International Symposium in Commemoration of the 100th Anniversary of KNCV Tuberculosis Foundation
Honourable Ministers, Colleagues, Friends,
One hundred years ago, the KNCV was founded to treat and care for people suffering from tuberculosis in the Netherlands. Over the years, its mandate has evolved, and today it has a leading role in advising and delivering TB control activities in developing countries. During my time as Director of Stop TB, it was my privilege to work closely with you in advancing our common commitment to TB control through DOTS expansion. I congratulate you on reaching this centenary, and on the many accomplishments you have made over the years.
The World Health Organization is relatively young in comparison with KNCV, having been founded only 55 years ago, with the objective of "the attainment by all peoples of the highest possible level of health". That objective does not change but it gives us an evolving agenda. Our most pressing concern is the failure to deliver AIDS medicines to those who need them. Our response must build on the extensive experience gained in expanding DOTS.
At the UN General Assembly last month I declared this to be a global emergency. In sub-Saharan Africa alone, over 4 million people need antiretroviral treatment, while only 50 000 are getting it. In some places HIV infection rates are more than 38%, which means that whole societies are being destroyed by this disease.
Our first step to respond to this crisis will be to reach "3 by 5" - 3 million people on antiretrovirals by 2005. This will require an all-out effort from WHO and from our many partners. A detailed plan is under preparation and will be launched in less than two months time, on World AIDS Day, December the first.
Some of its main elements are already clear. They include country-level emergency response teams, simple treatment guidelines, a global AIDS Drugs and Diagnostics Facility, rapid training for health workers, and detailed budgets and plans for financing. Much of this will sound familiar to you because it draws heavily on our experience with TB control programmes in many countries, including Africa, Asia and Eastern Europe. These are areas of the world where HIV infection rates are high. In many countries they continue to increase dramatically. Our challenge is to act quickly and effectively in scaling up access to treatment. Ten years after the declaration of a Global TB emergency in 2003, we are close to treating three million people a year in DOTS programmes. This is a remarkable achievement. But ten years is far too long, and three million is not enough. To achieve these global targets for DOTS and for ARV treatment by 2005, we must move faster. Business as usual is no longer an option.
As with DOTS, the most effective means of delivering ARV treatment is through strong national and local health systems. There is no need to try and build separate vertical systems. We will be building on the experience of TB clinics across the world, of efforts to prevent mother-to-child transmission of HIV, and of the existing health services in each country.
In fact it is no longer possible to manage HIV/AIDS and TB control programmes separately. About one in three of the people who are HIV-positive worldwide are co-infected with TB. In most cases, people living with HIV die within a few months of becoming sick with TB if they do not receive the proper treatment. HIV is the most powerful known risk factor for TB infection, and escalating TB case rates over the past decade in sub-Saharan Africa are largely the result of this deadly combination.
At the same time, TB programmes face pressing problems even without co-infection. Although large numbers of patients have been successfully treated under DOTS, only one third of all estimated infectious cases were diagnosed and reported by DOTS programmes in 2001. A much stronger support system is needed for health care workers to enable them to increase case detection and cure patients.
The most effective way in which WHO can help to meet that need is by focusing all our work on getting results in countries. Among other things, this will mean channelling more resources and staff into our country offices. They need the means to work more effectively with the local and national health authorities, as well as NGOs and other partners, to build up strong health systems based on primary health care. Especially in the high-prevalence countries, updating and carrying out national TB plans will be a central part of that effort.
NGOs play a vital role in reaching patients. The KNCV has achieved an enormous amount in this regard during its century of excellent work. For that very reason, more still will be demanded of it in the future. NGOs are frequently the engines that drive and lead DOTS expansion, and yours is one of the most effective of these engines.
The challenge is often closer to home than we think. KNCV has been at the forefront of TB control in Europe, nationally and regionally. The epidemics of TB in eastern Europe are of great concern, and demand a concerted response from all countries in the region – East and West.
Beyond the immediate targets for HIV/AIDS and TB control by 2005, we are looking ahead to the Millennium Development Goals for 2015. These include controlling the major infectious diseases, and reducing child and maternal mortality. The other MDGs are also directly related to health, and they reflect the commitment of the global community to our work. They imply strong support for NGOs like yourselves and the many others involved in TB control. We must all make maximum use of this support so that we can achieve the massive scaling up of DOTS that will be necessary to reverse the trend in TB.
Until recently, the major emphasis of WHO’s contribution to the MDGs was health measurement. The need for reliable data remains important, but we will be focusing more on building up country-level capacity to meet this need. The function of these data will be to help ensure that national plans are designed and implemented to make sustained headway in achieving national goals and the MDG targets.
In addition to KNCV's hundredth anniversary, this year we are also celebrating the 25th Anniversary of the Declaration of Alma-Ata. It challenged the world to embrace the principles of primary health care and so to overcome the gross health inequalities between and within countries. Its message was "Health for All", and this became the slogan for a movement. It expresses not just an ideal but a principle and a fact of life: everybody needs and is entitled to the highest possible standard of health. It is the obligation of society to meet that need. This has been WHO's guiding principle not just since 1978 but throughout its existence.
It is organizations like the KNCV that make it possible to uphold this principle. Thank you for your many years of excellent work in TB control, and for your support to WHO. But I hope that we will not need to celebrate the bicentenary of KNCV 100 years from now. If our work together is successful, we will see the eradication of TB long before the year 2103. To reach that goal, we still have much to do. Let us continue to work together for the health of all for many years to come.