Press Release WHO/87 23 November 1998 ASIA IS 'EPICENTRE' OF WORLD'S TUBERCULOSIS EMERGENCY HIV, multidrug-resistant TB and financial crisis increase TB threat to the region Bangkok – Asia is the epicentre of the world's TB emergency and must become a top priority among international efforts to control the disease, according to Dr Gro Harlem Brundtland, Director-General of the World Health Organization. In a statement today (23 November) at the Global Congress on Lung Health, 29th World Conference of The International Union against Tuberculosis and Lung Disease (IUATLD), Dr Brundtland warned that unless there is concerted action in Asia, the epidemic will continue to rise, jeopardising global control efforts. "Our ability to control the spread of TB pivots on Asia – now the epicentre of the world's TB epidemic," said Dr Brundtland. "If we cannot control TB in Asia we will never stop TB globally. Factors such as HIV, multidrug-resistant TB and the financial crisis converging in this region are increasing the complexity of the epidemic, making it far more difficult to contain." Six high-burden countries which account for over 50 percent of the TB epidemic are in Asia. According to WHO estimates, 4.5 million of the eight million new cases that occur each year are in India, China, Bangladesh, Pakistan, Indonesia and the Philippines. "We are at a crossroads in TB control," said Dr Brundtland. "We can allow the global TB epidemic to become more deadly and strengthen its grip on the world. Or we can act now to reduce the suffering and deaths. We can and must strike back with the tools that we have." Dr Brundtland issued her statement at a meeting attended by 1500 delegates from around 90 countries. The Global Congress on Lung Health was organized by the Anti-Tuberculosis Association of Thailand (ATAT) in collaboration with the Ministry of Public Health and the Thoracic Society of Thailand, and sponsored by IUATLD. This is the largest meeting of lung disease experts to be held in Asia in a decade. "We cannot afford to lose the battle against this age-old killer," said Professor Don Enarson, Director of Scientific Activities of IUATLD. "We can cure TB. But we not only need political commitment at national level, but also internationally. We face a major political challenge." WHO is concerned that the problem will be compounded by three factors: multidrug resistant TB (MDR-TB), HIV and the economic crisis. Surveys in selected sites in Asia show high levels of MDR-TB that cannot be treated with the most powerful anti-TB drugs. Experts predict an increase in the number of TB cases as a result of HIV. HIV weakens immune systems, increasing TB transmission to both HIV-positive and HIV-negative people. By the end of the century, HIV will cause three quarters of a million new TB cases globally that would otherwise not have occurred. WHO is also concerned that a decline in the standard of living in the region could increase the spread of communicable diseases such as TB, and in a climate of changing health sector priorities, some disease programmes lose critical funding. The 1998 WHO report on the TB epidemic, TB: A Crossroads, released at the meeting, documents the consequences of inaction in countries that are not investing in effective TB control. One of the biggest problems is that high-burden countries are not implementing effective control. This includes failure to invest in good quality TB drugs. The report also describes the progress made by thousands of people around the world who are using the DOTS strategy to stop TB. DOTS is recommended by WHO and IUATLD as the most effective and affordable way to detect and cure infectious TB patients. The strategy not only involves direct observation of treatment. It also requires political commitment, microscopy services, reliable drug supply and monitoring of patient progress toward cure. Over one hundred countries are now using DOTS. In the last three years, one million TB patients have been treated with DOTS. In some areas where DOTS has been introduced, death rates have been reduced fivefold to less than five percent. Cure rates in half of China where DOTS is being used are 95 percent. "Three years ago, TB was made a priority here in Thailand," said Dr Songkram Supcharoen, Chairman of the Organizing Committee of the Global Congress and President of IUATLD. "In the last year, coverage increased fourfold. The government has committed to a five-year plan to ensure that every patient in Thailand has access to DOTS." Dr Brundtland invited participation in a new 'Stop TB' initiative to catalyse a global coalition of partners from all sectors of society, led by WHO, to address the problem of TB in Asia and the rest of the world, and to encourage the use of DOTS more widely. The Stop TB initiative will develop a global action plan for TB control which identifies the role of different partners. The initiative will focus on a global charter to secure commitments to improve TB control from Heads of State of endemic countries, international organizations including from the UN family, and donors. It will develop mechanisms to ensure global access to quality, fixed dose combination TB drugs. Urgent action focussed on high burden countries, the emerging MDR-TB problem and management of TB control in settings of high HIV prevalence is also planned. The initiative will support a balanced agenda for global TB research focusing on short- and long-term results. "By elevating TB control to a political level, there is so much more that we can do," said Dr Brundtland. "I urge you to take the right course, support the new initiative and join us to use DOTS more widely and stop TB." For more information, please contact Gregory Hartl, WHO, Geneva on +41 22 791 4458, Becky Owens, WHO, Geneva on +41 22 791 2630 (cellphone +41 79 217 3403/+ 41 79 213 4314), Patrick Bertrand, IUATLD, Paris on +33 1 44 32 0442 (cellphone +33 6 85424387), or Wattana Manaviboon, Ogilvy PR, Bangkok on +662 632 8300. All WHO Press Releases, Fact Sheets and Features as well as other information on this subject can be obtained on Internet on the WHO home page http://www.who.ch/