Interview with Dr. Karen Smith
-What needs to be done in the fight against TB to move from a policy of control to one of eradication?
A move to eradication would require a significant increase in resources. Current funding is barely adequate to control TB in many areas. Moving to a policy of eradication would require outreach into communities with the largest numbers of individuals with latent TB infection – particularly communities with recent immigrants from areas of the world with high rates of TB. These communities would need effective education on the reasons for diagnosing and treating LTBI. In addition, medical services for diagnosis and treatment would need to be made available at little to no cost and in very convenient ways, e.g. home delivery of medication.
A second key area which would need to be addressed for a effective eradication policy is global TB. Only by substantially decreasing TB rates around the world are we likely to achieve eradication in the US.
At this point, I don’t think a policy of eradication is even feasible outside of the most developed countries.
-What further resources would be the greatest asset to current TB control efforts? (Money, equipment, personnel, etc?)
The greatest need is political will. Only with persistent political will will it be possible to achieve the sustained commitment to control activities necessary for TB control. This commitment is essential even as rates of TB decline to avoid resurgences such as that seen in the late 1980s and early 1990s in the US.
-Where should monetary resources be coming from? UN and WHO, or from individual governments?
Neither the UN nor WHO have much direct funding available for this kind of activity. Each country’s government must be committed to TB control or all the money in the world will not be effective. The amount of money needed can realistically only come from international aid from the richest countries, such as the US, and organizations like the International Monetary Fund.
-What are drug companies doing to facilitate the global control of TB?
I’m not aware of any significant activities on the part of drug companies in the fight against global TB.
-What is the situation with Hmong refugees in California? Correspondingly, what is the status of tuberculosis in Northern California?
I’m going to refer you to Dr. Jennifer Flood, Chief of the Surveillance and Epidemiology Course, at the state TB Control Branch to answer this question. Dr. Flood will have the latest on this as I’m a bit out of touch. You can reach her at email@example.com. Tell her I directed you to her.