eliminate TB. At the same time, the updated plan, finally completed after undergoing six months’ worth of rewriting, stresses the need for forging new partnerships, strengthening advocacy, and finding new tools, especially a new TB vaccine.
"We acknowledged that the goal of elimination is one to which we should re-commit," says Charles Nolan, MD, chairman of the Centers for Disease Control and Prevention’s Advisory Committee to Eliminate Tuberculosis (ACET) and TB control officer for King County/Seattle. "But a lot has changed in the years since the first plan was rewritten. To eliminate TB, we’ll need new partners, more visibility, and new tools."
Due out sometime this month in the Morbidity and Mortality Weekly Report, the plan also is expected to stress that local and state TB programs should tailor their efforts to fit the local epidemiology.
"We don’t have one homogenous situation in the U.S. anymore," says Nolan. "TB in the U.S. is not one epidemic, but a number of different epidemics; and that means that for a local area to get control of its TB problem, it needs to do an in-depth study of how disease is occurring in its own population."
Unlike the 1989 plan, which set 2010 as a target date for elimination, the new plan doesn’t propose a specific date. Part of the decision not to name a new date reflects the increase in TB among the foreign-born, and ACET members’ perception that immigration will continue to be a driving force in the American TB picture.
"It’s my personal feeling that it would be foolish to name a date for eliminating TB in the United States without having eliminated it in the rest of the world," says Masai Kawamura, MD, medical consultant to TB control division of San Francisco and one of a few ACET members who worked with Nolan on the final draft of the plan. "We cannot be isolated in this fight," she adds. "The global struggle against TB has to be our struggle."
Just as the new plan is expected to call more attention to the impact of the global epidemic on TB rates in this country, ACET members say TB advocacy needs to move out of the public health community and into the community at large. "Perhaps politicize’ isn’t exactly the right word, but certainly, we need to communicate our needs to the community more effectively," she says.
As the final draft of the elimination plan evolved, the plan grew more general, as a nod to the Institute of Medicine (IOM), which is preparing its own report of TB control in the United States and is expected to make a number of specific recommendations. "The IOM has a lot of expertise, and we’re expecting them to provide a lot of specifics in their report," says Rick O’Brien, MD, chief of the research and evaluation branch at the CDC’s Division of TB Elimination and another member of the rewrite committee for the plan.
"We decided that instead of specifics, what this should be was more of a general call to action," he explains.
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