Hartman worked in Afghanistan from 1976 until the Soviet invasion in 1979; he returned in 2004, after the Taliban had been removed from power, and spent nearly 3 years there helping to rebuild the country's TB control program.
With his June 4th speech in Egypt, President Barack Obama has begun a major effort to strengthen U.S. relations with the Muslim world. His call for fresh engagement, based on, as he says, "mutual interest and mutual respect" is certainly very welcome.
Now Mr. Obama must look for ways to turn this promise into a reality and in a way that reaches ordinary people. An excellent place to start would be to partner with Muslim countries in the fight against tuberculosis, especially in Afghanistan, Pakistan, Indonesia and Bangladesh, where millions are affected by the disease and where important, but fragile, gains have been made.
When I arrived in Afghanistan, after the Taliban was ousted, to help repair a badly frayed health care system, I went to the village elders to ask them where we should start. "Our women and children are dying," they told me.
Indeed, TB was ravaging Afghan families. The country had the 6th highest mortality rate in the world from TB, and sixty-five percent of those who contracted TB were women of reproductive age. These women were passing TB on to their friends and family--and to their children.
In neighboring Pakistan, the population has been hit even harder. Every year, about 300,000 Pakistanis develop TB, and 47,500 die from the disease. TB pushes families into poverty and desperation as their main income earners are sidelined by the disease. The drug distribution system is so weak that an estimated 100,000 infected patients will go without needed medications every year unless international funding is secured.
Afghanistan and Pakistan have made great strides in detecting and treating TB, with U.S. support for programs funded by the U.S. Agency for International Development (USAID) and the Global Fund to Fight AIDS, Tuberculosis and Malaria.
In Pakistan, an American-based international aid group called Mercy Corps has, using Global Fund resources, partnered with the private sector on a broad TB public education campaign, training thousands of health workers and strengthening lab capacity to test for TB.
In Afghanistan, because of USAID resources channeled through Management Sciences for Health, there are now more than 800 health centers providing tuberculosis treatment, 500 medical labs capable of testing for TB, and 14,000 community health workers trained in detection and treatment.
Yet all this progress is now threatened. Facing a large donation gap, the Global Fund has planned deep cuts in the most recent TB grants to Afghanistan and Pakistan, as well as to Indonesia and Bangladesh. These cuts will also hit TB programs in other countries with large Muslim populations, such as India and Nigeria. Grants from the Fund for health system strengthening, which build countries' self-sufficiency, will also be stalled.
Addressing this dangerous gap and launching a renewed focus on TB could have a meaningful and tangible impact on these politically strategic countries; it could stave off the illness and death that sends self-sustaining families into poverty and could serve as a public-health olive branch to the Muslim world.
We should also remember that TB does not need a passport, and, in fact, it poses a serious threat to the health of Americans. The U.S. Department of Homeland Security has identified Extensively Drug-Resistant TB (XDR-TB) as "an emerging threat to the homeland."
To get started, we need Senator Patrick Leahy (D-VT), Representative Nita Lowey (D-NY), and other key members of Congress who determine the appropriations process to take the lead by backing $650 million in next year's budget to scale-up our own vastly underfunded global TB program.
And, rather than freeze the US contribution to the Global Fund at the current level, as the Administration has proposed, the US should give the Fund the $2 billion it has requested for 2010. To date, each US dollar given to the Global Fund has been matched by two dollars from other countries, so the US donation leads to more money overall. This funding is urgent to fight XDR-TB and other forms of drug-resistant TB, which the World Health Organization recently called a "time bomb."
Putting real money behind the Obama administration's call for a "smart power" foreign policy strategy is urgent, because there is a direct connection between health and political stability in countries like Afghanistan and Pakistan, where the governments desperately need to show their people they can deliver basic services. "The ability to provide health-care and other basic services is viewed as a measure of a government's legitimacy," the U.S. National Intelligence Council concluded in a December 2008 report.
Rather than a luxury affordable only in prosperous times, funding for the Global Fund and USAID should be thought of as essential public health diplomacy and a vital tool in the administration's effort to repair relations with the Muslim world.
Dr. Frederick Hartman is a member of the Infectious Diseases Society of America. He has worked extensively in Afghanistan through Management Sciences for Health, a Massachusetts non-profit devoted to strengthening public health systems in poor countries. Hartman worked in Afghanistan from 1976 until the Soviet invasion in 1979; he returned in 2004, after the Taliban had been removed from power, and spent nearly 3 years there helping to rebuild the country's TB control program. He is the author of the book "Window on Afghanistan: Rebuilding Health, Hope and the Human Spirit."