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Like myriad aspects of American life, TB control has experienced the impact of the Sept. 11 terrorist attacks. As the attacks focused public attention on the nation’s underfunded public-health system, one question on the minds of many public-health practitioners was whether a rising tide of funds directed at bioterrorism would also lift the boats of TB control.
In Congress, an anti-terrorist bill approved in the House proposed to give an extra $232 million to the Centers for Disease Control and Prevention; its companion bill in the Senate put the amount at $182 million. In other action on the Hill, the House approved $136.5 million for domestic TB control for 2002, a $9 million increase over the current year’s budget. The Senate, meanwhile, voted a 7.4% increase for the HIV/STD/TB line item. With no breakout yet available for TB on the Senate side, still unknown is how much that bill stands to increase money for TB in particular.
In other business related to national security, Congress began scrutinizing the U.S. Immigration and Naturalization Service (INS). Members proposed a wide variety of measures, many of which, if passed, could affect foreign-born rates of TB.
For example, Sen. Dianne Feinstein (D-CA) proposed a six-month moratorium on student visas. That bill spurred vigorous protests from colleges and universities; eventually, Feinstein withdrew it, amid promises by universities to keep better track of foreign students and resolutions by Congress to give more money to the INS for a tracking system to accomplish that task.
Refugee quotas, usually out by Sept. 1, languished in a holding pattern, waiting as Congress dealt with more urgent matters. Before the events of Sept. 11, immigration limits for refugees from northern Africa and the Mid-East/South Asia region were about to be raised, according to U.S. State Department/Bureau of Consular Affairs spokesman Christopher Lamora. Despite the hold on refugee quotas, immigration visas continued to be issued without disruption.
"The main focus right now is on temporary visas, such as the visa waiver program, which lets people from 29 countries enter for certain purposes and for certain periods of time," says Lamora. "There’s talk of clamping down on a lot of [the INS system]. When the music stops, it’s impossible to say how many chairs there will be left."
At the southern border, lengthy inspections (coupled with a shortage of inspectors) were translating into waits of up to five hours for those attempting to cross. In El Paso, TX, binational patients at the county TB clinic were continuing to show up for treatment, with no evidence of disruption of care, says Miguel Escobedo, MD, MPH, director for the Texas Department of Health’s Region 9/10. In San Diego, there was also no apparent disruption of care for binational TB patients, says Kathleen Moser, MD, MPH, TB control officer for San Diego County Department of Health Services. "Some people have begun parking their cars on one side of the border, then biking over, or else walking across to a pre-arranged spot where they’re picked up by a friend," Escobedo notes.