Washington, DC - Today, the White House released a comprehensive plan that identifies critical actions to be taken by key Federal departments and agencies to combat the global rise of multidrug-resistant tuberculosis (MDR-TB). The National Action Plan for Combating Multidrug-Resistant Tuberculosis (hereafter referred to as the National Action Plan), developed by an interagency working group in response to Executive Order 13676:

Combating Antibiotic-Resistant Bacteria and the National Action Plan for Combating Antibiotic Resistant Bacteria, identifies a set of targeted interventions that address the core domestic and global challenges posed by MDR-TB and extensively drug-resistant TB (XDR-TB). The recommended interventions represent the U.S. Government’s contributions to reversing the worldwide spread of MDR-TB and can help inform policy development processes around the world. The National Action Plan is an effort to articulate a comprehensive strategy, and to mobilize political will and additional financial and in-kind commitments from bilateral and multilateral donor partners, private-sector partners, and governments of all affected countries.

TB has caused more deaths than any other single infectious disease worldwide, killing more than 1.5 million people each year; more than 4,000 people die of TB every day. Nearly one-third of the world’s population is thought to be infected with Mycobacterium tuberculosis (Mtb), the causative agent of TB, and is at risk of developing TB disease. The health impact of TB is extraordinary. Each year, more than 9.5 million people develop active TB and approximately 480,000 people develop MDR-TB each year.  However, fewer than 20 percent of individuals with MDR-TB receive the drugs they need to combat the disease and of them, less than half are cured.  Those who do not receive treatment or are not successfully treated continue to transmit the disease to others and face prolonged illness and likely death.   

The consequences of TB are much broader than its impact on health. TB can be economically devastating to individuals and their families, many of whom are already living on the edge of poverty. The average TB patient may lose up to 4 months of work and up to 30 percent of his or her annual income. The toll of TB on the global economy is estimated to be $12 billion each year. In countries with a high-prevalence of TB, the disease is estimated to decrease gross domestic product by 4 to 7 percent. In the United States, it costs about $17,000 to treat a patient with drug-susceptible TB, $150,000 to treat a single patient with MDR-TB, and $482,000 to treat a single patient with XDR-TB. 

Since 1993, when the World Health Organization (WHO) declared the TB epidemic a global health emergency, a renewed international commitment to expand access to care has reduced the incidence and prevalence of the disease. Intensified efforts to detect and treat TB have led to a nearly 50-percent decrease in global TB deaths, amounting to nearly 45 million lives saved in the last 15 years alone. In the United States, the number of individuals who develop TB has declined annually over the past 20 years, falling below 10,000 for the first time in 2012. This dramatic progress could, however, easily be eroded or reversed by the further development and spread of MDR-TB and XDR-TB, which is why the action plan is important.

Scope of the National Action Plan

The National Action Plan identifies critical immediate actions the U.S. Government will take over a 3- to 5-year period, with appropriate appropriations, to contribute to the global fight against MDR-TB. It is designed to achieve an impact within that timeframe and to serve as a call to action for the global community. The National Action Plan builds on existing mandates of U.S. Government departments and agencies to advance efforts such as those identified in the WHO’s End TB Strategy and the U.S. Government’s Global TB Strategy 2015–2019. It is aimed to make an impact on the global MDR-TB epidemic, emphasizing patient outcomes and program results through innovative approaches. The National Action Plan guides U.S. Government activities tailored to key domestic, international, and research and development needs and serves as a call to action for other bilateral and multilateral donors, private sector partners, and affected countries to further their investments in this critical area of worldwide concern.

National Action Plan for Combating Multidrug-Resistant Tuberculosis

The National Action Plan is organized around three goals that aim to strengthen health-care services, public health, and academic and industrial research through collaborative action by the U.S. Government in partnership with other nations, organizations, and individuals:

• Goal 1: Strengthen Domestic Capacity to Combat MDR-TB. Each year in the United States, around 100 individuals are diagnosed with MDR-TB and health authorities must follow up with every patient to ensure appropriate treatment and to determine if others have been infected and require treatment or preventive services. Goal 1 activities will help prevent TB drug resistance by ensuring that all patients with TB disease are promptly detected and treated, and that people who have been in close contact with infectious TB patients are identified, monitored, and if necessary, treated. Although any transmission of TB is of public health importance, an outbreak sparked by an individual with undiagnosed MDR-TB or XDR-TB could have serious consequences due to the difficulty and costs associated with treating patients infected with these resistant strains.

• Goal 2: Improve International Capacity and Collaboration to Combat MDR-TB. The emergence of MDR-TB and XDR-TB not only results in significant loss of human life and economic damage, but has the potential to impede progress in mitigating the devastating effects of TB. Goal 2 describes efforts the United States will take to address the global threat of MDR-TB through strategic investments to broaden access to diagnosis and treatment by engaging providers from both the public and private sectors in the most affected communities, improving innovative health technologies and patient-centered approaches to care, and advancing diagnostic and treatment options.

• Goal 3: Accelerate Basic and Applied Research and Development to Combat MDR-TB. New products and innovations for the diagnosis, treatment, and prevention of TB are needed to accelerate control of TB and MDR-TB at home and abroad. Goal 3 activities will help with the development of rapid tests to diagnose TB and determine susceptibility to available drugs; novel therapies and drug regimens that could cure TB and MDR-TB within weeks, making it easier for patients to complete therapy and decreasing opportunities for the emergence of drug resistance; and new vaccines with the potential to prevent all forms of TB.

Implementation of the National Action Plan and achievement of its goals and objectives will depend not only on sustained coordination among U.S. agencies to ensure a strategic whole-of-government approach, but also on close collaboration with global partner’s ministries of health, the WHO, the Stop TB Partnership, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and other domestic and global partners in the fight against TB, which include:

• U.S. and global front-line health-care providers who detect, diagnose, and treat MDR-TB;
• State and local public health departments in the United States and regional health departments;
• Ministries of health and national TB control programs in high burden countries, which have primary responsibility for preventing and controlling TB in their jurisdictions;
• Non-governmental organizations that help build health-care capacity and expand quality treatment services for MDR-TB in TB-endemic countries;
• Private sector partners who advance the development of innovative tools for the detection, treatment, and prevention of MDR-TB, including academic and industrial researchers; pharmaceutical, biotech, and not-for-profit product developers; public/private partnerships; and manufacturers of vaccines, drugs, and diagnostics;
• Community leaders, patient engagement organizations, and other community-based groups that provide health literacy and social support to patients undergoing treatment for TB and MDR-TB;
• Civil society organizations that promote civic engagement and advance the development of national health policies for the control of TB and MDR-TB;
• People who have had TB and other private citizens who serve as patient advocates and raise awareness related to the danger posed by MDR-TB; and
• Governments, foundations, and other donor organizations that support disease-control activities and innovative research to develop new tools for detection, treatment, and prevention of MDR-TB.

Over the next 5 years, the U.S. Government will work with members of the public and private sector, affected countries, non-government organizations, and global partners to meet the goals identified in the National Action Plan.  This initiative will require a sustained effort involving industry, non-governmental organizations, and international partners. This National Action Plan will solidify an ongoing partnership among these entities that will ensure resources are leveraged effectively to address this global challenge to public health and prosperity. A healthy global population makes for stronger, more prosperous, and more stable nations; enhances international security and trade; and ensures a safer, more resilient America.