Stop TB Partnership

Amsterdam Ministerial Conference

22-24 March 2000 Amsterdam, The Netherlands

Reports

Download the Amsterdam Report [.pdf]

Amsterdam declaration

English [.pdf], Chinese [.pdf], Russian [.pdf], French [.pdf], Spanish [.pdf]

Conference summary

Today, on World TB Day, all 20 countries present at the Ministerial Conference on TB and Sustainable Development have endorsed a declaration to take action on stopping TB world wide. His Excellence, Korn Dabbaransi Minister of Health, Thailand spoke on behalf of the Ministers of Health, Planning and Finance from the 20 countries that are the home of 80 percent of the world’s TB cases. "We today declare our intention to ensure that all TB patients in our countries have complete access to lifesaving cures for TB. We declare our intent to ensure effective, lifesaving medicines are available to all who suffer from this disease. Global access to effective TB treatment is a human right. Global access to effective TB treatment is also a government’s responsibility for protecting the health and welfare of the public."

In the short term, this means that countries must provide:

  • Readily available supplies of anti-TB drugs
  • Unhindered access to TB treatment
  • Effective systems to provide these medicines to patients
  • Affordable medicines for those who have developed drug-resistant TB

For the longer term, countries must develop:

  • Stronger, quicker-acting drugs
  • An effective vaccine

To make these objectives possible, the countries declared their intention to work in concert with WHO, the World Bank and others to create the following:

  • A global partnership agreement to Stop TB – the framework for action that will operationalize the declarations made during this Conference.
  • A Global Fund for Tuberculosis to mobilize and invest new, additional resources to support these activities – with a special focus on making life saving treatment cure universally accessible.
  • Accelerated research into the development of new tools, including diagnostics, drugs and vaccines.

The 20 countries unanimously committed themselves to meet the following objective by 2005: expanding coverage of the WHO-recommended strategy to combat tuberculosis – DOTS – to provide for at least 70% detection of all infectious cases by the year 2005. "This is our first and most important measurable step in providing global access to lifesaving tuberculosis medicines".

Dr David Heymann Executive Director, Communicable Diseases, World Health Organization stressed that actions must be taken to improve and expand TB control efforts around the world. "If we succeed in these efforts – and we must succeed – we will not only stop drug resistance from increasing, but in doing so we will save millions of lives and billions of dollars. We will also protect countries that are currently free of multidrug resistant TB – such as the Netherlands. Yes, it is inevitable that this super-deadly bacilli will eventually spread to the Netherlands in the near future. It is only a matter of time, as the world is shrinking as international travel is expanding. If we lose our race against time to repair TB treatment practices around the world that are unintentionally causing the emergence of MDR TB, there is no guarantee that drug resistant strains of TB might not one day become as crisis here in the Netherlands as it has been for New York City, Russia and parts of Eastern Europe".

Dr Gro Harlem Brundtland, Director General, World Health Organization, explained: "For the first time, we have evidence the drug resistant tuberculosis bacilli that have shaken New York City and Russia are increasing elsewhere. If countries do not act quickly to strengthen their control of TB, the multidrug resistant strains that have cost New York City and Russia hundreds of lives more than $1 billion each to control will continue to emerge in other parts of the world. North America and Europe may have the billions of dollars required to contain this emergency. The worst affected countries in Asia, Africa and Latin America do not.

Released today, Anti-Tuberculosis Drug Resistance in the World - Report No. 2 represents the first report ever to provide information on trends in global drug resistance. The report presents data from 72 countries and regions. We suspected that drug resistance was worsening in many parts of the world when we compiled the first report in 1997. This report confirms our worst fears.

For the past three days, the Ministers of Health, Ministers of Planning and Ministers of Finance from the 20 worst-affected countries have been meeting to discuss strategies for accelerating efforts to "turn off the tap" of drug resistance.

