WHO, UNAIDS Gear Up for World TB Day With New Global Plan of Action
Tomorrow will mark World TB Day 2001, set aside to raise awareness of tuberculosis which was once thought to be on the brink of elimination, but is now the world's leading curable infectious disease. In anticipation of the event, the World Health Organization has released a new report, titled " A Human Rights Approach to Tuberculosis." The report examines the rates of TB infection across the world and calls for "equitable and discrimination-free access to adequate treatment and services" for all who are infected with TB, according to a UNAIDS/WHO release. TB, which kills two million people worldwide each year, is a "leading killer" of people with HIV. TB is an airborne disease that can be spread when an infected person coughs, spits or sneezes. "Not only is reducing the TB and HIV burden a health imperative -- it is fundamental to human rights," WHO Director-General Gro Harlem Brundtland said. TB and HIV, which are "closely linked," are both "enhanced by poverty, homelessness, substance abuse, psychological stress, poor nutritional status [and] crowded living conditions," she added. About 13 million people are infected with both diseases, and about 12% of all TB patients also have HIV, the new report says. Dr. Peter Piot, executive director of UNAIDS, said that the link between the two diseases is "inescapable," as TB is often the "first manifestation of AIDS in more than half of all developing country cases." WHO's Directly Observed Treatment, Shortcourse strategy can cure most patients with six months of antibiotic treatment and costs between $10-$15 per patient. But in the regions "hi[t] hardest" by TB, treatment is an "unaffordable luxury," the UNAIDS/WHO release states. Treating TB "will not solve the worldwide AIDS crisis," Piot noted, "but it will significantly reduce its burden." According to UNAIDS' latest projections, nearly two-thirds of all people with HIV were living in countries with the "highest TB burden in the world," he added, leaving them susceptible to the opportunistic infection. Between 1997 and 1999, TB infection incidence rose by 20% in Africa (UNAIDS/WHO release, 3/22). WHO estimates that globally, there will be 10.2 million new cases of TB by 2005 "if nothing is done to stop" the spread of the disease. The organization hopes to raise $50 million a year over the next five years to aid treatment efforts (AP/Nando Times, 3/20).
A new global action strategy using the DOTS system was approved by a group of 24 health leaders at an international TB conference held last month in northern Italy, the Boston Globe reports. The new cooperative agreement comes after years of "infighting" between world health advocates, who felt WHO wanted "complete control" over worldwide TB policy. Under the new strategy, WHO and other groups will work together to distribute drugs and oversee treatment in 22 countries with the highest TB rates. The WHO's program currently only reaches 23% of people with active TB (Donnelly, Boston Globe, 3/19). The new plan calls for the establishment of the Global TB Drug Facility, which will act as a "procurement agency" to provide the necessary medications to "qualifying countries and organizations." Dr. Ian Smith of WHO said that the facility will be a "mechanism for ensuring increasing access to high-quality drugs." Drug shortages have been "one of the very significant reasons" for the lack of effective treatment, he added. Incomplete or improper administration of the drug therapy is another reason treatment has not been adequate. The DOTS protocol calls for daily observation of patients to ensure that they take their medicine and finish the course of treatment. Multi-drug resistant TB, resulting from incomplete or improper TB treatment, is "threaten[ing] to make TB untreatable in the future" ( Reuters/Deseret News, 3/20). The direct observation of treatment is a central part of WHO's anti-TB strategy, but it is also one of its most "controversial" aspects. Some say the practice is burdensome and can "drive some people into non-compliance" because it requires patients to attend clinics daily, disrupting their lives. "Instead of watching people swallowing pills, health workers could be counselling patients and helping them complete their treatment," John Walley, TB research program director at the Nuffield Institute for Health in Leeds, United Kingdom, said. But Walley acknowledged that "[s]upportive contact with patients" is a "critical" component of TB treatment. He and colleague Amir Khan are working with WHO's Stop TB department to tailor TB treatment programs for different areas in order to move away from the "one-size-fits-all" treatment approach (Moore, Lancet, 3/24).
