Massachusetts: A Treatable Biohazard Is Underfunded

"...The Massachusetts Department of Public Health has been forced to close several TB clinics and cap expenditures in others. Ironically, as we are increasing our capacity to control biohazards that we hope will never occur, we are becoming less prepared to control ever-present biohazards, such as tuberculosis and other transmissible infections. This is poor public policy.

"While cutting any effective public health program should cause concern, Massachusetts residents should be aware that cutting TB clinics is especially dangerous. First, TB is an ongoing threat in Massachusetts. ...

"Second, TB is an airborne infection. All that is required for infection is breathing contaminated air. Contagious cases that are not properly treated, or not prevented through effective contact testing and treatment, present a definite biohazard to the general population.

"Finally, unlike some public health programs, Massachusetts DPH-sponsored TB clinics provide direct clinical services.... To achieve high rates of cure, TB requires uninterrupted, closely supervised treatment for at least six months. Erratic and incomplete treatment leads to treatment failure and drug resistance.

"To protect the public it is critical to provide TB services without cost to patients, who are often uninsured, and to eliminate other barriers to treatment such as limited access to clinics, inconvenient hours, and long clinic waits.

"On the subway or in a movie theater, consider the possibility that the person coughing nearby may not have bronchitis or a common cold. While highly unlikely to have smallpox, he or she may well have tuberculosis, a preventable and treatable biohazard that will definitely increase as public health control programs are cut. Past cuts in TB programs in New York City led directly to a decade-long epidemic that resolved in 1992 only after a billon dollar investment in public health TB control.

"Massachusetts has a long and proud history of excellence in TB control. Underfunding such an effective public health program while preparing for far less immediate biohazards is extremely shortsighted. We can only hope that the Commonwealth's new administration and the Legislature will soon recognize that the state budget should not be balanced at the expense of the health or safety of its citizens."

Dr. Nardell is chief of pulmonary medicine at Cambridge Hospital, associate professor at Harvard School of Public Health, and director of TB research at Harvard Medical School's Program in Infectious Disease and Social Change.

Back to other CDC news for January 28, 2003

Previous Updates