In Africa only 60% of the estimated TB cases have been diagnosed. All the other infections are hidden by poverty—and so the disease continues to spread. Credit: Jeffrey Moyo/IPS.

By Morounfolu Olugbosi
JOHANNESBURG, Nov 8 2022 (IPS)

The news in many parts of the world is that tuberculosis (TB) is reclaiming the title of the world’s most deadly infection, even as the COVID-19 pandemic continues to kill an estimated 1,450 people daily around the world. But this is not news to African countries, which are home to one third of the people globally who die from TB, even though they have less than one fifth of the world’s population.

And on our continent, the real burden might be worse: only 60% of the estimated cases have been diagnosed. All the other infections are hidden by poverty—and so the disease continues to spread.

Consider Zanyiwe’s story, who is recovering from TB a fifth time. Her son-in-law died from the disease, and her 18-month old granddaughter has it currently. TB has hammered her family and her community in Cape Town, South Africa—but this story could be set in Nigeria, Kenya, or just about anywhere, as TB has never been contained in Africa.

Four years ago, there was hope that TB might be receiving the attention it deserves. The United Nations held a High-Level Meeting with heads of state in September 2018 where more than half of the world’s nations convened to rally support to tackle TB. Many pledges were made; fulfillment of these pledges got off to a slow start and then the COVID-19 pandemic derailed things completely.

The first commitment was to find and treat 40 million people with TB between 2018 and 2022, including 3.5 million children and 1.5 million people with drug-resistant TB. We’re 19% behind that overall goal, but 32% behind with children and 46% behind with drug-resistant TB. We now have new and shorter treatment regimens for TB and drug-resistant TB; using these new technologies could make next year, when another UN high level meeting on TB will convene, a different story.

The second commitment was to provide preventive treatment for 30 million people at risk for TB infections. We’re 48% behind here; while we already exceeded the sub-target of reaching 6 million people with HIV with preventive treatment, from 2018-2021 we’ve only provided preventive treatment to 2.2 million household contacts of people with TB, 11.5% of the goal. Once again, we now have new, more effective and shorter preventive regimens to deploy—but we need the outreach capacity and willingness of countries to get the treatment into the hands of the people who need it.

The third and fourth commitments are about funding. Leaders pledged to spend a total of US$13 billion annually on prevention, diagnosis and treatment by 2022; in 2021 only 42% of that yearly goal was spent. For TB research, US$2 billion annually was pledged by 2022 but in 2021 research spending reached less than half that amount (46%). Rolling out the new treatments and developing even better ones will require a stronger embrace of these commitments; the status quo simply will not get us there.

While we have yet to finish 2022, it is obvious that we will not meet these goals. With that being said, there have been signs of progress worth drawing attention to.

First, Gabon, Kenya, Liberia, Namibia, Republic of Congo, Sierra Leone, and Uganda all made progress in finding more cases of TB last year. And Central African Republic, Democratic Republic of Congo, Mozambique, Nigeria, Tanzania, and Zambia have all made progress throughout the pandemic—showing the political will needed to keep their people healthier. Overall, Africa found 4% more TB in 2021 than in 2020. It’s a start—and we can do better.

New TB medicines are being supported by the World Health Organization (WHO). Six-month therapy for drug-resistant TB has been approved in more than 20 countries, including the Democratic Republic of Congo, Mozambique, South Africa, and Zimbabwe. And Ethiopia, Ghana, Kenya, Malawi, Mozambique, South Africa, Tanzania, and Zimbabwe are working to roll out a new TB prevention treatment.

In Africa, we will not mistake these initial signs of progress for anything more significant. Yet, at the same time, it is still progress to be respected and built upon. Next year, the world will consider their long-ignored pledges. We need to show the world that it is time to move forward; all that’s been missing is the same thing that’s been missing for far too many years: political will.

Morounfolu (Folu) Olugbosi, M.D. is the Senior Director, Clinical Development, TB Alliance. He works with the clinical development of products in the TB Alliance portfolio and helps to oversee clinical trials in TB endemic countries and heads the South Africa office.

Tuberculosis has killed 1,5 million people in 2020 - mostly in African and Asian countries - while two million people died of COVID-19 worldwide during the same period. Credit: Athar Parvaiz/IPS

By Angelique Luabeya Kany Kany
CAPE TOWN, South Africa, May 19 2022 (IPS)

It is time to treat the scourge of Tuberculosis scourge with the same urgency as we did the COVID-19 pandemic.

As we emerge from the devastating toll of the pandemic on people’s lives and on global economies, we must wake up to face the staggering toll of 1.5 million Tuberculosis deaths and 10 million new infections recorded in 2020. And these deaths were mostly in African and Asian countries.

These deaths were largely invisible as we fought COVID-19. Even as countries lift COVID-19 restrictions due to declining numbers, we know that Tuberculosis continues to spread.

Access to Tuberculosis care was also hampered by the pandemic restrictions and COVID-19 prioritization on diagnostic and care at healthcare facilities. The World Health Organization (WHO) goal is to reduce new TB cases by 90% and TB deaths by 95% by 2035. We have 13 years left to reach that milestone.

Unfortunately, most people at risk of Tuberculosis are from low- and middle-income countries who will not afford costly vaccines or drugs. The incentive for these big pharma companies to invest in Tuberculosis vaccine development is low.

The harsh reality is that we still don’t have a protective vaccine, and drug resistant TB cases are rising. While research is ongoing, a critical factor hampering progress is the lack of funding. The only TB vaccine available, Bacille Calmette-Guérin (BCG) developed 1920, has limited efficacy.

The relatively quick availability of several vaccines, treatment, and diagnosis for COVID-19 illustrates how billions of dollars in funding can speed up vaccine development against a new deadly disease. For example, the funding available for COVID-19 vaccine development is estimated at 107 billions of dollars while only 0.117 billions available for Tuberculosis.

Yet Tuberculosis has killed 1,5 million people in 2020 – mostly in African and Asian countries – while two million people died of COVID-19 worldwide during the same period. To date, there are 109 vaccine candidates for COVID-19 and only 14 for TB. As noted, we only have one Tuberculosis vaccine while there are 18 vaccines available for COVID 19 .

Tuberculosis research needs at least US$15-billion to have a chance to reach the 2035 target. At the moment, researchers have access to only half of this amount.

Why is funding for a deadly and centuries old disease lacking?

One can argue that Tuberculosis research is too expensive. We have several phases for testing any new drugs or vaccines in clinical trials. Before testing in humans, new drugs and vaccines are tested in animals for adequate safety and immune response. Then there are at least four phases of testing in clinical trials. The next cost implication is that there are several strains of the Tuberculosis bacteria which increases testing costs.

Tuberculosis is a chronic disease with slow progression from infection to disease. Measuring vaccine efficacy requires resources, time and a large sample size of people participating in these studies. These steps increase complexity and cost for Tuberculosis vaccine development. But these costs are small compared to what we spend on COVID-19 research.

Could the reluctance in funding stem from the fact that the Tuberculosis burden falls largely on poor countries in the global South? Tuberculosis is not a pandemic, so the global urge to find a vaccine or drugs is different.

Pharmaceutical companies usually invest in drugs and vaccines from which they can earn profits. Rich countries therefore have other health priorities. Whereas rich countries were impacted by COVID-19, Tuberculosis is largely managed there.

Unfortunately, most people at risk of Tuberculosis are from low- and middle-income countries who will not afford costly vaccines or drugs. The incentive for these big pharma companies to invest in Tuberculosis vaccine development is low.

In the 2016 report of “The catalytic framework to end AIDS, TB and eliminate Malaria in Africa by 2030”, the African union (AU) itself noted that “funding for research and innovation is not prioritized in AU members, intra Africa cooperation lags behind and partnerships are still largely drawn outside Africa”. While external funding is critical, African countries should reinforce and rethink strategies to accelerate Tuberculosis vaccine and drugs development.

As we roll out COVID-19 vaccines and ARVs are made available to HIV patients, we must renew our efforts to do the same with Tuberculosis. Tuberculosis carries a high cost of infection, treatment and death. It is the biggest killer for HIV patients.

African and Asian countries should invest in seeking a vaccine and drug development because they have the heaviest burden. In addition, they must strengthen weak health systems and bolster efforts to identify and adequately treat Tuberculosis cases to stop transmissions.

HIV and COVID-19 pandemics have shown that money can be released when human kind is threatened. The rapid spread of SARS-CoV2 illustrates the fact that the modern world is a global village.

The world should wake up to the rise of microbial resistance that includes Tuberculosis Drug resistant Tuberculosis is a real threat to humanity.

We should not wait for a COVID-like crisis to act. We need to harness the partnerships from this pandemic to prevent another. A world without Tuberculosis feels like a dream. An efficient vaccine can make it come true.

Dr Angelique Luabeya Kany Kany is the Chief research officer at the South African Tuberculosis Vaccine Initiative, University of Cape Town. Dr Luabeya is the Principal investigator of several novel TB vaccines clinical trials, two COVID 19 vaccine trials and diagnostics studies. She is a WHO-TDR Clinical research and development fellow.

There is no shortage of pandemics that continue to plague humanity. TB was responsible for the deaths of more than 1.5 million people in 2020, and more than a third of these deaths took place in Sub-Saharan Africa. Credit: Athar Parvaiz/IPS

By Morounfolu Olugbosi
JOHANNESBURG, Mar 29 2022 (IPS)

As countries around the world—from Kenya to Canada, South Africa to Sweden—relish the prospect of an unofficial transition of COVID-19 from pandemic to endemic and start to ease pandemic-related restrictions, many of us in the tuberculosis (TB) community find it hard to relate. In TB, we know what can happen when a pandemic becomes an accepted fact.

Understandably, people everywhere are eager to return to normal. COVID-19, the thinking goes, has evolved to be milder, so it’s time to stop worrying and get on with our lives. Although the virus is still present, many think it has reached endemic levels and so restrictions are being lifted worldwide, despite warnings from more than a few epidemiologists.

There is no shortage of pandemics that continue to plague humanity. Malaria killed more than 620,000 people in 2020. TB was responsible for the deaths of more than 1.5 million people in 2020, and more than a third of these deaths took place in Sub-Saharan Africa.

Prior to COVID-19, hope was on the horizon that the TB pandemic was beginning to ebb. Over the past decade, case rates and fatalities had been slowly declining while research and development efforts had yielded breakthroughs.

After four decades without new medicines approved to treat TB, three have been approved in the past ten years. New technology can not only diagnose TB more easily and quickly than before, but also determine if the infection has any drug resistance. That counts as progress in the TB world—but there’s always the challenge of getting the technologies to the people who need it. And that’s where the COVID-19 pandemic really hit hard.

Dr.Morounfolu (Folu) Olugbosi

In 2020, the most recent statistics that we have for TB, the number of deaths equals that of 2017, with five years of progress eliminated. An estimated 9.9 million people had TB infections, but only 5.8 million were diagnosed. We lost ten years of progress in this benchmark. And only about one third of the estimated 450,000 people with multi-drug resistant TB or Rifampin-resistant TB started treatment in 2020, a 15% decrease from the previous year.

In Africa, countries like Nigeria, South Africa and Uganda had been making progress against TB, with deaths from the disease steadily declining, but these declines ended—all because of the COVID-19 pandemic and related control measures.

In 2015, the world pledged to reduce deaths from TB by 90% by the year 2030, and we are nowhere close to achieving this goal. Epidemiologists evaluating the impact of this failure found that, before the COVID-19 pandemic began, sub-Saharan Africa had been hit hard by TB, with a heavy economic impact and significant loss of life from failing to meet this ambitious benchmark.

And yet, the World Health Organization (WHO) reports that, in sub-Saharan Africa, domestic spending on TB prevention, diagnostic and treatment services has declined over the past 10 years. It is no wonder the pressures of COVID-19 tore apart the TB safety net. We too, in Africa, had decided it was ok to live with a lethal disease.

Yes, overall global spending on the disease is less than half of what it needs to be but for us in Africa, TB is not a disease of somewhere else. It is here and we need to roll up our sleeves and fight back or will never stop plaguing us.

No disease should be tolerated, especially deadly infections like TB and COVID-19. All diseases need to be tackled with new technologies and the outreach needed to make sure they are used appropriately. Endemic is never good enough.

Dr. Morounfolu (Folu) Olugbosi, M.D. is the Senior Director, Clinical Development, TB Alliance. He works with the clinical development of products in the TB Alliance portfolio and helps to oversee clinical trials in TB endemic countries and heads the South Africa office.