Funding the Strategy
In March of last year, a ministerial conference in Amsterdam set a global target level of 70% TB case detection by 2005. Conference participants also vowed to cure 85% of those cases within the same time frame. The G8 summit "endorsed the commitment" and agreed to halve the "global burden" of TB by 2010. But despite these promises, funding for TB treatment has remained "insufficient" (UNAIDS/WHO release, 3/22). The Canadian government announced yesterday it will contribute $32.2 million to fight TB through the Canadian International Development Agency. Fifteen million dollars will go directly to the Global Tuberculosis Drug Facility, the first such donation to the fund from any nation. Another $7.2 million will go to CARE Canada and WorldVision Canada to fight TB in India, while an additional $5.7 million will be allocated to improving TB control in Zambia. An ongoing WorldVision TB control and prevention plan in the Philippines will receive $4.3 million (Canada NewsWire, 3/22). In the United States, Rep. Sherrod Brown (D-Ohio) plans to introduce a bill that will provide $200 million in TB treatment and prevention funds next year. The United States has allocated $60 million this year for the international TB fight, up from $10 million in 1999 (Boston Globe, 3/19). Brown joined Reps. Connie Morella (R-Md.) and Henry Waxman (D-Calif.) on Wednesday to announce that they will introduce the Omnibus Tuberculosis Control Act of 2001. The legislation was drafted after reviewing the 2000 Institute of Medicine report, " Ending Neglect: The Elimination of Tuberculosis in the United States," which said the country is at a "pivotal point where it can either control TB or be swept away" by the disease (American Lung Association release, 3/19). Mario Raviglione, head of WHO's Stop TB program, said he "hopes that World TB Day 2001 will raise awareness of tuberculosis for national politicians so they not only realize the scale of the problem, but also implement appropriate programs of health care to tackle this scourge" (Lancet, 3/24).
World TB Day Facts
In anticipation of World TB Day 2001, several cities and countries have released TB statistics. The following is a summary of the TB news of the past week:
- TB rates in Russia "jumped" by 5.6% in 2000, according to Health Minister Yury Shevchenko, Agence France-Presse reports. Ninety out of every 100,000 residents are infected, Shevchenko stated. Seventy-five percent of those affected are "working-age adults," and the TB rate is almost 40 times greater among the nation's prison population than the general population, with 3,118 cases per 100,000 prisoners (Agence France-Presse, 3/21).
- Ukraine has reported a threefold increase in TB-related deaths over the last decade, BBC Monitoring reports. The current TB infection rate stands at 60.2 per 100,000 residents, and the TB death rate is 22 per 100,000 residents, according to figures presented at a Mar. 19 interdepartmental meeting on TB treatment strategy (BBC Monitoring, 3/22).
- California had 300 fewer cases of TB in 2000 compared to 1999, bringing the number down from 3,608 to 3,296, Ascribe News reports. However, an estimated 3.4 million TB-infected people live in the state, according to the American Lung Association of California. The association is calling on the state and local health departments to increase funding for TB prevention and control efforts (Ascribe News, 3/21). State officials are scheduled to announce statewide TB data today. In Contra Costa County, Calif., reported a "dramatic decline" in TB cases in 2000, falling 19.6% from 1999 figures, the San Francisco Chronicle reports. The decrease in cases was mainly located in the western part of the county, which saw a 42% drop (San Francisco Chronicle, 3/20).
- Tuberculosis cases in Washington, D.C., and Northern Virginia last year rose 21% and 5% respectively, American Health Line reports. TB cases dropped 6.6% last year nationally, but health officials say that the capital area experienced the increase in cases because of a "wave of immigration" from poverty-stricken areas in Africa, South America and Southeast Asia. Some health officials expressed "concern" over the increases, but others said that the increase in numbers came from "better case reporting" (American Health Line, 3/21).
- Health officials in New York City report that the city's TB rate is at its "lowest recorded level," which has decreased for the eighth consecutive year, AP/Newsday reports. Last year, 1,332 new cases were reported, a 9% decrease from 1999, according to Health Commissioner Neal Cohen. The city government will continue to target "high-risk communities" such as immigrants from China, the Dominican Republic, Haiti, Ecuador, India and Mexico, where TB is more prevalent (AP/Newsday, 3/22).