|Press Release WHO/16
23 March 1999
1999 World TB Day: WHO TB Report shows global response to epidemic inadequate
WHO Director-General calls for political commitment to Stop TB. "We must act now or multi-drug resistant TB will thrive," warns Dr Gro Harlem Brundtland
Washington DC: Multi-drug resistant tuberculosis is on the rise and there are 8 million new cases of TB every year. TB remains the single biggest killer of young women and kills as many women as all combined causes of maternal mortality. Still, only 16% of the world's infectious TB sufferers receive the TB treatment recommended by the World Health Organization (WHO).
"We are at a crossroads in the global tuberculosis epidemic," says Dr Gro Harlem Brundtland, Director-General of WHO. "We have a choice to act now and control tuberculosis, or we can continue business as usual and let strains of multi-drug resistant TB thrive. We have a cure, we need to mobilize the world to use it."
Dramatic successes in many countries with the WHO recommended TB Treatment, DOTS (Direct Observation Treatment, Short-course), show that the spread of TB and the emergence of multi-drug resistance can be stopped, according to the 1999 WHO Global Tuberculosis Report released today. But, due to an inadequate global response to the epidemic, "hot zones" of multi-drug resistance are emerging, particularly in Eastern Europe.
To meet the challenge, WHO has launched the Stop TB Initiative in partnership with the World Bank, the Centers for Disease Control and Prevention (CDC), and a growing coalition of non-governmental organizations working to stop TB*. The Initiative is working to accelerate TB control by expanding the global coalition of partners beyond the health sector; place TB higher on international political and health agendas; and significantly increase investment in TB control.
While the number of patients receiving DOTS has been increasing at a rate between 10% and 20% each year for the last four years meaning an additional 100,000 infectious patients treated each year -- an additional 250,000 patients per year need to be reached and treated to achieve the global goal by the year 2005, according to the 1999 Report.
In 1993, global goals of detecting 70% of all infectious TB cases and treating 85% of those cases with the WHO recommended treatment were set for the year 2000, but the response has not been aggressive enough to meet the 2000 targets. WHO is now urging a concerted effort to tackle TB by 2005.
The WHO-recommended treatment strategy DOTS combines five elements: political commitment, case detection through sputum smear microscopy, directly observed short-course treatment, regular drug supplies and monitoring systems. Once infectious cases have been detected using microscopy services, health and community workers and trained volunteers observe and record patients swallowing the correct dosage of anti-TB medicines, and document that the patient has been cured.
Asia and Eastern Europe, in particular, need an aggressive response to halt the further spread of TB and the emergence of drug-resistant TB. According to the 1999 WHO Global TB Report, the greatest number of cases without access to good treatment is in Asia, especially Bangladesh, India, Indonesia, Pakistan and the Philippines. "DOTS can serve as a catalyst to strengthen health services in these regions, as well as increasing attention to the health of the poor," says Richard Skolnik of the World Bank.
In Russia, high rates of treatment failure, due to an inadequate TB programme, have set the stage for high levels of multi-drug resistance. Studies are already revealing dramatic rates of multi-drug resistant TB in Russia, especially in prisons, and in other Republics of the former USSR.
In Africa, where one third of TB patients are infected with HIV, cure rates are also reported to be low. HIV/AIDS presents a significant challenge to African countries aiming to meet the 85% TB cure rate target.
China, on the other hand, has built an effective TB control programme covering half the country in the last six years, and cure rates among those reached are over 95%. By 1997, areas of China which had adopted DOTS in 1991 were preventing over three-quarters of TB deaths. However, half of the country still does not have access to DOTS. The challenge now is to sustain the DOTS programme already initiated, while making DOTS available to the whole country.
India, Indonesia and the Philippines, three of the highest TB-burden countries, have demonstrated that they can achieve high rates of treatment success, but need better progress in expanding DOTS coverage. Without accelerated expansion of DOTS, they, too, risk an unchecked spread of multi-drug resistant TB.
"Worldwide, few health initiatives have expanded as quickly as the DOTS strategy which focuses on detecting and curing new infectious TB cases in order to reduce transmission," according to Dr Nils Daulaire, President of the Washington DC-based Global Health Council. "The expansion, though, has not been rapid enough to effectively stop the spread of tuberculosis."
"The 1999 Report demonstrates successes in curing TB on all continents. But we need to do much more," urges Dr Arata Kochi, Director of Communicable Disease Prevention and Control at WHO. "We are at the same stage that child immunization was in the early 1980stechnical solution in hand and critical mass of people already trained, but coverage remained low at 20%.
"With political commitment and broad social support, immunization coverage rose from 20% to 80% between 1984 and 1990. We must make the same effort to mobilize broad support and accelerate access to DOTS. We must act now to halt the further emergence of multi-drug resistant strains of TB. Poorly managed TB control programmes are causing drug-resistant strains which could render TB incurable."
"We need an expanded partnership and political commitment to reach the most vulnerable populations," is the message from Dr Brundtland. "We have an opportunity now to Stop TB and win the race against drug resistance. But, the longer we take, the more difficult and expensive the task becomes as strains of TB resistant to anti-TB drugs emerge."
World TB Day (24 March) commemorates the day in 1882 when Dr Robert Koch announced his discovery of the TB bacillus.
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