Over the past decade, there has been considerable debate about countries' abilities to contain and prevent infectious disease outbreaks. In 2003, when the disease was ultimately contained, scientists called the agent severe acute respiratory syndrome (SARS). The World Health Organization (WHO) estimates that someone contracts TB every second and that about one-third of all people in the world are currently infected with TB; most of these cases, however, are latent. The TB bacteria most often becomes active and causes sickness when one's immune system is weakened, such as with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). Global TB Statistics6

Although TB is curable, WHO estimates that in 2006 (the year for which the most current data are available), there were 14.4 million prevalent cases of TB, including some 9.2 million people who contracted the disease that year. About 80% of annual TB cases occur in 22 high-burden countries (see Figure A-1 in the Appendix ). In 2006, about 3.10 million people in Southeast Asia were newly infected with TB (109 per 100,000 people) and about 2.81 million in sub-Saharan Africa (363 per 100,000). WHO asserts that a number of factors contribute to Africa's relatively high per capita rate. Key factors include weak health systems, low quality health care, poor access to health facilities, insufficient staffing and other human resource constraints, ill-equipped and substandard laboratory services, and little collaboration between TB and HIV programs. South Africa, with 0.7% of the world's population and the most number of people living with HIV/AIDS, had 28% of all HIV/TB co-infection cases and 33% of HIV-positive cases in sub-Saharan Africa. Global TB Efforts

A number of U.S. agencies, centers, and departments implement a range of programs aimed at treating and containing the global spread of tuberculosis. The Administration requested $97.1 million for USAID's FY2009 international TB interventions. U.S. Centers for Disease Control and Prevention (CDC)

CDC supports global TB efforts by providing epidemiologic, laboratory, and programmatic support to USAID, WHO, and the International Union Against TB and Lung Diseases. 108-25 , the U.S. Global Fund contributions. The foundation has pledged an additional $650 million to the Global Fund to Fight AIDS, Tuberculosis, and Malaria, of which $350 million has been paid to date. In FY2008, Congress significantly boosted support for global TB programs, providing $162.2 million to USAID for international TB efforts and directing OGAC to provide not less than $150 million for joint HIV/TB programs. Although Congress voted to increase support for global TB efforts, some Members expressed concern that the additional funds might be provided at the expense of other global health programs. The section below presents some issues Congress might consider as it debates the appropriate level of funding for global TB initiatives. In October 2007, the House passed and the Senate Foreign Relations Committees reported out companion TB bills, S. 968 and H.R. 1567 , the Stop Tuberculosis (TB) Now Act. The bills are aimed at fighting tuberculosis overseas and authorize $330 million in FY2008 and $450 million in FY2009 for related foreign assistance programs. They also authorize $70 million in FY2008 and $100 million in FY2009 for anti-TB programs at CDC.
Infectious diseases are estimated to cause more than 25% of all deaths around the world. A number of infectious disease outbreaks over the past decade, such as H5N1 avian influenza and severe acute respiratory syndrome (SARS), have heightened concerns about how infectious diseases might threaten global security. International air travel and trade have complicated efforts to detect and contain infectious diseases. People could cross borders carrying a highly contagious disease before an infectious agent causes symptoms.
Non-health officials are becoming increasingly aware of the threat that infectious diseases pose. An event that illuminated the issue occurred in May 2007, when a man known to be carrying a drug-resistant form of tuberculosis (TB) crossed a number of international borders unabated. The World Health Organization (WHO) estimates that someone contracts TB every second and that about one-third of all people in the world carry TB; most of these cases, however, are latent. In 2006, an estimated 14.4 million people were living with TB globally, including 9.2 million who contracted the disease that year. About 1.7 million people carrying TB died in 2006, including 200,000 people co-infected with HIV/AIDS. About 80% of all estimated new TB cases arising in the world each year occur in 22 high-burden countries (HBCs).
WHO indicates that the global incidence of TB per capita peaked around 2003 and since then, incidence per 100,000 population stabilized in Europe and declined in all five WHO regions, although the absolute number of new cases increased between 2005 and 2006 in Africa, the Middle East, Europe, and Southeast Asia. In sub-Saharan Africa, weak health systems, minimal access to health facilities, insufficient staffing and little human resource development, ill-equipped and substandard laboratories, and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) co-infection have limited countries' ability to contain TB.
In FY2008, Congress funded U.S. global TB operations at unprecedented levels. Through FY2008 Consolidated Appropriations, Congress provided $162.2 million to international TB programs and an additional $840.3 million for a U.S. contribution to the Global Fund to Fight HIV/AIDS, TB, and Malaria (Global Fund). The House passed and the Senate Foreign Relations Committees reported out companion TB bills, Stop TB Now Act (H.R. 1567 and S. 968) to support global TB efforts and authorize $330 million in FY2008 and $450 million in FY2009. They also authorized $70 million and $100 million for anti-TB programs at the U.S. Centers for Disease Control and Prevention (CDC) in FY2008 and FY2009, respectively. Although Congress voted to increase support for global TB efforts, some Members expressed concern that the additional funds might be provided at the expense of other global health programs. The Administration requested $97.1 million for FY2009 global TB efforts, some $55 million less than appropriated in FY2008. This report, which will be updated periodically, discusses some key issues Congress might consider as debate ensues about the proper level and use of global TB funds.