By Gustavo Capdevila
GENEVA, Mar 24 2004 (IPS)

World Tuberculosis Day found the scientific community divided on the status of this disease: the optimism of the World Health Organisation contrasts with the gloomy forecasts of Doctors Without Borders (Médecins Sans Frontières, MSF).

Meanwhile, every year nearly nine million people are infected with TB, and the disease kills around two million more.

In its global TB control report, released this week, WHO says there has been progress in the number of patients diagnosed and treated through DOTS (Directly Observed Treatment, Short-Course), a strategy launched a decade ago.

But the non-governmental MSF says, "We are losing the battle against tuberculosis because we rely on archaic diagnostic tests and drugs."

In order to provide adequate TB treatment would require a reliable diagnostic test, "but we don’t have one," says Rowan Gillies, president of MSF International, participating in the main activities of World TB Day that took place in New Delhi on Wednesday..

The independent Paris-based group, which demands greater investment in TB research and development of medicines, noted that the HIV/AIDS epidemic has magnified the tuberculosis problem.

The WHO experts who presented the annual report in Geneva acknowledged some of MSF’s observations.

Research is under way for new medications and diagnostic methods that are intended to improve control of the infection, said epidemiologist Catherine Watt, of the WHO’s tuberculosis division.

Brian Williams, also of the same WHO department, stressed that the main problem is that the shortest treatment for the disease is a six-month programme. It is very difficult to convince people to take a medication for such a long period, he said.

Olivier Brouant, head of the MSF tuberculosis mission in Mumbai, India, said that the best TB drugs were developed during 1940 to 1960. "We can’t be satisfied with the TB treatment we and our colleagues in national TB programmes have at our disposal today.."

According to MSF, pharmaceutical companies are conducting research and development related to TB, but have generally cut their investments in investigation of antibacterial treatments.

The drug industry "cannot be relied on to bring a new TB drug to a market that mainly consists of people with very little purchasing power," adds the organisation.

The WHO report identifies 22 countries considered "high burden" in terms of TB infection rates: India, China, Indonesia, Nigeria, Bangladesh, Pakistan, Ethiopia, Philippines, South Africa, Democratic Republic of the Congo, Russia, Kenya, Vietnam, Tanzania, Brazil, Uganda, Zimbabwe, Mozambique, Thailand, Afghanistan, Cambodia and Burma.

The number of reported infections grew much more quickly in African countries where there is a high prevalence of HIV (the precursor to AIDS), said Williams.

The same phenomenon occurs in Eastern Europe, particularly in the countries that were part of the former Soviet Union.

The United Nations health agency underscored the rapid expansion of the DOTS method. Some three million people receive DOTS today – an increase of more than a million in the past two years.

The DOTS expansion is one of the major public health successes of the past decade, and has saved thousands of lives, said WHO director-general Lee Jong-wook.

This method combines five elements: government commitment, detection of the virus, a standardised treatment of six to eight months, adequate and ongoing distribution of medicines, and effective patient follow-up.

The WHO’s goal for 2005 is to detect 70 percent of all TB cases and to cure 85 percent of those.

WHO figures indicate that as of 2002, the detection rate was 37 percent of the estimated incidence of the disease.

The agency has calculated that in order to meet its objectives for detection and treatment in the high burden countries, except Russia, it will need to spend 950 million dollars in 2004.

The budget for 2005 would be 1.1 billion dollars. In 2002, expenditures were 540 million, and in 2003, 850 million dollars.

Russia presented a budget for 400 million dollars for this year, but has not yet obtained even half that sum, says the report.

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