Community support workers are key in raising awareness about TB and promoting diagnosis and treatment. Credit, Busani Bafana/IPS

By Busani Bafana
BULAWAYO, Zimbabwe, Jan 7 2022 (IPS)

Global efforts to end tuberculosis (TB) are futile without dedicated investment in research into the debilitating disease that is killing 4000 people a day, Stop TB Partnership warns.

“TB is a disease that is not a darling of donors and investors,” Lucica Ditiu, the Executive Director of the Stop TB Partnership, told IPS in an interview from Geneva.

“We do not have a Bill Gates that can support TB research, yet TB remains a disease of concern with deaths increasing for the first time in over a decade,” she added.

TB, a bacterial disease mainly affecting the lungs, has been around for over millennia and remains one of the top killer diseases globally. But it is preventable and curable with the right investment in diagnosis and treatment.

Ditiu attributed the rise in TB incidents to several factors; many people diagnosed and on treatment for TB have defaulted owing to the disruption of health services in the wake of the COVID-19 pandemic and global lockdown. Furthermore, many people remain undiagnosed because they have not been reached.

Dr Lucica Ditiu, Executive Director of the Stop TB Partnership. Credit: Stop TB Partnership

“Southern Africa has done a good job in respect of Zambia, Zimbabwe and South Africa as well as Rwanda in trying to disrupt as little as possible the treatment and diagnosis of people with TB,” Ditiu said. She commended awareness programmes in the media and community door-to-door campaigns to promote diagnosis and treatment.

Countries need to invest more in finding people with TB and putting them on treatment. Until you find people, you cannot put them on treatment, and this is where we are very much lagging, she said.

Ditiu fears the worst should the world fail to change the current TB transmission trend. An estimated 5.8 million people received treatment for TB in 2020; a drop of 21 percent from 2019, and more than 4 million people worldwide remain untreated. According to Stop TB Partnership, half of those untreated are likely to die from the disease.

Admitting that funding for TB has always been insufficient, Ditiu said TB was the poor cousin compared to the deep pockets for HIV and AIDS.

“In general, we have available only 30 percent of the funding needed globally. We have places that have done well in preventing TB in people living with HIV. Prevention of TB in people living with HIV is going well, especially in African countries because HIV has resources.”

According to the Stop TB Partnership, a network of international organisations established in 1998 to help end TB as a public health problem, funding for TB research and development (R&D) has remained flat since 2018.

Global funding for tuberculosis (TB) research totalled 915 million US dollars in 2020 – less than half the goal of 2 billion US dollars set forth by participating country governments at the 2018 United Nations High-Level Meeting on TB.

In 2021, TB had a funding gap of 13 billion US dollars globally, with only 5,3 billion US dollars available for its programmes. It experienced a drop in funding amounting to 500 000 US dollars in 2020 as many countries took money away from TB to respond to COVID-19.

A new report, Tuberculosis Research Funding Trends, 2005–2020 by Treatment Action Group (TAG) and the Stop TB Partnership, found that TB received less than 1 percent of the amount invested in COVID-19 Research and Development over the first 11 months of the pandemic.

“The mobilisation of over 100 billion US dollars for COVID-19 research and development in the first 11 months of the pandemic shows us just how powerful a coordinated effort against a disease can be,” noted Ditiu.

While the pandemic has shown that effective vaccines can save lives, the world is still banking on a 100-year-old vaccine, Bacillus Calmette-Guérin or BCG. However, a more effective vaccine could have higher efficacy rates, especially for adults. Why has it taken so long to develop a new, more effective TB vaccine when the health burden of TB is increasing?

“This is the drama,” Ditiu commented. “We have a vaccine for a hundred years that we know for the last 40 years does not work (effectively) except for newly-born babies, and yet we have not done much about it.”

While ongoing research on new vaccines had been slow because of poor funding, Ditiu said several potential vaccines were in the pipeline, and a vaccine could be expected by 2027.

“It takes a long time to get a vaccine. But because of COVID (we realised), it is possible to have a vaccine much quicker, and we hope to use the learnings from COVID-19 to get a TB vaccine,” Ditiu told IPS.

Tuberculosis vaccine research has been slowed by chronic underfunding with only one moderately effective century-old TB vaccine, compared to over 20 COVID-19 vaccines.

“What’s enabled the development of dozens of COVID-19 vaccines in less than a year has essentially been money,” noted Austin Aurinze Obiefuna, Executive Director of the Afro Global Health Alliance and incoming Vice-Chair of the Stop TB Partnership Board.

“I think that the same enormous amount of funding should be applied with equal vigour to the development of TB vaccines. But that simply doesn’t seem to be happening.”

According to the Stop TB Partnership, making much-needed progress against TB demands investment that matches the threat of the disease around the world. This includes a commitment to rectify the inadequate funding of the past. Over the next two years, 10 billion US dollars are needed to close the tuberculosis R&D funding gap.

“Wealthy countries need to step up and put more money into correcting global health inequalities, which COVID-19 vaccine allocation inequities laid bare,” urged Mark Harrington, Executive Director of TAG, an independent activist, and community-based research and policy think tank.

“COVID-19 made more people around the world aware of the importance of R&D spending than ever before. Now is the time to finally start making investments ambitious enough to end TB for good.”

Follow @IPSNewsUNBureau
  

A TB patient at the Srinagar-based Chest Diseases Hospital in the Indian state of Kashmir. Credit: Athar Parvaiz/IPS

By External Source
Jan 15 2021 (IPS)

In July 1921, a French infant became the first person to receive an experimental vaccine against tuberculosis (TB), after the mother had died from the disease. The vaccine, known as Bacille Calmette-Guérin (BCG), is the same one still used today.

This first dose of BCG was the culmination of 13 years of research and development.

BCG remains the only licensed vaccine against TB and 2021 marks its 100th anniversary.

Today, all eyes are on the rollout of the COVID-19 vaccine. But while the number of people who died from COVID-19 in the last year is shocking, TB kills about the same number of people — about 1.5-2 million — each year, and has done so for many decades.

In fact, it’s estimated that over the last 200 years, more than 1 billion people have died from TB, far more than from any other infectious disease.

If we have a vaccine, why do so many people still die from TB?

Tuberculosis is caused by the bacterium Mycobacterium tuberculosis. It’s transmitted when a person with active TB coughs up aerosol droplets, which are then inhaled by someone else.

There are about 10 million cases of active TB annually, and it’s estimated up to 2 billion people are what’s known as “latently infected”. That means they are not sick and do not transmit the disease, but in about 10% of these people the disease reactivates.

In most TB endemic regions of the world, BCG is given to infants shortly after birth. The vaccination prevents childhood versions of TB and saves thousands of children’s lives annually.

However, the efficacy of BCG wanes over time. In other words, it stops working. Protection against TB is often lost by adolescence or early adulthood.

Importantly, BCG doesn’t prevent active lung TB in adults, the most important driver of ongoing transmission and cause of death.

The World Health Organization has a goal of TB elimination. To do that, we need to find a TB vaccine that also works in adults.

Why hasn’t BCG been replaced with a more effective TB vaccine?

Over the last decades only about 15 new TB vaccine candidates have entered clinical trials (versus 63 for COVID-19 in one year).

Worryingly, many of the most advanced TB vaccine candidates work no better than BCG.

Because the current TB vaccine candidate pipeline is relatively small, these setbacks and trial “failures” mean BCG may remain the gold standard for many years to come.

Despite being 100 years old, exactly how BCG vaccine works is largely unknown. It’s unclear why BCG usually only confers protection against childhood versions of TB or why protection wanes in adolescence.

Given those uncertainties, we can count ourselves lucky the bureaucratic hurdles for vaccine development were significantly lower in the 1920s.

If BCG were developed today, it would probably never be used; the current complex regulatory framework for vaccine development and licensing would likely not allow the use of a vaccine for which nothing or little is known about how it works.

The reasons BCG hasn’t been replaced with a more effective TB vaccine include:

• the decline of TB in many Western countries in the 20th century
• limited interest from pharmaceutical companies to invest in TB vaccine development
• the fact TB research and pre-clinical vaccine development is logistically challenging and requires special biological containment facilities
• the short-term and fiercely competitive environment for government and philanthropic research funding makes it difficult for academics to commit to TB vaccine research as a career path.

Where there’s a will, there’s a way

The pace of COVID-19 vaccine development shows what’s possible when the political will, pharmaceutical interest and funding is there.

While TB is no longer widespread in Australia, it is an issue in remote Indigenous communities.

Papua New Guinea, Australia’s closest neighbour, has high rates of multi-drug resistant TB and low BCG coverage rates. TB has been introduced into Australia via the Torres Strait, with a high proportion of cross-border diagnoses in North Queensland and over-representation of Indigenous children.

Resistance to current TB treatments increases steadily. Treatment of multi drug-resistant TB is hugely expensive and can take up to two years, requiring multiple antibiotics and close monitoring.

Now is the time to put financial and political will into finding a more effective TB vaccine.

2020 taught us pathogens can cause enormous harm to societies and economies. Investment into infectious disease research and vaccine development represents a fraction of the economic cost of a pandemic.

Tuberculosis is a global threat and a public health concern on a scale similar to COVID-19. The development of a new and effective TB vaccine is crucial if TB is to be significantly reduced, let alone eradicated.

Although the anniversary of BCG is cause for celebration, it should also serve as a reminder more needs to be done to combat this deadly disease.

Andreas Kupz, Senior Research Fellow, James Cook University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

A doctor examines the x-ray of a TB patient in New Delhi. Credit: Bijoyeta Das/IPS.

By Lyndal Rowlands
UNITED NATIONS, Mar 24 2017 (IPS)

New antibiotics that could treat tuberculosis may rapidly become ineffective, according to new research published by the Lancet ahead of World Tuberculosis Day.

The rise in multi-drug resistant tuberculosis, which affected 480,000 people in 2015, could mean that even newly discovered drugs will soon be useless, the study found.

In total both drug resistant and non-drug resistant Tuberculosis (TB) killed an estimated 1.8 million people in 2015, making it the world’s deadliest infectious disease. The five countries where TB is most predominant are India, Indonesia, China, Nigeria, Pakistan and South Africa.

Multi-drug resistant tuberculosis reflects the meeting of an ancient and under-addressed disease – tuberculosis – with an emerging modern threat – antimicrobial resistance. The inappropriate use of antibiotics, including taking them without prescription or not following doctor’s orders closely is slowly rendering many antibiotics useless.

“Resistance to anti-tuberculosis drugs is a global problem that threatens to derail efforts to eradicate the disease,” said lead author of the Lancet report Professor Keertan Dheda from the University of Cape Town, South Africa.

“Even when the drugs work, TB is difficult to cure and requires months of treatment with a cocktail of drugs. When resistance occurs the treatment can take years and the drugs used have unpleasant and sometimes serious side effects,” said Dheda.

Dheda added that it is important for improved diagnostic tests, which are currently being developed, to be made available in low-income countries “so as to inform treatment decisions and preserve the efficacy of any new antibiotic drugs for TB.”

The report was published in the Lancet Respiratory Medicine on World TB Day – 24 March.

Meanwhile, according to Medecins Sans Frontieres (MSF) Access Campaign fewer than five percent of people with multi-drug resistant Tuberculosis have access to new medicines, four years after these medications were released.

“It’s downright disheartening that, with hundreds of thousands of people living with deadly drug-resistant tuberculosis, only 4,800 people last year received the two new drugs that could dramatically increase the number of lives saved,” said Dr. Isaac Chikwanha, TB advisor for MSF’s Access Campaign.

“Our first major problem is that pharmaceutical corporations are not even registering important new drugs in some of the countries hardest hit by TB; The next major problem is their high price,” said Dr. Chikwanha.

“People with drug resistant TB who don’t have access to the two new drugs continue to be treated with older, more toxic regimens that cure only 50 percent of people treated and cause severe side effects ranging from severe nausea to deafness to psychosis,” said MSF Access.

Dr Margaret Chan, Director General of the World Health Organization recently told IPS at a press conference on antimicrobial resistance that “there is no denying the fact that TB is a top priority for the world.”

She says that there are two high level meetings planned in 2017 and 2018 to “shine a light on TB” and give it “the political attention and the investment in research and development that it deserves.”

However according to both MSF Access and the new Lancet study, research and development alone, though needed, is not enough to address the shortcomings in the global response to TB and Antimicrobial Resistance without a matching political response.

In a comment article published alongside the new Lancet study David W Dowdy from Johns Hopkins Bloomberg School of Public Health said that the difference between “a drug-resistant tuberculosis epidemic of unprecedented global scale” or “an unprecedented reversal of the global drug-resistant tuberculosis burden,” falls largely to whether there is “political will to prioritise a specific response to the disease.”

200 million people worldwide rely on fishing and related industries for their livelihoods. Credit: Christopher Pala/IPS.

