New burdens for Africa
THE UNITED STATES and other wealthy nations have responded generously to the AIDS epidemic in Africa, both through country-to-country programs and through the United Nations Global Fund to Fight AIDS, Tuberculosis, and Malaria. Recently, though, two threats to continued progress against AIDS have become acute. One is a form of TB that is resistant to several drugs and is causing the deaths of many AIDS patients. The other is the departure of many of Africa's health professionals, who leave for more lucrative positions in North America and the European Union. Bills pending in Congress would mobilize new resources to keep both TB and the brain drain from undermining efforts to combat AIDS and other diseases.
AIDS and TB are often a one-two punch because AIDS weakens patients' immune systems, permitting latent TB infections to thrive. Relatively cheap first-level antibiotics can check the disease, if the drugs are taken as prescribed. If not, drug-resistant forms of TB can develop. The most persistent of these is called extensively drug resistant TB, or XDR-TB. Patients can also acquire this strain from other infected persons.
Last week an official of the World Health Organization, Mario Raviglione, said XDR-TB could lead to a "practically uncontrollable" epidemic among AIDS sufferers. In 2004, more than 400,000 people worldwide were identified as having TB strains resistant to at least two first-line TB drugs. Now the XDR-TB strain that resists three or more drugs has been identified in 28 countries, including the United States.
Raviglione said African countries need better diagnostic tools and healthcare procedures. A $300 million emergency funding bill before Congress would address these needs and supply second-level TB drugs more promptly than the global fund, which operates on annual grant cycles.
Africa's efforts to fight both these diseases and improve public health will be hobbled if it cannot keep its trained medical personnel. A bipartisan bill whose sponsors include Senators Richard Durbin of Illinois and John Kerry would provide $600 million over three years to curb the healthcare brain drain. It would finance safer working conditions, the training and recruitment of health workers in underserved rural areas especially, and better health systems management. Whether or not this bill is enacted, the Bush administration could help stem the flow of healthcare workers out of Africa by encouraging governments there to increase their spending on both medical personnel and facilities.
The AIDS epidemic has focused the world's -- and Africa's -- attention on the shortcomings in its public health systems. Short-term help in limiting the spread of virulent TB and longer-term help in keeping trained African personnel from emigrating are sensible US investments in the continent's future.
