Trade, foreign policy, diplomacy and health

3. Tuberculosis control

Jim Yong Kim, Aaron Shakow, Arachu Castro, Chris Vande, Paul Farmer

Producing TB control: The 'global plan'

  • Prior to 1990 an integrated global approach to TB control did not exist
  • 1991 WHO established Global TB Program
  • 1998 WHO established Stop TB Global Partnership
  • 2002 WHO published Global Plan to Stop TB
  • Global plan will cost US$ 9.1 billion: half from poor countries, rest from external funding, such as developed countries, World Bank and charitable foundations.

Prior to 1990 an integrated global approach to TB control did not exist, the WHO had only one employee devoted solely to the control of TB, and TB was a low priority in global health funding. In 1991 the WHO established the Global TB Program, and in 1998 the Stop TB Global Partnership, and the publication of the Global Plan to Stop TB in June 2002. The Global Plan includes an analysis of the current state of TB control in the world, a budget that estimates the total cost of a comprehensive global TB control program, and detailed action plans for each of the six working groups that make up the Stop TB Partnership (DOTS Expansion Working Group, TB-HIV Working Group, Working Group on DOTS-Plus for MDR-TB, and working groups on R&D for new drugs, new diagnostics and new vaccines).

The cost of these activities over the next five years is calculated at US$ 9.1 billion, with half coming from poor countries in which TB is endemic. Approximately U.S.$ 700 million per year is the amount that will be needed from external funding sources to reach the targets set out in the plan. Prospects for expanded funding for TB control have improved dramatically. The US expanded donations for TB control to $85 million for 2001, bilateral aid from other countries (especially United Kingdom, Canada, Netherlands and Finland) also expanded, the World Bank may turn loans for TB control into grants for the poorest countries, foundations such as Gates Foundation, Open Society Institute and Rockefeller Foundation have made serious commitments to funding TB control efforts, and most importantly the Global Fund to Fight AIDS, TB and Malaria was formed in 2001.