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and vaccines should be better characterized and access to these markets for these new products should be facilitated.

Recommendation 5.5 To define the applicability of any new tools to the international arena and facilitate their development, the U.S. Agency for International Development (AID), NIH, and CDC should build upon international relationships and expertise to conduct research.


Tuberculosis is a leading cause of death worldwide, even though it is a readily treatable and preventable disease. Although an altruistic argument for promoting the global control of tuberculosis can easily be advanced, worldwide control of this disease is also in the nation's selfinterest. The proportion of foreign-born patients with tuberculosis in the United States has been steadily increasing. In 1998, 41 percent of all patients with tuberculosis were foreign-born. It benefits the United States to help strengthen tuberculosis control programs globally, particularly in the countries that are the sources of the most tuberculosis cases imported into the United States. Tuberculosis will not be eliminated in the United States until the worldwide pandemic is brought under control.

Recommendation 6.1 To decrease the number of foreign-born individuals with tuberculosis in the United States, to minimize the spread and impact of multidrug-resistant tuberculosis, and to improve global health, the committee recommends that

  • The United States expand and strengthen its role in global tuberculosis control efforts, contributing to these efforts in a substantial manner through bilateral and multilateral international efforts.

  • The United States contribute to global tuberculosis control efforts through targeted use of financial, technical, and human resources and research, all guided by a carefully considered strategic plan.

  • The United States work in close coordination with other government and international agencies. In particular, the United States should continue its active role in and support of the Stop TB Initiative.

  • AID, CDC, and NIH should jointly develop and publish strategic plans to guide U.S. involvement in global tuberculosis control efforts.

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