We failed on TB

[Guest guest]

Sorry for cross-postings. Bobby

News: We failed on TB

Mail and Guardian, SA. Belinda Beresford. 09 Feb 2008

The marriage between tuberculosis and HIV must be recognised and treated as a

union of social -- and not medical -- diseases if the goal of eliminating

tuberculosis in humans is to be achieved, says the head of the World Health

Organisation’s Stop TB Partnership.

Marcos Espinal was speaking at a symposium in Cape Town after visiting TB

research facilities where the South African TB Vaccine Initiative is testing, or

about to test, the six leading candidates for an effective vaccine against the

disease.

He said lack of potential profit had for decades stifled private sector research

into TB vaccines, because the disease was so heavily concentrated in developing

countries. This attitude was changing because of a growing understanding of the

risk TB poses to all countries, not just those carrying the burden of disease.

But, he said, the TB community needed to learn about social and political

mobilisation, as well as how to attract funding from Aids activists. The massive

worldwide TB epidemic was a “disgrace” particularly for a disease that, unlike

HIV, is curable if properly treated.

“We made mistakes. The international community concentrated on technical issues;

we didn’t concentrate on advocacy that needed to be in place … TB control is the

responsibility of government plus others -- the private sector, civil society

and communities,” he said.

In South Africa it is estimated that only about 58% of people treated are cured

of TB. The WHO pushes Dots -- directly observed therapy, a treatment that

includes supervision of the patient physically taking medication -- to encourage

adherence to the six- to nine-month course of antibiotics needed to cure the

disease.

Espinal said Dots varies in quality around the world: some countries achieved a

50% cure rate, while others had a rate exceeding 85%. He advised South Africa to

engage in more operational research.

The primary goal of the Stop TB Partnership is to cut the number of new TB cases

in half by 2015, and to eliminate the disease by 2050 -- to have less than one

case per million people worldwide. The strategic plan, the Global Plan to Stop

TB, was launched in 2006 and runs until 2015. Estimates are that, if the plan is

implemented, about 50-million people will be treated for TB and about 14-million

lives will be saved.

In 2006 1,6-million people are estimated to have died from the disease. The two

regions with the heaviest disease burden are South East Asia, with 34% of the

world total, and Africa with 28%. Various factors explain the geographical

variation. In Africa TB and HIV “run in parallel, they are married”, said

Espinal, with each fuelling the other.

In Asia the TB epidemic is driven to a greater extent by the demographic

explosion, while Eastern Europe has seen the spread of the drug-resistant

disease because the healthcare systems that used to hospitalise every patient

collapsed.

It is estimated that the plan will require $55-billion to be implemented, with

about $5,5-billion a year spent on diagnosis and treatment of TB.

A forthcoming UN report that analyses TB in 134 countries will show that the

number of new infections is falling fastest in those countries that score best

on the human development index, have lower child mortality and better access to

sanitation.

“TB is a disease of the poor,” said Espinal, especially in overcrowded

environments that provide a “nice recipe” for transmitting drug-resistant TB.

There are two TB drugs far along the development pipeline and Espinal hopes that

a new, truly short course of one to two months will be available by 2010. A

vaccine against the disease is pencilled in for 2015/16.

Online at:

http://www.mg.co.za/articlePage.aspx?articleid=331867 & area=/insight/insight__nat\

ional/#

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Bobby <bjohn@...>