Literally, this is a public health crisis where $10 of prevention is worth $5,000 dollars of cure. If we cure TB patient’s right the first time, the medicines cost as little as $10 per patient in developing countries. If we are careless in providing for their treatment, the medicines may then cost over $5,000 the next time they become sick. For most people in developing countries who have TB this cost is prohibitive, making TB a virtual death sentence.

During this conference, we have all become convinced that the economic and social costs of tuberculosis are just as staggering as their economic costs. Take for example India. More than 300,000 children are forced to leave school each year because of their parent’s tuberculosis, and more than 100,000 women with tuberculosis are rejected by their families due to social stigma. It is estimated that the economic cost of TB to India is more than $2 billion each year.

These costs – both medical as well as economic and social – will only continue to sharply rise the longer we wait and give opportunity for drug resistance to spread.

Some may chose to ignore danger signs now and find the money later. I disagree. The time for a massive effort to control tuberculosis is now, not later".

Dr Donna E. Shalala Secretary of Health and Human Services, USA, said: I am optimistic about the prospects for success. I would like to briefly share a few lessons we have learned from our own truggle to contain this epidemic in New York City.

In 1992, the number of tuberculosis cases in New York City had tripled from the previous decade. Nearly 4,000 people in the metropolitan area became sick from the bacilli that year, one out of every three patients would not respond to one or more of the highly-effective medicines used for treating it. More than 500 of these patients who became sick with multidrug-resistant TB strains eventually died.

I would highlight three lessons we learned about how to bring the problem of drug resistant TB under control.

First, make TB treatment accessible for patients, not something to fear. Second, spend the money now, rather than later. It costs just $10 to $20 for the medicines to cure TB in developing countries. But if we permit the disease to become drug resistant, drug costs increase 100-fold. And third, fight epidemics globally to protect people locally.

International travel continues to double every decade. Diseases can now criss-cross the world in hours in first class cabins. There are no practical and effective ways of building a "fortress America" or "fortress Europe" against strains of TB around the world. But there are effective and proven ways for even the poorest counties to prevent drug resistance from emerging in the first place".

Participants

Ministerial Delegations from the Following Countries:

Bangladesh
Brazil
Cambodia
China
Congo DR
Ethiopia
India
Indonesia
Kenya
Nigeria
Pakistan
Peru
Philippines
Russia
South Africa
Tanzania
Thailand
Uganda
Viet Nam
Zimbabwe

Plenary Speakers:

- Dr Els Borst-Eilers, Minister of Health, Welfare and Sport, The Netherlands
- Dr Gro Harlem Brundtland, Director-General, WHO
- Dr William H. Foege, Sr Advisor, Gates Foundation
- Ms Eveline Herfkens, Minister for Development Cooperation, The Netherlands
- Dr David L. Heyman, Executive Director WHO Programme on Communicable Diseases
- Dr Arata Kochi, WHO, Director Stop TB Initiative
- Ms Mieko Nishimizu, Vice-President, The World Bank
- Dr James Orbinski, President of Médicins Sans Frontières (MSF)
- Dr Peter Piot, Executive Director UNAIDS
- Mr Andre Roberfroid, Executive Director for Programme and Planning, UNICEF
- Dr Donna Shalala, Secretary, Department of Health and Human Services, USA
- Ms Hilary Bowker Moderator
- Ms Keshini Navaratham Moderator
- His Royal Highness Prins Claus of The Netherlands Special guest
- Honourable Clare Short, Secretary of State for International Development, Session Chair

Representation of Government Organizations:

- Cabinet of Development Cooperation, Belgium
- Department for International Development, UK
- Department of Health and Human Services, USA
- Embassy of the Federal Republic of Germany
- International Cooperation, Minstry of Foreign Affairs, The Netherlands
- Minister for Environment and Development Cooperation, Finland
- Ministère de l'Emploi et de la Solidarité, France
- Ministre Plénipotentiaire, Luxembourg
- Ministry of Health and Social Services, Finland
- Ministry of Health and Welfare, Japan
- Ministry of Health, Welfare & Sport, The Netherlands
- National Institute of Public Health and Environmental Protection (RIVM), The Netherlands
- Service National des Maladies Infectieuses, Luxembourg
- Swedish International Development Cooperation Agency (SIDA)

