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Recommendation 7.2 To increase the effectiveness of mobilization efforts the committee recommends that the National Coalition for the Elimination of Tuberculosis continue to provide leadership and oversight and that CDC continue to work in collaboration with the coalition to secure the support and participation of nontraditional public health partners, ensure the development of state and local coalitions, and evaluate public understanding and support for tuberculosis elimination efforts, with the assistance of public opinion research experts.

Recommendation 7.3 To assess the impacts of these recommendations and to measure progress toward accomplishing the elimination of tuberculosis, the committee recommends that, 3 years after the publication of this report and periodically thereafter, the Office of the Secretary of Health and Human Services conduct an evaluation of the actions taken in response to the recommendations in this report.

Social mobilization has been identified as a vital prerequisite to accelerating the decline of tuberculosis in the United States. In March 1998, the World Health Organization convened an ad hoc committee on tuberculosis to analyze individual countries' abilities to reach year 2000 targets for tuberculosis control. Although the committee's focus was on the 22 so-called high burden countries that account for the majority of the world's burden of tuberculosis, the committee's major findings also apply to low-burden countries such as the United States. The committee found:

Intensified technical efforts will not by themselves bring about the acceleration and expansion needed for tuberculosis control programs. This Committee has identified six principal constraints regarding action by health authorities. These are financial shortages, human resource problems, organizational factors, lack of a secure supply of quality anti-TB drugs, and public information gaps about TB's danger. The most fundamental constraint is the lack of political will to develop and sustain effective TB programs. (Emphasis added) (World Health Organization, 1998)

The Ad Hoc Committee identified four factors important to creating and sustaining political will:

1. Popular Perception: The public should recognize tuberculosis as a priority problem with an achievable solution.

2. Technical Consensus. The consensus among the technical and scientific communities is thought to be indispensable. Such consensus al



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