/CORRECTED REPEAT/HEALTH: WHO Wants TB Remedy Available for All

By Marwaan Macan-Markar Reprint | | Print |

Marwaan Macan-Markar

MEXICO CITY, Feb 6 2001 (IPS) - The World Health Organisation (WHO) is determined to ensure that an available remedy for tuberculosis (TB) is easily accessible for all who need it.

And in an effort to raise the profile of that objective, the Geneva-based health body has called on governments worldwide to back the theme to mark World TB Day, which falls on Mar. 24. That theme is ‘DOTS – TB cure for all’.

“We have heard ministers agree that no one should be denied access to DOTS. This means that DOTS should be available to all who need it, wherever they live, whether they are young or old, man or woman, homeless or housed, jailed or free,” says Dr. Gro Harlem Brundtland, director-general of the WHO, in a statement issued in preparation for World TB Day.

According to this United Nations health agency, political leaders have “no excuse for inaction” in the face of an available, cost-effective cure for TB, an infectious disease that kills close to two million people annually.

Furthermore, it points to countries like China, Bangladesh, Vietnam and Peru where the TB epidemic has been successfully controlled through DOTS, which stands for Directly Observed Treatment Short-course.

Under DOTS, health workers and public health systems are called upon to play a significant role in achieving a cure, rather than the onus being completely borne by the patients.

For health workers, that means having to conduct diagnosis through “sputum smear microscopy”, and once a TB patient has been identified, ensuring an adequate drug supply, and thereafter providing “standardised short-course chemotherapy by directly-observed treatment”.

Furthermore, health workers are expected to follow the WHO- recommended system for recording and reporting treatment outcomes for all cases.

The WHO has a lot of faith in DOTS, justifiably so, figures show. Cure rates of up to 95 percent have been recorded in some countries across the developing world where the programme has been effectively implemented.

Take Peru for example. That South American nation has reduced the number of TB infections over the last 10 years. “New research shows that the decline in the incidence of TB in Peru almost doubled between 1991 and 1999 through the implementation of DOTS preventing at least 70,000 cases and deaths,” states ‘Health, a Key to Prosperity: Success Stories in the Developing World’, a report released in December, 2000.

Peru is one of only a handful of countries to have achieved the WHO targets for TB control of 70 percent case detection rates and 85 percent cure rates, adds this report, which was jointly produced by six UN agencies and the World Bank.

China also ranks high in this regard. “In half of China, cure rates among new cases are 96 percent.”

According to WHO, more countries need to ensure equitable access to TB services for anyone who is suffering from this disease, which is “growing and becoming more dangerous”.

Currently, this disease, which spreads through the air like the common cold, infects close to 3 million people annually in South and East Asia, while the annual infection rate in sub-Saharan Africa is over 1.5 million cases and in Eastern Europe the annual infection rates are over 250,000 cases.

According to WHO estimates, however, if TB control measures are not further strengthened, close to 1 billion people will be newly infected with this disease by 2020, and of that number 200 million will get sick and 35 million will die.

In addition, what worries the WHO is the manner in which the human immunodeficiency virus (HIV) has contributed to the spread of TB. “HIV and TB form a lethal combination, each speeding the other’s progress,” it notes.

That means, a person who is HIV-positive and infected with TB is “many times more likely to become sick with TB than someone infected with TB who is HIV-negative.” This has resulted in TB being identified as a leading cause of death among people who are HIV-positive.

In Africa, for instance, HIV has become “the single most important factor determining the increased incidence of TB in the last 10 years”, reveals the WHO.

Furthermore, another factor has also given public health experts a reason to worry the emergence of strains of TB resistant to all major anti- TB drugs.

According to the WHO, multidrug-resistant TB (MDR-TB) has begun to spread “at alarming rates in some countries, especially in the former Soviet Union, and threatens global TB control efforts”.

What is more, the WHO admits that drug-resistant TB is difficult to treat because the new drugs used are “generally more expensive, more toxic, often difficult to obtain, and less effective than the drugs commonly used to treat ordinary forms of TB”.

Governments need to take the emergence of MDR-TB seriously, says Dr. Jose Ramon Cruz, consultant for the TB control programme at the Pan American Health Organisation (PAHO). “They need to prevent its spread by implementing the DOTS strategy with the required resources.”

If not, he admits, the gains in TB control can be lost, resulting in the disease evolving into a bigger epidemic.

The WHO echoes a similar concern, too. If DOTS is not used more widely, it says, TB cases and deaths will continue and the global epidemic “will remain uncontrolled and harder to manage MDR-TB will be created”.