By Lyndal Rowlands
UNITED NATIONS, Jan 10 2017 (IPS)

UN member states hope to reach agreement on a diverse range of global issues in 2017, from managing the world’s oceans to banning killer robots to stopping tuberculosis, one of the world’s deadliest diseases.

In recent years the UN has tackled big issues including ebola, the global migration crisis, financing for development and climate change, with varying degrees of success.

Many pressing environmental, humanitarian and development issues continue to fill the UN’s agenda – even as incoming President of the United States has argued that things will be different at the UN after his inauguration on 20 January.

Trump has suggested that the UN “is just a club for people to get together, talk and have a good time.” However UN discussions have led the 71 year old organisation with 193 member states to create more than 560 international treaties.

Oceans and Life Below Water

One of the biggest meetings on the UN’s agenda this year is focused on the oceans or more specifically Sustainable Development Goal 14: Conserve and sustainably use the oceans, seas and marine resources.

“The United Nations has the opportunity to drive profound change for the oceans in 2017,” Elizabeth Wilson, director, international ocean policy at the Pew Charitable Trusts told IPS.

“This event will provide UN member states an opportunity to assess progress on ocean conservation, make new commitments, and create meaningful partnerships,” she said.

The meeting – which will take place in New York from 5 to 9 June – is considered to be of global importance for many reasons. For example, according to a 2016 World Economic Forum report, there will be more plastic than fish in the world’s oceans by the year 2050. Declining fish stocks will effect the more than two billion people worldwide who rely on fish as a source of protein. The UN’s Food and Agricultural Organisation also estimates that 200 million people worldwide rely on fishing or related activities for their livelihoods, the vast majority of whom live in developing countries.

Another important related issue on the UN’s agenda in 2017 will be working towards creating a treaty to protect the high seas, the areas of the global oceans, which fall beyond any country’s sea borders, said Wilson.

Tuberculosis

The UN General Assembly has only ever convened special high-level meetings on two global health threats, HIV/AIDS and antimicrobial resistance. However in 2018, the General Assembly will meet to discuss Tuberculosis.

Although the decision to convene the special meeting has been welcomed, it will not come soon enough for the nearly two million people who will likely die of tuberculosis in 2017.

“The tuberculosis burden is much higher than we expected and the measures to be taken must be much more focused and serious than before,” Lucica Ditiu, Executive Director of the Stop TB Partnership told IPS.

A series of global meetings will be held in 2017, in preparation for the 2018 meeting however, said Ditiu who also noted that these global meetings should not be seen as a silver bullet.

Although tuberculosis is treatable, the emergence of multi-drug resistant tuberculosis in recent years is a major cause for concern. Multi-drug resistant tuberculosis is just one example of antimicrobial resistance – a serious health problem which world leaders addressed at the UN General Assembly in 2016.

Banning Nuclear Weapons and Killer Robots

Possibly the most ambitious item on the UN’s agenda in 2017 will be an attempt to create an international treaty for the abolition of nuclear weapons.

The first session of the UN conference to negotiate a legally-binding instrument to prohibit nuclear weapons, leading towards their total elimination will take place in New York from 27 to 31 March.

The treaty will be a more ambitious iteration of the already existing Treaty on the Non-Proliferation of Nuclear Weapons.

However proponents of total abolition of nuclear weapons will face an even more challenging political context in 2017, with US President-elect Donald Trump appearing to have unpredictable views on nuclear weapons potentially at odds with the existing non-proliferation treaty which bans new countries from acquiring nuclear weapons.

Another, more contemporary issue on the UN’s agenda in 2017 will be killer robots. UN member states have agreed to begin talks to ban killer robots this year. According to the Campaign to Stop Killer Robots the talks will “(bring) the world another step closer towards a prohibition on the weapons.” A similar agreement back in 1995, led to government agreeing to pre-emptively ban lasers that would permanently blind, according to the campaign.

In Papua New Guinea, most people live in rural areas with poor access to health services, increasing the challenges of fighting infectious diseases, such as tuberculosis. Credit: Catherine Wilson/IPS

By Catherine Wilson
CANBERRA, Australia, Mar 23 2015 (IPS)

Rising multi-drug resistance in patients suffering from tuberculosis, a debilitating infectious lung disease which mainly impacts the developing world, has led to a public health emergency in the southwest Pacific Island state of Papua New Guinea, according to state officials.

While efforts to combat the disease worldwide have produced results, with the global death rate dropping by 45 percent since 1990, the annual number of new cases in Papua New Guinea has risen from 16,000 to 30,000 over the past five years.

“The biggest barrier for the moment is cultural beliefs about the causes of diseases [...]. The first source of help [for many patients] is witchdoctors and local remedies." -- Louis Samiak, chairman of public health at the School of Medicine and Health Services at the University of Papua New Guinea
On World Tuberculosis (TB) Day, observed on Mar. 24, the country’s health experts spoke out about the challenges they face in tackling a disease that thrives in communities struggling against hardship and inadequate access to information and basic services.

“The biggest barrier for the moment is cultural beliefs about the causes of diseases. TB is a disease with long incubation and the first source of help [for many patients] is witchdoctors and local remedies. When patients present late [at health facilities] with advanced disease, it is difficult to treat,” Louis Samiak, chairman of public health at the School of Medicine and Health Services at the University of Papua New Guinea, told IPS.

Disease symptoms include fever, chest pains, fatigue, weight loss and cough, frequently with sputum and blood, which results in the airborne spread of bacteria.

The illness transmits quickly in overcrowded impoverished settlements and in Papua New Guinea, where sanitation coverage is only 19 percent and less than half the population have access to clean water, it is the leading cause of hospital deaths.

In rural villages of Kikori District in the southern Gulf Province the TB incidence rate is an alarming 1,290 per 100,000 people, according to the Papua New Guinea Institute of Medical Research. The national prevalence is 541 cases per 100,000 people, compared to the global average of 126.

The campaign to halt the epidemic in Gulf Province is supported by the international medical non-governmental organisation Doctors Without Borders (MSF). Operating from the main town of Kerema, MSF has since last year diagnosed an average of 50 new TB cases every month, inlcuding patients as young as 10 months.

Adults aged 15-54 years are mainly afflicted, but youth account for about 28 percent of cases in PNG, while pulmonary TB and TB meningitis contribute to malnutrition and mortality in children.

One mother took her ill six-year-old child to Kerema General Hospital in an arduous journey from her mountain village, which took three hours by boat and two by truck.

“In the beginning, the mother did not understand what TB is, why the child needs treatment every day for long periods and why she has to be away from her village. It took two months to gain her acceptance of the treatment and for her to prepare for living away from the village,” a spokesperson for MSF in Papua New Guinea recounted to IPS.

“But the child is now receiving treatment every day with signs of improvement.”

Threatening disease control efforts is increasing resistance in patients to the strong first-line drugs, isoniazid and rifampicin. Common practice of patients stopping medication as soon as they feel better and not fully completing treatment is the main cause of multi-drug resistant TB in the country, Suparat Phuanukoonnon of the Institute of Medical Research told IPS.

When treatment is interrupted, the lower level of medication consumed fails to eradicate all the bacteria, which then develop resistance in the patient’s body.

In 2013, 4.5 percent of diagnosed TB cases in the country were multi-drug resistant, a significant increase from 1.9 percent in 2010. Drug resistant TB is rising in the rural Western and Gulf Provinces and the capital, Port Moresby, where more than half the population live in squatter settlements.

The impact on development is acute, with 75 percent of people with TB worldwide of working age.

“TB can affect all or any part of the human body. It, therefore, affects the whole person and reduces their ability to be productive to society or their community,” University of Papua New Guinea’s Samiak said.

While sufferers face rising healthcare expenses, the inability to work reduces their incomes. Poverty is perpetuated in the next generation when the disease affects both parents, forcing children to withdraw from school in order to care and provide for the family.

Papua New Guinea is the most populous Pacific Island nation with a population of seven million. But there are immense logistical challenges to fighting infectious diseases in the country, with more than 85 percent living in rural areas with poor, if any, access to roads and readily available transport to urban centres and health facilities.

A further hindrance is insufficient healthcare professionals with less than one doctor and 5.3 nurses per 10,000 people and a decline in the country’s health services since 2002, according to a report last year by the National Research Institute.

It found the availability of basic drugs in health clinics has fallen by 10 percent and visits from doctors dropped by 42 percent in the past decade. Despite rapid population growth, the number of patients seeking medical help per day has decreased by 19 percent.

Resources also need to be directed toward public education following a medical research institute survey of 1,034 people in the Central, Madang and Eastern Highlands Provinces, which showed the majority to be unaware of TB, its causes, and treatment.

Phuanukoonnon explained, “Prior to the Global Fund grant for TB [eradication] in PNG in 2007, it was a neglected disease in terms of political commitment and proper funding for the control programme.”

Limited health services are stretched as it is and, while TB information is available at health centres, overworked staff members still have little time for advocacy.

Any educational approach should address “how people receive and process information and believe the information enough to take action”, which requires that “health communication should be relevant to local contexts,” she continued.

Resources to assail the epidemic have been boosted, with the Global Fund announcing last month a further 18 million dollars of funding to fight TB in Papua New Guinea over the next three years.

Samiak said that financial resources could be well spent developing in-country laboratory facilities and staff training, so that TB test results are processed more efficiently and patient follow up and treatment expedited.

Edited by Kanya D’Almeida

Many specialist doctors and nurses in Africa are migrating to greener pastures, leaving cancer patients with few options. Credit: Jeffrey Moyo/IPS

By Jeffrey Moyo
HARARE, Feb 13 2015 (IPS)

Hidden by the struggles to defeat Ebola, malaria and drug-resistant tuberculosis, a silent killer has been moving across the African continent, superseding infections of HIV and AIDS.

World Cancer Day commemorated on Feb. 4 may have come and gone, but the spread of cancer in Africa has been worrying global health organisations and experts year round. The continent, they fear, is ill-prepared for another health crisis of enormous proportions.

By 2020, according to the World Health Organisation (WHO), approximately 16 million new cases of cancer are anticipated worldwide, with 70 percent of them in developing countries. Africa and Asia are not spared.“Africa is at a crossroads in the face of rising cancer cases, with the disease proving to be more deadly than HIV/AIDS and it is worsening at a time when the continent faces a serious shortage of cancer specialists,” Menzisi Thabane, private oncologist in South Africa’s Eastern Cape Province

“Africa is at a crossroads in the face of rising cancer cases, with the disease proving to be more deadly than HIV/AIDS and it is worsening at a time when the continent faces a serious shortage of cancer specialists,” Menzisi Thabane, a private oncologist in South Africa’s Eastern Cape Province, told IPS.

“Africa and its leaders have failed to recognise cancer as a high-priority health problem despite millions of people succumbing to the disease,” added Thabane.

Most of Africa’s 2,000 plus languages have no word for cancer. The common perception in both developing and developed countries is that it is a disease of the wealthy world, where high-fat, processed-food diets, alcohol, smoking and sedentary lifestyles fuel tumour growth.

While many cancers are linked to unhealthy diets and smoking, a large number – particularly in Africa – are caused by infections like hepatitis B and C which can lead to liver cancer and the human papillomavirus (HPV) that causes almost all cervical cancers.

An HPV vaccine treatment costs 350 dollars for three doses over six months in most sub-Saharan African countries, whereas in Zimbabwe radiotherapy costs between 3,000 and 4,000 dollars for a whole session.

A study published in 2011 found that since 1980 new cervical cancer case numbers and deaths dropped substantially in rich countries, but increased dramatically in Africa and other poor regions. Overall, 76 percent of new cervical cancer cases are in developing regions, and sub-Saharan Africa already has 22 percent of all cervical cancer cases worldwide.

According to Zimbabwe’s Ministry of Health and Child Care, the country only has four oncologists catering to over 7,000 cancer patients nationwide. “The shortage of cancer doctors stands as an impediment to comprehensive treatment and care for cancer patients here,” Dr Prosper Chonzi, director of Health Services in the Zimbabwean capital, Harare, told IPS.

The shortage of cancer specialists is also seen in West Africa.

Last year, The Vanguard, a Nigerian newspaper, reported that there were an estimated 60 oncologists serving over 300 million people in the West African sub-region with fewer than 20 oncologists serving 160 million Nigerians. Ghana has only seven for 24 million people, Burkina Faso two and Cote D’Ivoire just one. Sierra Leone has more than six million people and no cancer doctors.

Across the continent in Kenya, cancer accounts for approximately 18,000 deaths annually, with up to 60 percent of fatalities occurring among people who are in the most productive years of their life. Men are most commonly diagnosed with prostate or oesophageal cancer, and women are most frequently affected by breast and cervical cancer.