UN Agencies & Other Organizations:

- UNICEF
- UNAIDS
- The World Bank
- WHO
- American Lung Association
- American Thoracic Society (ATS)
- Centers for Disease Control and Prevention (CDC)
- German Development Bank
- International Committee of the Red Cross (ICRC)
- International Federation of the Red Cross and Red Crescent Societies (IFRC)
- International Pediatric Association (IPA)
- International Union Against Tuberculosis and Lung Disease (The Union)
- Partners in Health
- Public Health Research Institute (PHRI)
- The Rockefeller Foundation
- Royal Netherlands Tuberculosis Association (KNCV)
- Royal Tropical Institute (KIT)
- Soros Foundation/Open Society Institute
- U.S. Agency for International Development (USAID)

Agenda

Wednesday, 22 March 2000

19:30-20:00 Opening Ceremony
  Welcoming Remarks
Dr Gro Harlem Brundtland
Director-General, World Health Organization
Statement
Ms Eveline Herfkens
Minister for Development Cooperation, The Netherlands
20:00 Dinner Reception
  Hosted by
Ms Eveline Herfkens
Minister for Development Cooperation, The Netherlands

Thursday, 23 March 2000

08:45-09:30 Session one
  Improving Health: A Catalyst for Development
08:45-08:50 Opening of Session
Ms Clare Short, Secretary of State, Session Chair,
United Kingdom of Great Brittain and Northern Ireland
08:50-09:00 "TB Control: A Dynamic Process in a Low Burden Country"
Dr Els Borst-Eilers
Minister of Health, Welfare and Sport, The Netherlands
09:00-09:10 "Meeting the Threat of TB: The Case of New York City"
Dr Donna Shalala
Secretary, Department of Health and Human Services, USA
09:10-09:15 Video Clip
"Tuberculosis and Sustainable Development"
09:15-09:25 "Tuberculosis Control: Why it Makes Development Sense"
Ms Mieko Nishimizu
Vice-President, The World Bank
09:25-09:30 Closing of Session
Ms Clare Short, Session Chair
 
09:30-10:00 Tea/Coffee
 
10:00-12:30 Session Two
  Confronting and Overcoming Challenges
10:00 Opening of Session
Dr David Heymann, Session Chair
Executive Director, WHO Programme on Communicable Diseases
10:05-10:15 TB, HIV/AIDS and the Global Response
Dr Peter Piot
Executive Director, UNAIDS
10:15-10:20 Short Video
"Tuberculosis and HIV/AIDS - the dual epidemic"
10:20-11:45 Ministerial Panel - Confronting and Overcoming Challenges
Presentations: Kenya, Peru, Tanzania, United Republic of Bangladesh, Viet Nam followed by Plenary Discussion
11:45-12:00 Summary of Discussions-Session Two
Dr David Heymann, Session Chair
 
12:00-13:30 Lunch
 
13:30-15:00 Session Three
  Taking Action
13:30 Opening of Session
Dr Ernest Loevinsohn - Session Chair
Director General, Canadian International Development Agency (CIDA)
13:35-13:45 Opportunities for Action
Dr Arata Kochi, Director, Stop TB Initiative, WHO
13:45-13:55 Personal Testimony on TB
Mr Ram Khadka, Katmandu, Nepal
13:55-14:00 Video Clip - "Serving the Poor: Primary Health Care and TB Control in Peru"
14:00-14:45 Preparation Session - Conference Declaration
H.E. Korn Dabbaransi, Declaration Chair
Minister of Public Health, Thailand
14:45-14:50 Closing of Session
Dr Ernest Loevinsohn, CIDA
14:50-15:00 Transition to Concurrent Roundtables
 
