Plagues, Pestilences and Diseases
Experts: More Tuberculosis now than ever and U.N. efforts failing
A nurse administers a shot to tuberculosis patient Rupali Kalita, 25,
at the state TB hospital in Gauhati, India, in April 2010.
GENEVA (AP) — Global efforts to control tuberculosis have failed and
radical new approaches are needed, experts said Wednesday.
With more than 9 million people infected last year, including 2 million
deaths, officials say there is more tuberculosis now than at any other
time in history. In a special tuberculosis edition of the British
medical journal Lancet published on Wednesday, experts said past
failures prove new strategies are required.
For years, the World Health Organization and partners have fought TB
largely with a program where health workers watch patients take their
drugs — even though the agency acknowledged in a 2008 report that this
treatment program didn't significantly curb TB spread.
Experts said TB isn't only a medical problem, but is intertwined with
poverty, as it spreads widely among people living in overcrowded, dirty
places. They said TB programs need to go beyond health and include
other sectors like housing, education and transportation.
Some officials questioned whether continued U.N. programs could even
combat TB. "The main priority for TB control is improved living
conditions and economic growth, which is outside the control of the
U.N.," said Philip Stevens, a health policy expert at International
Policy Network, a London-based think tank. "TB cannot be tackled in
isolation."
Stevens said the global health community also needs to be more vigilant
about the drugs they buy for TB programs. According to a 2007 report
from the Global Fund to fight AIDS, Tuberculosis and Malaria, half of
the drugs the fund bought for poor countries didn't comply with their
own drug quality standards.
Dr. Mario Raviglione, head of WHO's TB department, said the recent fall
in TB was "very minor" and that the agency was trying to understand how
better to fight the epidemic.
Still, WHO said their basic TB programs cured more than 36 million
people between 1995 and 2008, and saved up to 6 million from dying of
the potentially fatal lung disease.
But the recent spread of drug-resistant TB illustrates there have been
major shortcomings. Drug-resistant TB emerges when patients don't
finish their pills or take substandard drugs — like many of those
bought by the Global Fund.
One of the public health community's biggest failings in fighting
drug-resistant TB is the lack of basic data. In a WHO report published
in March, the agency said it didn't know whether the global outbreak of
drug-resistant strains are getting bigger or smaller.
"It is surprising how much data we're lacking," said Pamela Das,
executive editor at Lancet, who co-authored an accompanying commentary
in the journal. "There are so many gaps that we don't really know
what's going on."
One of the Lancet papers called for the disease to be eliminated by
2050, while another said WHO guidelines on treating people infected
with both TB and AIDS were not based on good evidence and needed to be
revised.
Das said WHO and partners should be proud of drop in TB cases, but that
the agency has failed to achieve its mandate and those gains could soon
be reversed. She doubted the disease could be wiped out by 2050 unless
current strategies addressed the poverty underlying much of TB.