Press Release WHO/79
28 October 1998
TOP-LEVEL MEETING AT WHITE HOUSE
Soros, Wolfensohn and Brundtland meet with Hillary Clinton;
Urgent action needed to prevent drug resistant tuberculosis strains.
Washington At the invitation of First Lady Hillary Rodham Clinton, Secretary of Health Donna E Shalala, the Administrator of the US Agency for International Development (USAID), Brian Atwood, World Health Organization (WHO) Director-General Dr Gro Harlem Brundtland, World Bank President James D Wolfensohn and financier George Soros met with her at the White House this afternoon to discuss possible new initiatives to fight tuberculosis (TB) and prevent the emergence of drug-resistant strains.
It is hoped that such initiatives would mobilize millions of dollars in new funds to accelerate international TB control efforts, the majority of which would go directly to fighting TB in high-burden countries. More international attention to the TB problem is needed if solutions to challenges facing TB control efforts are to be developed. One major challenge is to ensure that effective anti-TB drugs are available everywhere in the world. The DOTS (directly observed treatment, short-course) strategy is recommended by WHO to accomplish this (see background note for full explanation of DOTS). It is also important that new tools be developed to help in the eventual elimination of TB.
Currently, TB is the single biggest infectious killer of youth and adults, causing between 2 to 3 million deaths each year. Increasingly, TB is appearing in forms resistant to multiple drugs (MDR-TB) that cannot be cured by once-effective medicines.
In October 1997, WHO warned of the emergence of multidrug-resistant "hot zones" around the world, where TB could become incurable for anyone who does not have access to the most sophisticated and expensive healthcare. MDR-TB raises treatment costs 100-fold -- up to US $250,000 per patient in industrialized countries -- and greatly reduces the chances of survival.
A three-pronged strategy will be used to stop drug-resistance. First, to help countries expand their use of DOTS, thereby ensuring that powerful anti-TB drugs are taken properly. This has been shown to prevent the emergence of MDR-TB in Korea, Algeria, Chile, Tanzania and New York City. Second, to increase research into implementing an enhanced version of DOTS, known as "DOTS Plus", that can treat existing drug-resistant cases. And third, to develop a long term vision for TB research that can develop new tools to one day completely eliminate the threat of TB.
Without increased funding for and political commitment to the fight against TB, WHO estimates that over 200 million people alive today will become ill with the disease.
BACKGROUND ON TB
Deaths - TB kills nearly three million people each year, making it the biggest infectious killer of youth and adults in the world. TB also accounts for one third of AIDS deaths worldwide. The disease orphans hundreds of thousands of children each year and is the single biggest killer of young women. Every ten seconds, somebody dies of TB.
Economic Burden - 80% of TB patients are in the most economically productive years of their lives. TB sends many self-sustaining families into poverty. If the breadwinner of a family is not properly diagnosed or treated, he/she will lose, on average, a full year of work.
Drug Resistance Multidrug-resistant TB (MDR-TB) has emerged as a major threat in some countries, including Russia and the Baltic States. In Latvia, for example, 22 per cent of TB patients had resistance to two or more anti-TB drugs. Poorly managed treatment practices are the root cause of MDR-TB. Drug resistance can develop when patients get the wrong drugs, drug supply is unreliable or patients stop taking their medicines because they feel better. TB strains that are resistant to two or more of the most common drugs are 100 times more expensive to treat and often cannot be cured.
The DOTS Strategy DOTS is the most effective strategy available for detecting and curing TB patients and preventing new infections. It was developed from the collective best practices, clinical trials and programmatic operations of TB control over the past two decades. DOTS not only involves direct observation of treatment, it also requires government commitment, microscopy services, reliable drug supply and monitoring systems. DOTS can help any country rich or poor to achieve high cure rates as high as 95%. Countries as diverse as China, Peru, Vietnam, Bangladesh and the United States are examples of its success.
Advantages of DOTS The strategy can be integrated successfully within general health services to achieve widespread coverage. DOTS doesn't require hospitalization or isolation. Patients can remain in their homes and return to work in a few weeks. DOTS is one of the most affordable ways of extending the life of a HIV-positive person.
Cost Effectiveness of DOTS - DOTS helps prevent multidrug resistance, which is often fatal and up to 100 times more expensive to treat. The World Bank considers DOTS one of the most cost-effective health strategies available. A six-month course of drugs for DOTS costs as low as $10 to $20 in some developing countries. DOTS is a sound economic investment for any government. For example, proper use of DOTS in Thailand could save the country $2.3 billion over twenty years.
The Success of DOTS DOTS is one of the most rapidly expanding and successful health interventions of the 1990s. During this decade, the number of countries using DOTS has dramatically increased, from 12 to nearly 100. In the last three years, one million TB patients have been treated with DOTS.
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