Zimbabwe’s health activists blame the absence of cancer education for the upsurge of fatal cases in the African nation. “Very few people, including government, consider cancer a real threat to the health delivery system,” Agnes Matutu, director of the Zimbabwe Cancer Alliance, an anti-cancer lobby group here, told IPS.

Melody Hamandishe, a retired government nutritionist, told IPS she blamed imported genetically modified foods. This contributes to cancer, she said, as does the abuse of alcohol, often causing liver cancer.

In Zambia, anti-cancer activists accuse the government of not prioritising the fight against the disease. “People are perishing in huge numbers because of cancer here in Zambia while government is seized with fighting HIV/AIDS,” Kitana Phiri, a cervical cancer survivor, now a devoted anti-cancer activist based in the Zambian capital, Lusaka, told IPS.

In Tanzania, cancer is also wreaking havoc. A January 2014 report by the Ocean Road Cancer Institute (ORCI), the only specialised facility for cancer treatment in this east African nation, said there are 100 new patients in every 100,000 population out of the country’s population of 45 million.

Finally, in Namibia, uranium workers were reported to have elevated rates of cancers and other illnesses after working in one of Africa’s largest mines.

Rio Tinto’s Rössing uranium mine extracts millions of tonnes of rock a year for the mineral. “Most workers stated that they are not informed about their health conditions and do not know if they have been exposed to radiation or not. Some workers said they consulted a private doctor to get a second opinion,” say researchers at Earthlife Namibia and the Labour Resource and Research Institute who collaborated in a study.

“The older workers all said they know miners dying of cancers and other illnesses. Many of these are now retired and many have already died of cancers,” says the study report.

Cancer is not beyond us in terms of cancer control and reducing the impact of the disease, declared the Cancer Association of South Africa (CANSA) on World Cancer Day this year.

“The global cancer epidemic is huge and set to rise,” said Elize Jourbert, head of CANSA. “In South Africa, more than 100 000 are diagnosed annually. This day helps us spread the word and raise the profile of cancer”.

Under the tagline ‘Not beyond us’, World Cancer Day in South Africa focused on taking a positive and proactive approach to the fight against cancer, highlighting that solutions do exist regarding cancer care and early detection and that they are within reach.

Meanwhile, Ellen Awuah-Darko, the 75-year-old founder of the Accra-based Jead Foundation for breast cancer, says it was her personal experience of finding a breast lump and ending up paying tens of thousands of dollars to be treated in the United States that made her start to push for change.

“In America I had to put down 70,000 dollars before they’d even talk to me,” she said in an interview with Reuters. “I was lucky, I could afford it after my husband died and left me money, but I thought ‘why should I get treatment when others can’t’.”

Now, every Wednesday, Awuah-Darko goes with healthcare workers into communities in the Eastern Region of Ghana to offer women a simple breast examination and show them how to check themselves.

“Early detection can save your life,” she said. “I want everybody to know that. It’s not something people should be ashamed of or embarrassed about.”

Edited by Lisa Vives/Phil Harris    

Doctors are warning of a worsening tuberculosis epidemic in Eastern Ukraine as the continuing conflict there begins to take a heavy toll on public health.

With thousands of people fleeing the region every day, medical supplies severely disrupted and those left behind under growing physical stress and increasingly unable to access medical services, conditions are ripe for a rise in new TB cases.

Dr Masoud Dara, Tuberculosis Programme Manager at the World Health Organisation (WHO) Europe, told IPS: “The situation with TB was not good before the conflict, but we can say that the conflict has certainly made it worse.”Since the outbreak of hostilities and the Ukrainian military’s push to reclaim control of areas in Eastern Ukraine from pro-Russian separatists, health care providers in the region have come under increasing pressure

Since the outbreak of hostilities and the Ukrainian military’s push to reclaim control of areas in Eastern Ukraine from pro-Russian separatists, health care providers in the region have come under increasing pressure.

Not only have hospitals been forced to deal with treating of casualties of the fighting, they have also had to cope with patients being moved in and out of hospitals and abandoning or interrupting treatment as the security status of individual towns and cities changes.

It has also become increasingly difficult to obtain supplies of vital medicines, and terrified staff – up to 70 percent of medical staff are estimated to have fled Donetsk and Luhansk, according to U.N. officials – have left hospitals and clinics.

The problems have been particularly acute with regard to TB. Ukraine has one of the worst TB problems in Europe, second only to Russia in terms of infection numbers.

According to official data, there are 48,000 people registered with the disease and it claimed the lives of just over 6,000 people in 2013. However, one in four people with TB are not officially registered, according to WHO.

The country also has a particular problem with multidrug-resistant tuberculosis (MDR-TB) which is much harder to successfully treat than normal TB.

WHO reports that Ukraine is one of “27 high multidrug-resistant tuberculosis (MDR-TB) burden countries in the world,” adding that “despite the adoption of the Stop TB Strategy by the National TB Programme (NTP), its components have not been sufficiently implemented.”

Organisations working in the region say they fear the disease will claim lives as the fighting is making it impossible to identify cases, monitor or guarantee timely treatment for those who need it.

Dr Dara told IPS: “There are indications that incidence of TB may increase. TB sufferers need to have medicines provided to them in a timely fashion and if that cannot be done and TB sufferers’ treatment is interrupted and they cannot access treatment elsewhere, there is a risk that the disease could then be spread and that people may die.

“We do not have detailed information at the moment on how exactly the conflict has affected the TB situation in Eastern Ukraine, but we do know that it has, at least, affected TB control efforts. It is hard to thoroughly implement checks on all people with TB in the conflict zone.”

Doctors in Donetsk, a city of one million and regional stronghold for pro-Russian separatists, have told humanitarian organisations working in the region of their fears over the fate of patients needing treatment.

Ole Solvang of Human Rights Watch, who carried out detailed research in Eastern Ukraine on the effects of the current conflict on the region’s health care, told IPS: “One hospital administrator in the main hospital in Donetsk told us that his hospital had a capacity for 1,200 patients but that because of the war they had only 450 at the moment.”

Solvang said that “the explanations put forward for this are that because people were afraid of travelling they were not coming to the hospital, that they were saving money and did not want to pay to get to hospital or that so many people have left the region because of the conflict.”

But his fear was that people with medical problems not connected to the conflict, such as serious diseases, are now not getting the treatment that they need.

Other doctors have warned that problems with medicine supplies because of the conflict could turn out to be an even bigger problem than the interruption of TB treatment.

One who spoke to IPS said that if a TB patient was given only a few drugs instead of the full range of medicines needed as part of treatment, it could lead to developing the much more dangerous drug-resistant TB.

The true scale of the problem with TB in the region is impossible to ascertain clearly because of the rapidly changing conditions in the conflict zone, while many under-pressure medical staff working directly in the conflict zone have been reluctant to speak in detail to anyone other than colleagues.

Regional officials also declined to comment when approached by IPS.

One doctor from Donetsk who spoke to IPS said that TB patients in regional hospitals, as well as hundreds being treated on an out-patient basis, were receiving the treatment they needed.

According to Dr Yuriy Semionovich, “there are 550 tuberculosis patients in Donetsk and Slavyansk hospitals at the moment. They are getting all the medicines and treatment they need. There are 200 patients treated on an out-patient basis and they too are receiving what medicines they need. We have the situation under control.”

However, some others are far more pessimistic in their assessment of the TB threat to the region.

Natalia Chursina, deputy head of the Donetsk Regional Tuberculosis Hospital, told local media earlier this month that “we will definitely have an outbreak in prevalence of all forms of TB after all this ends”.

Despite claims from some Ukrainian officials that the separatists will soon be dealt with and that fighting could be over in a matter of weeks, many experts say a quick end to the conflict is unlikely. And even if that were to happen, it is unclear how quickly medical service provision would return to normal, nor how many TB patients may have abandoned or interrupted treatment.

What is clear though is that without a change in current conditions, the situation with TB in the region is unlikely to improve any time soon.

“If conditions improve with regard to the supply of treatment, medicines and provision of health care services then we can foresee some improvement with the TB situation,” Dr Dara told IPS. “But without a change in those, then there is little hope that TB treatment can improve.”

(Edited by Phil Harris)

When Veronika Sintsova was diagnosed with tuberculosis in 2009, she spent six months in hospital before being discharged and allowed to continue treatment as an outpatient.

Today clear of the disease, the 35-year-old former drug user from Kaliningrad says the fact that she beat tuberculosis (TB) is not because of, but rather in spite of, the way many people with tuberculosis are treated in Russia.

“I think it would be fair to say that Russian authorities don’t take the problem of tuberculosis seriously,” she told IPS.

Tuberculosis is a major health threat in Russia, where it is the leading infectious disease killer.The country has the highest rates of multi-drug resistant (MDR) and extremely drug resistant (XDR) tuberculosis in Europe and the third highest in the world. And those rates are climbing.Tuberculosis exploded in Russia after the collapse of the Soviet Union as health care infrastructure crumbled, the country was thrown into economic crisis and crime and poverty soared, leading to overcrowded penal institutions.

It also has the 11th highest burden of all TB in the world, according to the World Health Organisation (WHO), which just last week said that parts of the country were “disaster areas” for the disease.

Tuberculosis exploded in Russia after the collapse of the Soviet Union as health care infrastructure crumbled, the country was thrown into economic crisis and crime and poverty soared, leading to overcrowded penal institutions.

But, say NGOs in Russia and international groups working to combat the disease, the continued use of outdated and inefficient approaches to the disease are still fuelling its spread.

Long stays in health facilities filled with people with TB were a cornerstone of the Soviet health care system’s approach to the disease, and have remained, even though they were abandoned years ago in the West because they were seen as contributing to the spread of the disease.

But it is not just in health care facilities where people with TB are being failed. The disease is rife in Russian jails. Overcrowding, poor conditions and bad nutrition all contribute to high infection rates with one in seven prisoners having active TB, according to the Russian Federal Penitentiary Service.

The way prisoners with TB are treated typifies the general approach to the disease by authorities. Sintsova said that although she was treated well by doctors, it was during a sixth month spell in prison for a drug offence that she had what she says was “the worst experience” of all the time she had the disease because fellow inmates and wardens took no pity on her when she left her cell.

“They would shout out ‘tuberculosis sufferer on a walk’ as I went along. That really hurt me. It was probably the worst thing I experienced in all the time I had tuberculosis,” she told IPS.

And this abuse is typical, she said, of the way many people with the disease are viewed in Russia. TB is common among those at the margins of society – drug users, alcoholics, people with HIV and those in dire poverty. “In our society, a drug user is not a person and their death from tuberculosis is seen as something they deserve,” Sintsova, who herself has HIV, told IPS.

Third sector groups working with TB sufferers say approaches towards such people need to be changed. Anya Sarang, president of the Andrei Rylkov Foundation for Health and Social Justice, has previously told local media that the “unjustified imprisonment of Russian people, especially drug users, leads to prison overcrowding” which in turn fuels continued TB infection.

Others point to the need to provide integrated care for people with co-infections, such as HIV and hepatitis C. Oksana Ponomarenko, Russia country director for the U.S. organisation Partners in Health (PIH) which works with TB patients in Russia, said on the group’s website: “The biggest problem lies in the fact that each health system in Russia is vertical and operates separately –TB, drug addiction services, HIV care, psychiatric services, among other health programs.

“At federal level and in individual regions these programs are not connected. Often, clinicians in one programme will not have complete information on other nearby services and programmes.”

PIH and other local organisations have started programmes to try and provide integrated treatment to people with TB in some cities, including a mobile clinic.

Some success has been reported in a scheme in the city of Tomsk where prisoners with TB are all housed in one facility. If released before their treatment has finished, they are placed straight into hospital to prevent infecting others when they return to wider society.

PIH says that its methods have been adopted as official state policy on TB and legislation was recently brought in to emphasise the importance of ambulatory, rather than institutional, care in TB treatment. The government has also increased spending on TB in recent years, modernised diagnostic equipment and overhauled research institutes specialising in TB.

But what worries many working with TB patients is the Kremlin’s approach to some of the biggest international funders of TB projects. It recently decided to reject money from the Global Fund for Aids/TB and Malaria, justifying the move by saying that Russia is now a donor to the Global Fund and that it would be wrong for it to continue to take money from it.

Some see the move as entirely political and part of attempts by the Kremlin to crack down on foreign NGOs operating in Russia. Another major funder of groups working on TB programmes, USAID, was expelled from the country in 2012 and forced to stop operating, on the grounds that it was interfering in Russian politics.

Some projects, including a few run by PIH, have already been affected.