15:00-17:30 Session Four
  Concurrent Roundtables
15:00-16:00 Concurrent Roundtables-First Round
Roundtables are open to all Conference participants and will consist of short country presentations followed by facilitated group discussions
  Finance Track, Health Track
  (Ball Room ABC), (Staten/Nassau Room)
  "Socio-economic impacts of TB and TB/HIV"
"TB and Health Systems Development"
  Dr Peter Piot, Session Chair, Executive Director, UNAIDS
Ms Satu Hassi, Session Chair, Minister for Environment & Development Cooperation, Finland
  Short presentations by: India, Indonesia, Uganda, Zimbabwe, Cambodia, China, Ethiopia, The Philippines, Viet Nam
 
16:00-16:30 Tea/Coffee
 
16:30-17:30 Concurrent Roundtables-Second Round
  Finance Track, Health Track
  (Ball Room ABC), (Staten/Nassau Room)
  "Options for Financing and Sustainability"
"Strategies to Cope with the Dual Epidemic"
  Dr David Nabarro, Session Chair, Project Manager, Roll Back Malaria, WHO
Dr Uton Muchtar Rafei, Session Chair, Regional Director, SEARO, WHO
  Short presentations by: DR Congo, Pakistan, The Philippines, The Russian Federation, South Africa, Thailand, Uganda, Zimbabwe
 
17:30 Adjourn
 
17:30-18:30 Convening of Declaration Drafting Group
(Incorporating Contributions from Ministerial Roundtable Rapporteurs) 
 
18:45 Boat Tour of Amsterdam Canals
followed by Dinner at The Grand
 
20:00 Dinner
  Event hosted by
Dr Els Borst-Eilers,
Minister of Health, Welfare and Sport, The Netherlands
 
Friday, 24 March 2000
08:45-11:00 Session Five
  "Investing in Health for the Long-term"
Co-Chaired by: Ms Mieko Nishimizu - Vice-President, The WorldBank
Dr Gro Harlem Brundtland - Director-General, WHO
08:45 Opening of Session
Ms Mieko Nishimizu - Session Co-chair
08:50-09:30 Presentation of Roundtable Summaries
Rapporteurs from Concurrent Roundtables held on Thursday, 23 March
09:30-09:40 "TB &Sustainable Development - Lessons from Other Health Programs"
Dr William H. Foege, Senior Health Adviser, Bill and Melinda Gates Foundation
09:40-10:50 Ministerial Panel - "Financing andSustainability"
Presentations: Brazil, China, India, Nigeria
followed by Plenary Discussion
10:50-11:00 Closing of Session
Dr Gro Harlem Brundtland - Session Chair
 
11:00-11:30 Tea/Coffee
 
11:30-12:00 Adoption Session: "Amsterdam Declarationto Stop TB"
H.E. Korn Dabbaransi, Declaration Session Chair Minster of Public Health, Thailand
 
12:00-13:30 Lunch
 
12:45-13:30 Press Conference & Launch of World TB Day 2000
 
13:30-15:15 Concluding Session
  "Forging New Partnerships to Stop TB"
Co-Chaired by: Dr Hussein Gezairy - Regional Director, EMRO,WHO
Dr Barbara Turner - Acting Deputy Director, USAID
13:30 Opening of Session
Dr Hussein Gezairy - Session Co-Chair
Regional Director, EMRO, WHO
13:35-13:45 "Tuberculosis - Women and Children Can No Longer Wait"
Mr Andre Roberfroid
Deputy Executive Director, UNICEF
13:45-13:50 Forging New Partnerships to Stop TB
Dr James Orbinski
President of Médecins sans Frontières (MSF)
13:50-14:50 Ministerial Panel - "Partnerships for Action"
Presentations: DR Congo, Indonesia, Nigeria
followed by Plenary Discussion
14:50-15:05 Concluding Address
"Forging New Partnerships to Stop TB: A Development Imperative"
Dr Gro Harlem Brundtland, Director-General, WHO
15:05 Conference Adjourns
 
15:05 Tea/Coffee

Country Speeches

Background information

Intro

Tuberculosis (TB) is a global threat. Nearly two million people die of the infectious disease every year, despite the fact that a highly cost-effective TB control strategy exists. Millions more are unable to work or care for their children due to TB, resulting in significant social and economic costs.

