The Hindu : Fighting TB worldwide

Online edition of India's National Newspaper
Friday, Apr 11, 2003

Opinion

Opinion - Leader Page Articles

Fighting TB worldwide

By Gro Harlem Brundtland and
James D. Wolfensohn

GENEVA. Ten years ago, the World Health Organisation declared a Global Emergency to battle the resurgent epidemic of tuberculosis. The international community is making steady headway, but "steady" is too slow and the emergency remains in force. Two million people die from TB every year, worn down slowly and painfully by an infectious disease that destroys their lungs and wastes their bodies.

The epidemic is still growing in Africa and in the countries of the former Soviet Union. TB thrives on poverty and social disruption. It is a close companion of HIV/AIDS as it takes advantage of the weakened immune systems of those who are infected with HIV... The emergence of drug-resistant strains of the disease has revived TB's centuries-old reputation as the "captain of death".

We have an effective weapon against this killer. Known as "DOTS", it ensures that people suffering from TB are fully treated with a powerful combination of drugs under the regular supervision of health workers or community volunteers. The treatment costs $10 or less for six months of drugs and uses primary care services. Over the past few years DOTS has turned the TB tide in several countries and more will follow suit.

Since 1993, 10 million TB patients have been treated successfully worldwide, more than 90 per cent of them in developing countries. A total of 155 countries have now adopted the DOTS strategy, which is vital to ensuring high cure rates and preventing the spread of infection.

China and India have shown remarkable progress in expanding population coverage while maintaining high cure rates. Some 50,000 new TB patients are put on effective therapy each month in India alone. In China, active TB cases fell by 35 per cent in areas applying DOTS over the last decade. Other countries, such as Peru and Vietnam, have already surpassed 2005 targets for TB detection and treatment.

Yet, only a third of all people with TB are being treated under DOTS programmes at present. We must move much faster in scaling up and reaching out to communities at the greatest risk. As the world moves to extend the life and hope of those living with HIV through treatment with antiretroviral medicines, DOTS must become part of the treatment package for the millions of people infected with both HIV and TB. We also have to boost health systems to enable faster response on a range of public health threats.

Poor distribution, management and capacity of health manpower, labs and health posts create barriers for those most vulnerable to disease. Local community and political leaders can be mobilised far more.

The highest TB burden countries, together with G-8 Governments, our institutions, non-governmental organisations (NGOs), foundations, universities and committed individuals such as George Soros and Bill Gates are all supporting the "Global Plan to Stop TB" and are committed to the "Stop TB Partnership". The new "Global Fund to Fight AIDS, TB and Malaria" is a major new contributor to this work and is bringing still more energy to the fight. Through these partners, hundreds of millions more dollars are available now than in previous years for DOTS expansion, for innovative response to HIV-associated TB and drug-resistant TB, and for research and development for new diagnostics, drugs and vaccines. Still, this is still well under the billion dollars more needed annually to change our trajectory in TB control.

Reversing the major communicable disease epidemics of HIV/AIDS, malaria and TB is among the Millennium Development Goals for 2015 adopted unanimously in 2000 by all members of the United Nations. High burden countries are putting considerable money and expertise into defeating TB, with positive, verifiable results. As G-8 leaders prepare to meet in France in June, they should unite in scaling up the fight against these diseases. Millions of lives hang in the balance.

(The writers are Director-General of the World Health Organisation and President of the World Bank respectively.)

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