Nadezdha Tolokonnikova and Maria Alyokhina (fourth and fifth from the right) with activists from the Andrei Rylkov Foundation for Health and Social Justice in Moscow marking the United Nations International Day Against Drug Abuse and Illicit Trafficking with calls for reform of Russia's hard-line drug policies. Credit: Andrei Rylkov Foundation

By Pavol Stracansky
MOSCOW, Jun 26 2014 (IPS)

A protest in Moscow Thursday marking the U.N. International Day Against Drug Abuse and Illicit Trafficking has highlighted the ‘torture’ drug users are put through in the Russian criminal justice system.

Nadezhda Tolokonnikova and Maria Alyokhina, members of the Pussy Riot Group who were controversially jailed for performing in a Moscow cathedral in 2012, spoke in the Russian capital to highlight the plight of drug users in Russia.

Joining protestors in more than 80 cities around the world demanding drug policy reforms, they attacked what they said was their country’s “cruel and inhuman” treatment of drug users.

Describing a litany of rights abuses against drug users, including torture and beatings by police and prison warders, they said Russian authorities viewed imprisonment as a “cure for drug dependency”.“Similar to xenophobia and homophobia, narcophobia has become a protective cloak for the authorities .... Creating an image of the enemy, the subhuman, the zombie, and reinforcing that image in the public consciousness justifies the inhuman treatment of drug dependent people in our country” – Nadezhda Tolokonnikova and Maria Alyokhina, members of the Pussy Riot punk rock group

“People who use drugs are outcasts – they are despised, hated, accused of all problems, and criminalised. Similar to xenophobia and homophobia, narcophobia has become a protective cloak for the authorities…. Creating an image of the enemy, the subhuman, the zombie, and reinforcing that image in the public consciousness justifies the inhuman treatment of drug dependent people in our country,” they said.

“Russia’s drug policy is built on torture. Humiliation and violation of human dignity – thisis what drug dependent people face everywhere, from hospitals to prisons and other state facilities,” they added.

Russia takes a hard-line approach to drug use, implementing repressive drugs legislation, including lengthy jail terms for possession of even tiny amounts of hard drugs.

Drug users say they are also targeted by police: official figures show that one in six of the Russian prison population is a drug user and, according to other surveys, just under 30 percent of drug users have been arrested at some point since they started using drugs.

They say they also regularly have confessions extracted from them or are coerced into helping officers as they go into withdrawal in detention – a charge police deny.

There is a complete lack of relevant medical services for drug users in temporary holding facilities and pre-trial detention centres and even painkillers are rarely given to addicts going into withdrawal.

Drug users in prison face particular hardship. Conditions for all prisoners are poor with hygiene often bad, cells massively overcrowded and brutality and disease rife. But drug users are especially vulnerable.

Anya Sarang, head of the Moscow-based Andrei Rylkov Foundation for Health and Social Justice, which works to raise awareness of drug problems, told IPS: “Russian prison is torture in itself with prisoners not given basic medical infection control, nutrition etc., and general human rights violations. But drug users are more vulnerable than other prisoners.

“For instance many are HIV positive, but not only are there problems getting their medicine or starting them on treatment because they are not given necessary immune system checks in some cases, but their diet is poor and there is always the risk of infections, such as tuberculosis.”

Tuberculosis (TB) is a major problem in Russian prisons, according to the World Health Organisation (WHO) and other bodies. Studies have shown that a person with HIV is 25 times more likely to contract TB in a Russian prison than outside one.

But the risk of potentially deadly infections is only one problem facing drug users in prisons. As in many jails across the world, drugs are smuggled in and traded between inmates, giving users, some of whom may never have tried hard drugs, access to substances like heroin and experience of dangerous drug-taking methods.

Campaigners say that this is further evidence of how the criminalisation of drug use only perpetuates and worsens drug problems.

Michel Kazatchkine, UN Special Envoy for HIV/AIDS in Eastern Europe and Central Asia, told IPS: “We know from studies that contact with the criminal justice system is associated with increased injection drug use and other similar behaviour, among other problems. Putting drug users in prisons …. is making things worse not just in prisons but also for communities when they are released from prison.”

Activists point to how opioid substituition therapy (OST) for people in custody or prison has been successfully implemented in some Western states.

But the practice is completely banned in Russia, despite being widely implemented in many countries around the world, recommended by the World Health Organisation (WHO), and having been proved to be successful in helping halt the spread of HIV/AIDS.

Russia has one of the world’s fastest growing HIV/AIDS epidemics – there were 78,000 new HIV cases registered last year, up from 69,000 in 2012 and 62,000 in 2011 – which the Joint United Nations Programme on HIV and AIDS (UNAIDS) and other bodies say has been historically driven by injection drug use.

Drug use in the country is growing equally rapidly. According to figures from the country’s Federal Drug Control Service (FSKN) there were an estimated 8.5 million drug addicts in 2013 – up from 2.5 million since 2010. The service says up to 100,000 people die each year in Russia from drug abuse. It is also the world’s largest heroin consumer.

Tolokonnikova and Alyokhina said only a reform of drug policy including decriminalisation would improve the situation in prisons.

But Russian authorities show no sign of lifting the OST ban nor improving the very limited harm reduction services which exist in the country and FSKN officials have made a number of public statements in recent months reaffirming their commitment to hard-line drugs policies.

Kazatchine told IPS: “I don’t see any sign of Russia’s approach to drugs softening. What I am seeing is a toughening of the way Russian society looks at marginalised groups, such as drug users, men who have sex with men, LGBT people, etc. The climate has toughened and Russia is de facto criminalising drug use and recession.”

This, critics say, has left Russian drug users in a terrible position in society. Sergey Votyagov Executive Director of the Eurasian HRM Reduction Network (EHRN), told IPS that they were “one of the most stigmatised and under-served populations” in the country.

Meanwhile, the devastation wrought by Russia’s drugs policies has been seen clearly in its newest territory. Just days before Thursday’s protest in Moscow, campaigners in Ukraine had raised the alarm over the fate of drug users in Crimea following its recent annexation.

OST is available in Ukraine and had been provided to 800 people in Crimea. But as part of Russia, Moscow ordered OST programmes there shut down at the start of May.

A mission by the Council of Europe to Crimea which ended last month reported that at least 20 people had died following the cessation of the programmes and at least 50 more had migrated to the Ukrainian mainland, while a few had gone to Russia for detoxification and rehabilitation treatment.

Those who remained spoke of having to deal with intimidation by new authorities and, in some cases, losing their jobs because of either worsening health or their status as former OST patients being made public.

Some who have fled the peninsula described the fear and desperation among drug users still there.

Speaking at an event organised by the International HIV/AIDS Alliance in Ukraine in Kiev earlier this month, one woman, Oksana, who left the day after her OST treatment had stopped, said:  “I might have died if I had stayed in Crimea.

“I am disabled, I have had a stroke and I know very well how it feels to be left without therapy and help. Those who could not leave Crimea are in terrible conditions. Some of them are already dead, others have chosen suicide.”

There is little hope that things in Crimea will change any time in the foreseeable future. Earlier this month, Sergei Donich, deputy prime minister in the Crimean government, told local media that OST was ineffective and was being pushed by pharmaceutical firms who stood to gain from it.

Kazatchine described the situation on the peninsula as a “tragedy”, adding that it was unlikely there would not be more deaths among drug users.

He told IPS: “Evidence shows that OST reduces mortality, it prevents overdoses among drug users. I think it is inevitable that [with no more OST] more drug users will die.”

An elderly TB patient at the Srinagar-based Chest Diseases Hospital in the Indian state of Kashmir. Credit: Athar Parvaiz/IPS

By Athar Parvaiz
SRINAGAR, India, Jul 22 2013 (IPS)

Twenty-three-year-old Haleema (not her real name) was not the first female patient at Srinagar’s Chest Diseases Hospital in the Indian state of Kashmir to try to run away.

While undergoing treatment in the isolation ward reserved for tuberculosis patients, she hatched a plan with her brother to dodge the watchful eyes of the officer in charge, Ali Mohammad, and make a quick escape.

“She told me they wanted to take a stroll,” Mohammad told IPS. “I followed them and managed to get her (Haleema) back to the ward…but not without resistance.”

“I don’t have TB,” a distraught Haleema told IPS from the bed where, for the time being, she is reluctantly continuing her treatment.

Her doctors say she is suffering from all the telltale TB symptoms, including a bad cough that has lasted for over two weeks, evening temperature rises, blood in her sputum and loss of weight and appetite.

Worried that the infection could lead to fibrosis (a thickening of the lung tissues) if left untreated, doctors are administering daily doses of isonicotinylhydrazine (INH), rifampin, ethambutol and pyrazinamide, which they hope to continue for six months.

Far from being grateful for the care she is receiving at the state-run facility, the young woman insists that the hospital staff are putting her future “at risk” by forcing her to stay put.

By way of explaining this unusual claim, Haleema’s brother told IPS: “We won’t be able to find her a husband if she remains in the hospital. The word will spread about her illness and no one will want to marry her.”

Dangerous misconceptions

Haleema’s desperate escape attempt is not an isolated case, but rather a trend in this region of 12 million people, where misconceptions about TB are thwarting doctors’ attempts to stamp out the disease.

Women often bear the brunt of the stigma attached to TB.

Rehana Kausar, a researcher with Kashmir’s health department who presented a study entitled ‘Sex Differences in Key Aspects of Tuberculosis Control’ at a recent conference at the Srinagar-based Sher-i-Kashmir Institute of Medical Sciences (SKIMS), found that 87.6 percent of 240 female respondents said they would deny or hide a TB diagnosis for fear of “spoiling marital life or ruining their marriage prospects.”

“Nearly one-third of married women feared desertion by their husbands and the majority (95.9 percent) of unmarried women said they would not be able to find a match (marriage partner) if their TB diagnosis was revealed.”

According to Mushtaq Ahmad, director of the State Tuberculosis Diagnostic Centre (STDC), misunderstandings about the disease and its impacts pose “a major challenge” to the medical establishment.

He says that some TB patients prefer to visit private doctors rather than check into free, government-run health centers, in the hopes of keeping their health status a secret.

“This is a dangerous trend,” Ahmad told IPS, “because these patients often leave the treatment midway… when they can no longer bear the cost of paying private doctors themselves.”

Experts say incomplete treatment is a serious health hazard for the entire region.

Ghulam Ahmad Wani, Kashmir’s chief tuberculosis officer, told IPS that patients frequently declare themselves infection-free after a month, even though a full course of TB medication typically runs for at least six months.

“Though the symptoms may disappear, this does not mean the disease has been cured,” he stressed, adding that, on the contrary, stopping TB treatment prematurely simply makes the disease harder to treat.

Patients end up developing multidrug-resistant tuberculosis (MDR-TB), a particularly virulent strain of the disease that refuses to respond to isoniazid and rifampin, the two most potent TB drugs, and a host of related medications.

The worst-case scenarios, says Suraiya Farooq, an MD at the Chest Diseases Hospital, include extensively drug-resistant tuberculosis (XDR-TB) and totally drug-resistant tuberculosis (TDR-TB), which are particularly worrisome strains for people living with HIV/AIDS, since the body effectively stops responding to even second-line intravenous drugs, leaving the patient with a severely weakened immune system.

The repercussions of this trend are magnified in India, the country with the highest number of TB patients in the world.

According to the World Health Organisation (WHO), India accounts for one-fifth of global TB cases, with two million people developing TB annually, of which roughly 870,000 are thought to be infectious cases. It is estimated that 300,000 Indians die of TB every year.

Residents of the mountainous state of Jammu and Kashmir, nestled between the Great Himalayas and Pir Panjal mountain range, are highly susceptible to TB, especially those who dwell in traditional mud huts without proper ventilation.

Unhygienic and crowded living conditions also encourage transfer of the disease, according to Suraiya.

In 2012, Kashmir’s Tuberculosis Cell conducted sputum tests of 50,000 people who complained of TB-like symptoms: 5,800 were diagnosed with TB.

In the previous two years, according to officials speaking to IPS under condition of anonymity, more than 15,000 out of roughly 100,000 suspected cases tested positive for TB.

The officials refused to divulge the number of deaths resulting from these cases.

However, Wani said that state hospitals “treated 93 percent of those patients, who recovered fully, while the remaining seven percent left the treatment midway.”

Most experts agree that a lack of awareness about the disease is the main culprit for the high infection rate and for the number of people who either deny their diagnosis or discontinue their treatment.

Quoting figures from her recently published study, Kausar told IPS that 10 percent of women with TB did not know they were living with the condition, while 60 percent of female patients had no knowledge about the disease and how it spreads.