Tuberculosis (TB) is a global threat. Nearly two million people die of the infectious disease every year, despite the fact that a highly cost-effective TB control strategy exists. Millions more are unable to work or care for their children due to TB, resulting in significant social and economic costs. The epidemic is worsening, especially where the related HIV/AIDS epidemic also rages. In addition, increasing reports of multi-drug resistant TB are alerting the world that we can quickly lose ground on health and development gains, if we do not accelerate our actions now.

In this era of international trade, travel and migration, tuberculosis control is increasingly seen as a global public good. It makes sense to invest in TB control as the benefits accrue to all communities.

Key governments of 20 high burden countries are being invited to the Conference in order to better understand the social and economic impacts of TB; assess how effective tuberculosis programmes can contain the epidemic and contribute to overall development; and identify priority actions for the new millennium.

Some countries have taken the lead in demonstrating that effective tuberculosis programmes can be put in place quickly with political and civic support. These examples provide clear evidence of a country's commitment to good governance, equity and human rights.

This Ministerial Conference on TB and Sustainable Development is a valuable opportunity to strengthen national responses to tuberculosis in the context of health and social development, including developing strategies for sustainable financing, resource mobilisation and partnership building.

I. Conference outline

The objective of the Ministerial Conference is to examine tuberculosis (TB) in the context of social and economic development. How is the TB epidemic impacting on development? How can an effective, inter-sectoral response to TB contribute to strengthening health systems, poverty alleviation, good governance, equity, and overall improved health and development status?

To achieve this, Conference organizers are aiming to engage ministers of health, finance and development planning, along with top civil servants, from twenty of the highest burden countries in the world. High-level delegations from donors and technical health agencies are also expected to participate in the discussions.

The Conference will call for concerted global action to accelerate equitable access to TB treatment and prevent the further spread of TB and Multi-Drug Resistant TB through mobilizing all relevant sectors, both public and private.

The meeting is structured around keynote addresses, panel presentations and discussion, and ministerial roundtables addressing:

  • Socioeconomic Impacts of TB
  • Challenges posed by the dual epidemic of TB & HIV/AIDS
  • TB and Health Systems Development
  • Options for Financing and Sustainability, and,
  • Partnerships for Action

Panel presentations by country delegations (5 minutes each) will highlight key issues relevant to the panel theme, based on their country experience, which will be followed by discussion.

Ministerial Roundtables will allow Ministers to convene into smaller parallel sessions, one focused more on finance issues and the other on health systems. As in the panels, presenting country delegations will briefly highlight strategies and challenges based on their country experience, followed by discussion.

Open exchange of information between and among country delegations, donors and other participants is expected. As such, sessions are open to all Conference participants.

The Conference will culminate in the launch of World TB Day 2000 on the theme of "Forging New Partnerships to Stop TB."

II. Background situation analysis documents

This set of documents will review the status of TB, TB/HIV, and MDR-TB in the world today, as well as the implications for sustainable development.

Stop TB 2000: TB and Sustainable Development [.pdf] (PDF file) outlines the social and economic tolls which TB continues to exert on populations around the world, and then gives evidence of the significant contribution which effective TB control can make to social and economic development and to poverty alleviation.

Social and Economic Impacts of TB [.pdf] is a review of research on the social and economic impacts of TB , with particular attention to family and community level impacts.

Country profiles for the 20 participating high burden countries will outline the human development indicators as well as the TB situation for each country.

WHO Global TB Control 2000 Report [.pdf] presents key epidemiological findings regarding the status of TB and DOTS implementation around the world.

Multi-Drug Resistant TB (MDR-TB) 2000 white paper outlines the most recent findings on the status of multi-drug resistance around the world–including identification of MDR-TB "hot spots".

III. Stop TB Action briefs

This set of documents will be 1-2 page briefs on the different areas of strategic action being led the Stop TB Initiative. These 1-2 page briefs will outline key components of the activities below