25 March 2004 01:34
Tackling tuberculosis
TUBERCULOSIS CLAIMS the lives of more than 5,500 people every day and yet a simple, effective treatment is available.
An estimated 8.8 million people fell ill last year. Up to 80 per cent of TB patients are HIV positive in parts of
Sub-Saharan Africa, and TB is a top killer of persons living with HIV/AIDS. TB incidence also continues to rise in
Eastern Europe.
A special surveillance report just issued by the World Health Organisation finds that patients in parts of Eastern
Europe and the Russian Federation are 10 times more likely to have multi-drug-resistant TB than in the rest of the
world. As the just reported outbreak of disease in the Netherlands shows, TB does not respect borders, it exploits them
- in this case crossing from Eastern to Western Europe. Accordingly, we must consider TB control as a global public
priority. Reversing major communicable disease epidemics is rightly among the United Nations' Millennium
Development Goals for 2015.
And yet the world has some powerful weapons at its disposal that have already made a difference in curing millions of
TB patients. Without the changes of the last few years, many of these people, especially the poorest, would have died as
the bacterium slowly, painfully ravaged their lungs, and respiratory system. Thanks to the public health strategy known
as DOTS (Directly-Observed Treatment, Short course) - where those ill with TB are detected and provided medicines with
the assistance of trained workers or volunteers - the world has a proven and highly cost-effective means to reduce
transmission, suffering and death.
Of the 210 countries that reported their TB cases and treatment results to WHO in 2002, 180 are today implementing
the DOTS strategy and providing access to services for nearly 70 per cent of the world's population. WHO reports
that the number of patients being treated under DOTS is now rising much faster than at any time in the last decade.
Increasing foreign aid and domestic financing are helping DOTS coverage expand.
This is one area where the world community can take credit for stepping forward to act, in response to the worsening
epidemic and guided by a Global Plan to Stop TB devised by a growing partnership of governments, donors, civil society,
corporate and academic partners. Still there is far to go in this work and the national capacity and resources to
respond urgently need strengthening. To fulfil the plan, we still need an extra $1 billion a year in investment at the
local and global levels.
The Government of India has a big story to tell. It is a leader in the rapid national expansion of TB programmes.
With more than 100,000 more patients being treated under DOTS each month. Millions have been treated successfully since
the revised programme was launched in 1997. India also demonstrates that it is no simple task to reach and cure those
who are ill - a huge country, vast differences among communities and patients at risk, a complex cascade of government
public health services and a dominant private sector in health service provision. Yet, the scale up of TB control has
progressed as quality results have been demonstrated and new partnerships forged outside the public sector.
China has also won significant gains, with increasing national commitment to public health, local government
engagement and foreign assistance. A national survey has demonstrated that where DOTS was in place in China, TB
prevalence fell by 36 per cent from 1990-2000, vs. only a three per cent drop in areas not covered. The national TB
control effort in China is also placing special focus now on helping poor regions and vulnerable populations build their
services and engage communities. In Sub-Saharan Africa, there are leaders already, such as Malawi, in developing a joint
response to TB and HIV/AIDS, and other large and small countries that have launched DOTS with greater speed than seen in
the past.
As these country cases show, global consensus on strategy and diverse local models to serve patients can make a
difference. Still, to reach the most vulnerable due to poverty, HIV/AIDS, war or social disruption, many more
governments, researchers, community and corporate leaders need to join in stopping TB. If the global community could
raise the additional billion dollars a year we need to expand the reach of the Global Plan to Stop TB, deaths from the
disease could fall dramatically within a decade, and we would be on the road to eliminating TB during the lifetime of
our children.
(Praful Patel is the World Bank's Vice-President for South Asia; Jack Chow is Assistant Director General for
HIV/AIDS, Tuberculosis, and Malaria at the World Health Organisation.)
[The Hindu] |
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