According to her research, few patients were aware that TB is a bacterial infection, caused by inhalation of respiratory fluids emitted by an infected person; in fact, one-fourth of the women surveyed attributed the disease to “tension”, stress, domestic strife and “past sins”, while 21 percent of nearly 250 male respondents believed the disease was caused by smoking.

Ahmad lamented that Kashmir’s health department had yet to create a comprehensive awareness campaign, though he welcomed recent efforts undertaken through the Revised National TB Control Programme (RNTCP), which is being implemented throughout India as part of a nationwide TB eradication initiative.

States are now utilising radio and television stations to advertise that the disease is treatable. “We are also (mobilising) school teachers and preachers from the mosques to help spread the word,” he said.

Suraiya says awareness is crucial not only for ending the stigma but also for urging people, especially residents of the Himalayan foothills, to come for regular check-ups or sound the alarm when a family or community member has been coughing continuously for more than a week.

Argentina is one of the countries in Latin America with the highest levels of vaccination coverage. But experts are concerned about the growing campaign by vaccine critics against immunisation.

“Vaccines have saved as many lives as clean water. Risking not giving shots is like playing Russian roulette,” Dr. Carlota Russ, secretary of the Argentine Paediatric Society’s Committee on Infectious Diseases, told IPS.

Russ said that in industrialised countries, immunisation coverage is in decline as the culture of vaccination weakens, creating a risk of re-emergence of diseases that have already been controlled, like measles.

“Fortunately, in Argentina, the anti-vaccine movement is not strong,” she said.

Vaccines are obligatory in Argentina. Credit: Alviseni/CC BY 2.0

However, when a case of refusal to vaccinate reaches the courts, the story has a great impact in the media and produces a wave of uncertainty that reaches even clinics and doctors’ offices, she said.

Well-informed, well-educated parents with small children are drawn in by theories alleging adverse effects from the inoculation of viruses, bacteria or toxic substances.

In 2012, the case of a couple who refused to vaccinate their child reached the Supreme Court, which ordered that the mandatory state immunisation plan be administered, “by force” if necessary, “for the greater good of the child and of public health.”

In an interview with IPS, paediatrician Eduardo Yahbes, of the Argentine Homeopathic Medical Association, said the family “had a poor legal defence,” and endorsed their right to refuse to have their child immunised.

Yahbes is one of the health professionals who contribute to the web site “Libre Vacunación” (Vaccination Freedom), which says that the idea that immunisation is safe and effective, or that it is the only means of preventing diseases, is a myth.

“Vaccines are not effective; the idea that infectious diseases have disappeared thanks to vaccines is a fraud,” said the paediatrician, a practitioner of alternative medicine.

Yahbes quoted a number of research studies that purportedly show the adverse effects of vaccines, and blamed “the hegemony of the dominant medical system that violates people’s human rights” by forcing them to receive medical treatments they do not want.

In Argentina the mandatory vaccination schedule included four vaccines in 1970, and now includes 16. According to the Pan American Health Organisation (PAHO), it is one of the most comprehensive protocols on the continent.

In addition to traditional vaccines like BCG (against tuberculosis) or the Sabin anti-polio vaccine, new ones, for example for preventing infection with human papilloma virus, which can cause cervical cancer, have been added in recent years.

Russ said vaccines are “essential to reduce the chances of contracting illnesses and their complications; they are mandatory because the burden of the illness justifies protection.”

She pointed to the re-emergence in Europe and the United States of cases of measles, while in Latin America there are only a few cases imported from other regions of the world.

“We are covered, but we must not lower our guard,” she said.

Russ acknowledged that “there are occasional adverse side effects, as with any medication. But they are so minimal that the use of vaccines is amply justified.”

She referred to the alleged link between autism and vaccines, reported by Yahbes in a 2011 article in the publication Homeopatía para Todos, of the Argentine Homeopathic Medical Association. Yahbes wrote that “vaccinations are regarded as a major factor in the development of this pathology (autism).”

Russ said the theory, which created a scare that was “disastrously harmful,” “was later shown to be untrue.” In 2010, the British scientific journal The Lancet, at the request of the General Medical Council (GMC) of the United Kingdom, retracted a paper by researcher Andrew Wakefield on the presumed link between the two, published in 1998.

Wakefield had postulated a link between the triple viral vaccine against measles, mumps and rubella (MMR), autism and gastrointestinal symptoms. After investigating, the GMC ruled that the scientist had acted “dishonestly and irresponsibly” in his research and banned him from practising medicine.

However, the rumours and scares proliferated, and won new converts in the field of alternative medicine. As a result, measles vaccination coverage in developed countries has fallen, leading to the re-emergence of diseases like measles and whooping cough.
In Argentina, the official schedule of vaccinations is legally binding and free of charge. Since 2009 immunisations have been a requirement for receiving the universal child allowance, a direct cash transfer to families with children.

The allowance is paid to families with parents who are unemployed or who work in the informal economy, with children under 18, or disabled dependants of any age, in exchange for regular school attendance, health checks and certified vaccinations.

A child is vaccinated for polio outside Peshawar, Pakistan. Credit: Ashfaq Yusufzai/IPS

By Katelyn Fossett
WASHINGTON, Apr 9 2013 (IPS)

A U.S.-based civil society coalition is calling on Congress and President Barack Obama’s administration to keep spending on global health aid at current levels, warning that recent budget cuts risk a dangerous backslide in health and development gains achieved over the past three decades.

The new brief has been published by InterAction, a Washington-based umbrella of international NGOs, is supported by 37 organisations. It warns that any future cuts to these programmes would endanger important health milestones achieved in part due to U.S. assistance.We have a choice: we can invest now or pay forever.

These include the near-eradication of polio and the treatment of over five million people living with HIV/AIDS. In addition, the brief warns that austerity-related budget cuts that went into effect on Mar. 1 could lead to the re-emergence or worsening of critical global health threats, like those posed by the spread of malaria and tuberculosis.

“The U.S. is at a critical juncture in its global health efforts: budget pressures threaten the global health gains that have been made and jeopardize programming … Capitalizing on our successes and meeting emerging global health challenges will require increased and sustained commitments by all donors,” the brief says.

But the warning is competing with snowballing enthusiasm for budget-cutting that has seized Washington since the recent cuts, known here as the “sequester”, went into effect. Cutting roughly five percent of all federal budgets, analysts say the sequester would slice around 433 million dollars from U.S. global health aid for the remainder of this fiscal year alone.

The United States is the world’s largest individual donor to a spectrum of global health initiatives.

“We see the brief as a resource for members of Congress and their staff on U.S. investments in global health,” Danielle Heiberg, one of the authors of the brief, told IPS. “By highlighting how current and past U.S. investments have made significant progress in global health, we hope that Congress will understand the value and importance of maintaining appropriate funding for the global health accounts.”

“Sustained US investments in global health programs and health systems strengthening are crucial – health problems will only be more expensive and more difficult to resolve in the future, especially with the rise of non-communicable diseases (cancer, lung and heart-disease and diabetes) in all populations,” the brief says.

Sequester-related cuts have been forced to impact on nearly all federal programmes, with Congress purposefully designing them so that neither policymakers nor agency heads could target the reductions at waste or initiatives of low priority. Critics note that foreign aid generally only constitutes about one percent of the U.S.’s total budget – with just a tenth of that for global health.

Nonetheless, U.S. spending still has an outsized impact on global health projects. Indeed, the United States has taken on an even more expanded role since the 2008 financial crisis led other donor countries to cut their aid programmes.

Newly released data from the Organisation for Economic Co-operation and Development (OECD), a grouping of rich, industrialised countries, has revealed a 5.4-billion-dollar decline in general international aid flows worldwide in the past year.

Advocates have expressed particular concern about the future of U.S. health assistance because it does not have the deep political support that bolsters other kinds of foreign developmental assistance. Projects for which mutual economic opportunities for donor and recipient countries are far more visible – such as improving infrastructure or trade, for instance – tend to benefit from deeper political support than that for health aid.

“Domestic donor interests have much more influence in donor capitals where aid decisions are being made,” Gregory Adams, head of the aid effectiveness programme at Oxfam International, a humanitarian group, told IPS. “The more locally owned and demand-driven aid gets cut first.”

Adams listed the Global Fund to Fight Aids, Tuberculosis, and Malaria, an international financing organisation, as one of the groups that is affected by this decision-making bias.

Indeed, on Monday the Global Fund announced a massive new 15-billion-dollar fundraising goal. If it attains this goal, the group says it will be able to prevent a million new HIV infections and save the lives of almost six million people with tuberculosis.

“We have a choice: we can invest now or pay forever,” Mark Dybul, executive director of the Global Fund, said Monday. “Innovations in science and implementation have given us a historic opportunity to completely control these diseases. If we do not, the long-term costs will be staggering.”

Double problem

Oxfam’s Adams further warns that there is a “double problem” with foreign aid.

“It’s not just that the [aid] is not getting to the people who need it, but you take these countries that trusted the United States and give them reason not to trust the U.S,” he said.

“We keep asking partner countries to show more leadership – to do a better job of leading and meeting their own countries’ needs, but sometimes the global donor country makes it very difficult for those countries to plan their leadership by changing the goal posts.”

In addition, failure to follow through on health assistance could introduce the additional obstacles of reduced immunity and new drug-resistant strains of a disease, particularly with malaria and tuberculosis.

“History shows that if we scale back funding, malaria will re-emerge worse than ever, especially since populations with reduced immunity will face an increase in morbidity,” the InterAction brief states.

In March, the World Health Organisation issued a statement on the increasing spread of drug-resistant tuberculosis, a growing public health crisis due in part to its history of incomplete treatments in developing countries. A study in August 2012 found that almost half of TB patients were not responsive to either first- or second-line treatments, suggesting the disease could become “virtually untreatable”.

For now, health and aid groups are expressing fear, uncertainty and a fair amount of outrage as they wait to feel the concrete effects of the March cuts.

“The sequester is going to have a significant and detrimental effect,” Oxfam’s Adams said. “[But] it’s a blunt instrument – it’s hard to predict how the axe is going to fall.”

HIV-positive children in Muhanga, a village in Rwanda. Credit: Aimable Twahirwa/IPS

By Carey L. Biron
WASHINGTON, Apr 4 2013 (IPS)

A first-time ranking of 54 top research universities in the United States and Canada has found that a miniscule percentage of funding goes to neglected diseases, despite the outsized influence that public universities play in developing medicines for illnesses often ignored by the private sector.

According to the University Global Health Impact Report Card, released Thursday, less than three percent of research funding at these 54 universities went to neglected diseases in 2010. This includes not only the tropical illnesses, such as Chagas disease and sleeping sickness, but also paediatric HIV/AIDS, malaria and multi-drug-resistant tuberculosis.Universities have a big role in making sure their research is translated into affordable medications for people in developing countries.

Altogether, more than a billion people globally suffer from these diseases, primarily in poor communities, according to data provided by the Universities Allied for Essential Medicines (UAEM), an international student coalition that carried out the research for the report card. Further, around 10 million people a year are said to die because they are unable to access required medicines, many of which are simply too expensive for them to purchase.

“We often hear from students in university labs who really want to focus on these issues but find that the same resources aren’t available to them as in more traditional areas of study,” Bryan Collinsworth, UAEM executive director, told IPS.

“This is not just about bringing in more grant funding – though that’s huge – but also about universities taking more concrete steps to say they’ll support this area of focus. For instance, hiring more faculty in these areas, making sure students have more fellowships in both the field and lab on these issues, and perhaps officially establishing a centre to ensure a specific focus.”

Indeed, 15 of the universities studied had created such a centre, and 10 of those succeeded in offering higher funding for neglected diseases, Alex Lankowski, a BostonUniversity student that participated in the UAEM research, told IPS.

Over the past three decades, some 1,556 new drugs were created, UAEM reports, but only 21 – less than two percent – were for neglected diseases.

“Universities are non-profit institutions operating in the public interest, heavily funded by government grants – meaning taxpayer-funded sources – so students know this means they have a special responsibility to serve the public good,” Rachel Kiddell-Monroe, president of the UAEM board, said Thursday at the report card’s unveiling.

“Universities regularly position themselves as places of learning, operating for the good of the world. Unfortunately, leading research institutions are not living up to their missions … So, students are demanding that these schools start taking concrete steps.”

The UAEM ranking does not focus solely on neglected diseases. Rather, it uses some 14 metrics to look more broadly at whether academic institutions are investing in research that addresses the health of poor communities worldwide.

This includes how those schools are licensing any research discoveries for commercial development, particularly whether they are doing so in socially responsible ways that ensure that related products will be affordable in developing countries. It also includes looking at university programming aimed at creating a subsequent generation of global health practitioners, as well as analysing the extent to which those attempts include a focus on low-income countries and quality of health worldwide.

Under these parametres – the data for which comes only from self-reported, publicly available sources – some of the world’s highest-profile universities fare poorly. Out of 54 schools listed, for instance, 15 are given “D” ratings, including the Massachusetts Institute of Technology (at 39th), New YorkUniversity (40) and ColumbiaUniversity (45).

By deadline, none of these schools had responded to request for comment for this story.

Clear challenge

Kiddell-Monroe notes that global health is no longer the sole prerogative of the United Nations or private foundations. Rather, universities are “increasingly a site of key research and development in medicine – a role that is only set to increase,” she says. “For this reason, we need to examine the impact they’re having and hold them to account.”

Researchers have estimated that up to a third of new medicines are developed within the university system, including at least a quarter of current HIV/AIDS treatments.

“Universities play a huge role, yet we really need to consider this role a bit more carefully,” Dr. Unni Karunakara, international president of Medecins Sans Frontieres (MSF), a humanitarian group, told reporters Thursday.

“It is a problem not only when universities are failing to conduct research on diseases that afflict the developing world. But further, when a university discovers a lifesaving new medicine and licenses it to a drug company in such a way that developing world patients can’t afford – that impedes global health.”

Karunakara notes that Glivec, the anti-cancer drug whose renewed patent was recently denied by the Supreme Court of India, was developed largely through research done in universities. It was subsequently priced out of the market in developing countries, however, when the drug was licensed to the Swiss pharmaceutical company Novartis.

“If universities make commitments to prioritise low-income communities, we can go a long way towards improving global public health,” Karunakara says. “Universities have a big role in making sure their research is translated into affordable medications for people in developing countries.”

The study does turn up some mixed data in this regard. For instance, 21 of the universities reported having come up with standards for socially responsible licensing, while more than half of research licenses are “non-exclusive” – though that figure drops to around a third for medical technologies.

Further, “Self-reporting universities rarely seek to patent their technologies in developing countries, at least within the first year of disclosure, meaning that generic drug manufacturers could develop affordable developing-world medical products from these discoveries without fear of patent restrictions,” a report accompanying the report card states.

“Even in the emerging BRICS economies (Brazil, Russia, India, China, South Africa), universities sought patents on new technologies less than 9% of the time, and less than 2% for all other low- and middle-income countries.”

Still, “provisions to promote global affordability in exclusive licenses” were found to be “exceedingly rare”, being included less than 11 percent of the time.

Together, these statistics present a “clear challenge” to universities, MSF’s Karunakara says: “As institutions dedicated to the public good, now is the time for them to step up and play a major role in improving health worldwide.”

Patients, doctors and international aid groups are calling on donors and governments to support measures that would make treatment of drug-resistant tuberculosis more effective and accessible.

The demands are being made amidst the recent or imminent approval of two new drugs, bedaquiline and delamanid. Advocates say the drugs present an historic opportunity to tackle the notoriously difficult-to-treat disease.

“As we know with all infectious diseases, we need to seize this opportunity before an airborne infectious disease gets too out of control,” Dr. Jennifer Cohn, a policy advisor with Medecins Sans Frontieres (MSF), an aid group, told IPS.

On Monday, MSF released a manifesto, signed by TB patients and their doctors in 23 countries around the world, noting that “after close to five decades of insufficient research and development into TB … Research is urgently required to determine the best way to use these new drugs so that treatment can be made shorter and more effective.”

It also warns that “If measures to tackle MDR-TB are not immediately expanded, rates of the disease will continue to increase worldwide, and a historic opportunity to improve abysmal cure rates will have been squandered.”

The call to action comes on the heels of a World Health Organisation (WHO) statement on the wide spread of drug-resistant tuberculosis – and warnings over an anticipated funding gap of 1.6 billion dollars needed to both identify new cases and combat existing strains.

An additional 3.2 billion dollars, according to WHO estimates, could be provided by governments. If the combined 4.8 billion dollars is funded, treatment could be provided for 17 million TB and drug-resistant TB patients.

“We have gained a lot of ground in TB control through international collaboration, but it can easily be lost if we do not act now,” Dr. Margaret Chan, the WHO director-general, said in a statement.

Twenty pills a day

While the overall incidence of tuberculosis has fallen in recent years, drug-resistant strains have increased. In a 2009 resolution to the World Health Assembly, the WHO noted that the highest levels of multidrug resistance reported in the agency’s lobal report “pose a threat to global public health security”.

The spread of resistant strains is particularly alarming because their long and difficult treatment process makes them significantly more difficult to cure than traditional strains.

The MSF manifesto makes reference to regimens that require up to 20 pills a day along with daily injections that make it painful to sit or lie down. The treatment is also known for strong side effects, including severe nausea and even deafness.

MSF is calling for universal access to diagnosis and treatment for patients suffering from drug-resistant tuberculosis, as well as the development of “more tolerable” drug regimens, and additional financial support from international donors and governments for research.

Perhaps the most serious obstacle to filling the 1.6-billion-dollar funding gap is the massive federal budget cuts that went into effect here in Washington in early March. These are slated to cut deeply into development assistance, including international health.

For instance, the United States will reduce its contribution to the Global Fund to Fight AIDS, Tuberculosis and Malaria alone by 300 million dollars, according to figures revealed by Secretary of State John Kerry.

“The United States is the number one donor to the Global Fund, and the Global Fund is the number one donor for treating multi-drug-resistant TB,” Cohn says. “So budget cuts are definitely a concern.”

Still, she notes, one of the biggest challenges lies in fostering cooperation among manufacturers.

“We need to see manufacturers engaging in trials on the different [anti-TB] drugs together, to determine their efficacy and to develop a regimen that works as strongly and safely as possible,” she says. “Unfortunately, we have not seen a lot of progress on this.”

Drug reservations

One of the drugs being lauded in the manifesto is bedaquiline. But some watchdog groups here are sounding alarms about the drug’s safety.

“I don’t have any problem with looking for more drugs to treat disease that is a terrible problem in many countries, but it has to be done very carefully and cautiously,” Dr. Sidney Wolfe, the director of the Health Research Group at Public Citizen, a Washington-based advocacy group, told IPS.

In a letter to the U.S. Food and Drug Administration sent in December, Public Citizen strongly opposed any accelerated approval of bedaquiline, noting that the drug has been shown to be highly dangerous in clinical trials. The letter referenced findings that patients taking bedaquiline in addition to standard TB treatment were five times likelier to die than those who took a placebo.

Despite these concerns, bedaquiline was approved in December.

“There are two possibilities,” Wolfe says. “Either [MSF] didn’t read the report [about the five-fold increase in death rate], or they did and decided that since the FDA approved it, it must be ok. Either one of these explanations is unacceptable. How can you be enthusiastic about a drug that is killing so many people?”

Cohn at MSF stresses the need to be vigilant about any new medication, and notes that the drug will now go through an additional phase of testing.

“Any new drug that comes to market we want to watch closely,” she says. “We are looking forward to data that will tell us more about the Phase 3 side effects of bedaquiline.”

The U.S. Food and Drug Administration (FDA), the sector’s primary regulator, has given accelerated approval to a controversial new drug for use by patients suffering from forms of tuberculosis that have proven resistant to other medicines.

Scanning electron micrograph of Mycobacterium tuberculosis bacteria, which cause TB. Credit: NIAID/public domain

While the drug, known as bedaquiline and to be sold under the brand Sirturo, has been lauded by many for offering a new approach to treating tuberculosis resistant to the other two main medicines in use, some are warning that the expedited approvals process circumvented the FDA’s own rules and glosses over significant health risks. According to the FDA’s own findings, these dangers could include a nearly five times greater risk of death.

The results have led to disagreement over how to balance significant and immediate unmet need for new solutions with the possibility that the new drug is outright dangerous.

“I don’t have any problem with looking for more drugs to treat a disease that is a terrible problem in many countries, but it has to be done very carefully and cautiously,” Dr. Sidney Wolfe, the director of the Health Research Group at Public Citizen, a consumer advocacy watchdog here, told IPS.

“No one would have guessed that this drug would have caused more damage than the placebo, but with this very worrisome data you now need to pay attention to the signals.”

Bedaquiline, developed and manufactured by an arm of the U.S. pharmaceuticals giant Johnson & Johnson, is being heralded for its ability to shut down the production of an enzyme that the tuberculosis bacteria need in order to reproduce. It is seen as the first in a new line of such drugs.

The FDA’s conditional approval marks the first time in nearly five decades that the agency has authorised a medicine that attacks tuberculosis in a different way.

While the FDA generally requires a lengthy three-stage testing process before any approval, bedaquiline was given an initial green light after just two periods of study; indeed, the second phase is still ongoing, according to the agency. The FDA has rationalised this stepped-up timetable by pointing to the significant unmet need for such a new approach, while Johnson & Johnson has promised to go forward with a larger, third round of testing in the future.

According to Medecins Sans Frontieres (MSF), the medical aid group, the scale of the multiple-drug-resistant tuberculosis epidemic is “huge” and growing, with 310,000 new cases in 2011 and just 19 percent of the estimated total caseload receiving treatment. On Monday, the group called bedaquiline a “major milestone” compared to current treatments, which typically require two-year regimens of drugs with heavy side effects, and which ultimately cure only about half of patients.

“There is a massive need for improved treatment, so something coming down the pipeline that appears to be significantly better than the standard background therapy is extremely exciting,” Dr. Jennifer Cohn, an infectious disease specialist with MSF, told IPS.

“This process is still predicated on doing a larger, phase 3 trial, so we’re supporting this as an appropriate next step for those in dire need right now.”

Balancing risk

Yet some critics suggest that the results of the second phase of testing were so surprising and so stark that they should have precluded the possibility of an expedited approval – or even halted the testing process outright on ethical grounds.

In randomised testing during the second phase of trials, nine patients taking the drug died, versus two that were assigned to a placebo group. Unfortunately, the testing was so small-scale (involving just 160 people) that it was unable to offer analysis on whether bedaquiline was directly implicated in this higher level of mortality, with the FDA noting simply that “association could not be explained”.

In mid-December, Public Citizen’s Wolfe co-signed a letter to the FDA suggesting that the evidence was strong that the drug could indeed have contributed to at least some of the deaths. He says that if those mortality levels are even partly connected to the drug, moving to a third phase of testing could be immoral.

For five deaths attributed to alcohol poisoning, hepatitis, septic shock and other causes, “bedaquiline cannot be ruled out as a potential contributing cause based on the available data, especially given the paucity of human clinical data with this new experimental drug,” the letter states.

It also suggests that the expedited approval process contradicted the FDA’s own rules.

“It is not possible to conclude that a surrogate endpoint (a marker of potential efficacy) is ‘reasonably likely’ to predict benefit for patients – as required by FDA regulations – when the same clinical trial of a drug using that surrogate endpoint shows a significant increase in mortality,” the letter states.

While the causes of death during the second phase of testing may be officially unexplained, the results clearly gave the FDA pause.

“Because the drug … carries some significant risks, doctors should make sure they use it appropriately and only in patients who don’t have other treatment options,” Edward Cox, a director in the agency’s Center for Drug Evaluation and Research, said in a statement this week.

Bedaquiline will also come with a prominent written warning, stating: “An increased risk of death was seen in the … treatment group (9/79, 11.4%) compared to the placebo treatment group (2/81, 2.5%) in one placebo-controlled trial. Only use [this drug] when an effective treatment regimen cannot otherwise be provided.”

Weakened standard

2012 was a banner year for the FDA’s drugs division, which approved a near-record 35 new medicines. Yet several of these have received criticism, underscoring mounting worries that the FDA’s regulatory strengths have been diminished in recent decades.

Starting in the early 1990s, the U.S. Congress began to turn over a massive amount of funding responsibility for the FDA to the drugs industry itself. According to Public Citizen’s Wolfe, today the industry bankrolls around two-thirds of the FDA’s related analysis – a “huge change in culture at the FDA”.

Simultaneously, Congress has continued to roll back its own oversight over the FDA’s functions. For some, the results have been an agency that remains respected worldwide but which is relatively more beholden to the industry it regulates.

“For a long period of time, the FDA was indeed the gold standard, but it has gotten much worse,” Wolfe told IPS. “Yet because that impression remains today, the approval of bedaquiline will almost certainly prompt further approval and use of this drug in many other parts of the world.”

Innovation in the pharmaceutical industry has declined drastically in the last ten years despite the high profitability of the so-called “research-based” industry, and the availability of better and more powerful science and technological tools. Not only has productivity in terms of research fallen, but the vast majority of new molecules introduced to the market do not provide new therapeutic solutions since other treatments already exist, normally at a lower cost.

Funding for research is focused on areas with the greatest potential for profit. Those areas that would actually have the biggest impact on public health remain largely ignored. A clear indicator is the lack of investment in fighting diseases that are prevalent in developing countries, such as Chagas’ disease, tuberculosis and malaria.

The problem is that although millions would benefit from this type of investment, the majority of them are poor people who do not create an attractive market for big companies. Neither can they benefit from treatments for non-communicable diseases such as cardiovascular insufficiencies and cancer: even where treatments are available, the high prices of patented medications make them inaccessible.

As a result, in the 21st century, communicable diseases cause more than 10 million deaths per year -according to Health Action International (HAI)- of which 90 percent take place in developing countries; a third of the global population does not have regular access to the medicines that they need. The situation is worse in least developed countries (LDCs) in which up to half of the population does not have access to medicinal treatment.

From both a moral point of view as well as a human rights perspective ­ the right to health is recognised in international conventions and in numerous national constitutions ­ this situation calls for greater responsibility by governments and a new research paradigm centered on public health interests, especially to meet the needs of developing countries.

On May 26, 2012, the World Health Assembly adopted a resolution that could mark the first step toward a change in the current pharmaceutical research model. The members of the World Health Organization (WHO) decided to undertake an in-depth examination, at the governmental level, of a report produced in April 2012 by an international group of experts that recommended the adoption of a binding convention on research and development (R&D). If approved and implemented, such research could generate the medicines needed, particularly in developing countries, to address communicable and non-communicable diseases.

Some of the conclusions and recommendations of the report were the following:

– the present incentive systems, in particular intellectual property rights, fail to generate enough R&D in either the public or private sector in order to meet the health needs of developing countries;

– recent trends in the pharmaceutical industry show a decline in innovation, as reflected by the small number of approval of new molecular entities (NMEs), the majority of which do not represent a therapeutic novelty;

– to promote better financing and coordination of research, an open approach should be promoted, with the results of R&D being treated as “public goods” not subject to the exclusive rights conferred by patents;

– new forms of shared financing, direct subventions, prizes and patent pools (to increase access to health products) should also be promoted, and mechanisms to coordinate research should be established at the global level.

The report recommended that all countries should dedicate at least 0.01 percent of their gross domestic product to R&D relevant to meet the health needs of developing countries. As regards coordination, it advised the establishment of a global observatory on R&D, advisory services and a network of research institutions.

The main purpose of the report was, however, more ambitious: to start discussions regarding a possible binding international convention to promote R&D centered on diseases prevalent in developing countries, including non-communicable diseases.

This recommendation caused the biggest controversy between developed and developing countries at the World Health Assembly. A possible explanation is that developed countries perceive the suggestion of a new research model as a threat towards the present system based on the appropriation of profits from innovation through the patent system.

But the convention, if adopted, would generate more resources and greater efficiency in terms of research by means of better coordination and a fixation of priorities. Although the main beneficiaries would be developing countries, developed countries could also utilise the results of the research. Some of these countries face a severe crisis in their public health systems owing to the increase in the cost of treatment and a reduction in budgets.

The magnitude of the problem that must be confronted in order to generate enough R&D for pharmaceutical products needed by developing countries is such that this objective cannot be reached without effective commitment from all countries. Voluntary contributions from foundations or governments do not offer a sustainable, structural solution. In fact, many of the most promising initiatives for developing new pharmaceutical products to address the diseases that affect the poor are extremely vulnerable, as they depend on the continuity of charitable financing.

In order to promote development of new products and their access to populations, especially in developing countries, it is necessary to change the current research model. The cost of research should be delinked from the prices of the products generated. The challenge is not only about increasing investment in research or improving the rate of innovation. This will not suffice if the new products are not accessible to those who need them. (END/COPYRIGHT IPS)

Carlos M. Correa is special advisor on trade and intellectual property of the South Centre, and a member of the Consultative Expert Working Group of the World Health Organization. For further analysis see South Bulletin 67 Article ( http://www.southcentre.org).

HIV/AIDS has caused a steady increase in the number of orphans in South Africa. Credit: Kristin Palitza/IPS

By Sarah McHaney
WASHINGTON, Nov 14 2012 (IPS)

After weathering the departure of its executive director amidst a misallocation scandal earlier this year, the world’s largest funder of programmes to address HIV/AIDS, tuberculosis and malaria is poised to announce a new leader Thursday.

The performance-based Global Fund is a giant in the field of multilateral health financing, channeling 82 percent of the funds for TB, 50 percent for malaria, and 21 percent of the international financing against HIV/AIDS. To date, it has approved 30 billion dollars’ worth of spending.

“They need to do reform 2.0 which focuses on better measurement and accountability on actual disease results,”
Amanda Glassman, director of global health policy at the Centre for Global Development, told IPS.

“We focus too much on paperwork being consistent instead of on what we want the paperwork to achieve,” she said.

The former executive director, Michel Kazatchkine, resigned at the beginning of this year after the AIDS Health Foundation wrote a report in September 2011 urging him to step down amidst a funding misallocation scandal.

More than a year later, the Global Fund is still attempting to recover from that experience, which saw millions of dollars go unaccounted for in four African countries.

“The Global Fund has a terrific record of saving lives,” Deb Derrick, the president of Friends of the Global Fight Against AIDS, Tuberculosis, and Malaria, told IPS. “They have cut their staff by 20 percent and are operating under a tightened budget. I think a good manager is very well-positioned to do even more with the resources at hand.”

The vast majority of that money, 95 percent, has come from the public sector. The United States leads donations, followed by France, Japan, Germany and the United Kingdom.

For this reason, however, the global financial crisis has hit the Global Fund hard, resulting in a large decrease of public sector donations. In May 2011, the Fund stated that it was 1.3 billion dollars short of its proposed budget for 2011-13.

The Global Fund gives grants based not only on need and vulnerability, but also on the results that recipient countries are able to show. Countries apply for each new round of funding and measure their results against the goals set by previous grants.

In November 2011, the Global Fund was forced to cancel its 11th round of funding due to inadequate resources from donors.

The Fund also suffered, both politically and financially, following the misallocation scandal that came to light in early 2011. Months prior, the Global Fund’s independent Office of the Inspector General had published reports finding that 34 million dollars had gone unaccounted for in four African countries receiving grants.

Germany and Sweden both suspended their donations following this discovery, although they resumed funding in 2011.

In direct response, in September 2011 the Global Fund announced a new five-year strategy for 2012-16 that supports more “aggressive management and oversight of grants, encourages more flexibility in tailoring activities to specific country’s needs, and embraces more country ownership of programs through increased involvement of country governments.”

Still, the Global Fund remains one of the most transparent aid organisations in the world – a fact that led to the discovery of misallocation in the first place. According to the Aid Transparency Index, a ranking of 77 aid-giving organisations and countries, the Global Fund is the fourth in the world.

“I think the inspector-general has done a fabulous job in looking at how to make the Fund more transparent and has undertaken a lot of the reforms and activities to achieve this,” Derrick told IPS.

In September, the Board approved a new funding model for the Global Fund based on the decrease in donations. The new model changes the way in which countries apply for grants, with the aim of putting more money into the most vulnerable populations.

However, there is concern that this will stray slightly from the performance-based funding for which the Global Fund is renowned.

“In order for the Global Fund to remain distinguishable from other organisations that can handle the money such as the World Bank, it needs to build out their performance base model and their accountability for results,” Glassman told IPS.

“If the Global Fund does this it will thrive in the next 10 years of its existence.”

Others are concerned that the new funding model would virtually leave Latin America and the Caribbean out of the Global Fund’s granting, due to how the Fund categorises income levels.

Commenting on this criticism, Derrick says, “Part of this whole reform effort is adjusting to this fiscally constrained environment, getting the money to where it is most needed, and trying to make sure that all vulnerable populations have money allocated to them.”

In October, the U.S. government passed a budget that included a 27-percent increase in funding for the Global Fund. However, the budget also included significant cuts to programmes that addressed only one of the diseases focused on by the Global Fund.

This will likely result in an increase of applications for grants from the Global Fund as money dries up from the U.S. malaria and TB programmes.

“In my view, this budget assignment shows a moving towards multilateral efforts and away from U.S. bilateral efforts. In terms of multilateral aid, the Global Fund performs well,” Glassman told IPS.

The new executive director will have to manage the new funding plan as well as the likely increase of applications while still maintaining the Global Fund’s defining principles.

Secretary-General Ban Ki-moon (centre) speaks with a tuberculosis (TB) patient during his visit to the Institute of Respiratory Medicine in Kuala Lumpur, Malaysia. Credit: UN Photo/Eskinder Debebe

By Sarah McHaney
WASHINGTON, Oct 17 2012 (IPS)

The next several years could see either the elimination of tuberculosis in some regions or millions of otherwise preventable deaths, according to new research released in Washington Wednesday by the World health Organisation (WHO).

The outcome, experts are warning, rests on a three-billion-dollar gap in funding needed to fully address TB next year as well to ensure the proper introduction of new drugs.

“On the one hand we have existing as well as new tools on the horizon which could make a significant difference and even support dreams of elimination (of TB) in some regions,” Dr. Mario Raviglione, director of the WHO’S Stop TB Department, told journalists Wednesday.

“On the other hand, we are at the risk of stagnation if additional resources are not urgently mobilised by the governments of affected countries and the international community.”

The global burden of TB remains enormous. The reported 1.4 million deaths related to the disease last year means that TB remains the second largest killer among infectious diseases.

“The WHO’s new Global Tuberculosis Report reinforces that multidrug-resistant tuberculosis is an escalating public health emergency, yet the global response is abysmal,” Dr. Grania Brigden, TB advisor for Médecins Sans Frontières’ Access Campaign, said in a press release.

Yet experts are optimistic that new drugs, if properly introduced, could see the elimination of TB within their lifetimes. New or re-purposed TB drugs, as well as new regimens to treat drug-sensitive or drug-resistant TB, are advancing in clinical trials and regulatory reviews, according to the report.

“We expect two if not three entirely new compounds that kill the TB virus very effectively to be available in the next few months,” Dr. Raviglione said.

These are the first new TB drugs in nearly a half-century, and the first drugs designed specifically for the treatment of the lung disease.

Out of the 8.7 million new cases of TB in 2011, close to a million were multi-drug resistant (MDR) TB. Only one in five MDR-TB cases are being properly diagnosed and reported, meaning most of the infected population is spreading the disease unknowingly.

Drug-resistant TB results from patients not being treated properly for regular TB.

“These two new drugs have not been used against TB before, so we are not likely to have resistance against them – and they look very promising,” Dr. Anthony Fauci of the National Institutes of Health (NIH) said Wednesday.

If these new drugs are introduced into TB treatment regimes correctly, experts say there is a chance they will start the end of the disease. Yet the gap in funding is putting this goal and millions of lives at risk.

“People can either pay now or pay more later,” warned Dr. Kenneth Castro of the U.S. Centers for Disease Control and Prevention.

Added Raviglione, “History teaches that in the fight against TB, a job not done is a fatal mistake. Efforts have paid off and saved millions of lives.”

These critical funds are needed to properly introduce these new drugs, ensuring that they are used to treat MDR-TB cases and are properly administered. The funding issue is compounded by the fact that the countries with the highest TB rates are often the least developed countries.

Based on past trends of TB funding, at least one billion dollars every year of the three-billion-dollar gap needs to come from the international community.

Africa has 10 of the 22 countries hardest hit by TB. Across the continent, the disease is also the primary cause of death for persons infected with HIV; globally, there are 1.1 million people afflicted with both TB and HIV.

“In Africa, the funding gaps are biggest relative to the need. There is probably a gap of half a billion dollars a year for just TB and another half for TB-HIV related treatment,” Katherine Floyd, coordinator of TB Monitoring and Evaluation at the WHO, said Wednesday.

In order to close this funding gap, Dr. Elizabeth Fox at USAID, the U.S.’s foreign aid arm, emphasises the importance of working with national TB programmes.

“Since 1998, USAID has put 1.6 billion dollars into this programme, and USAID will continue to be a strong supporter of the TB programme,” Dr. Fox said.

Efforts such as these have paid off, the WHO report suggests. In the past 17 years, 51 million people have been cured of TB and an estimated 20 million lives were saved.

“Without that treatment, 20 million people would have died,” said Raviglione. “This milestone reflects the commitment of governments to transform the fight against TB.”

Despite such commitments and successes, the global response is still falling short, a deficit that could lead to millions of additional deaths in coming years.

“I am completely optimistic that we can produce the drugs we need to fight tuberculosis. The question is, are we going to do it?” Dr. Fauci asked. “In my opinion, not addressing this is just not an option. I think we as a global society have a moral obligation to address this problem.”