WORLD HEALTH ORGANIZATION DIRECTOR-GENERAL NOMINEE SEES REDUCTION IN TB TRANSMISSION

BUT HIV A MAJOR THREAT TO TB CONTROL

Dr Jong Wook Lee, Director-General nominee of the World Health Organization (WHO), said today that for the first time since WHO declared TB a ‘Global Emergency’ in 1993 there are real prospects for turning the tide against the epidemic -- but only if the international community kept its focus, accelerated action particularly in the key endemic countries and increased resources for the Global Plan to Stop TB.

Speaking in London at a press conference organized by the global Stop TB Partnership on World TB Day (24 March 2003) with UK Secretary of State for International Development Clare Short, Dr Lee said the accumulating number of patients cured under DOTS, the internationally recommended TB strategy, has clearly slowed the spread of infection and signals a significant public health development. The international health community was closing in on TB, with a clear programme strategy and effective structures to do the job.

"By redoubling our efforts - and with strengthened funding for the Global Plan to Stop TB - we could expect to see a reduction in the sickness and death caused by tuberculosis world wide within the next few years, as we are already seeing in some countries like Peru," he said. "But we stand at a crossroads in this struggle and must not lose our direction and momentum. If we falter in our efforts at this crucial juncture, the hard-won progress of the past decade could easily be halted and even reversed."

The number of countries that have adopted the DOTS strategy has grown from fewer than 20 in 1993 to 155 and more than 60 percent of the world’s population now have access to free DOTS services, according to the WHO 2003 Global TB Control Report published today (24 March). Ten million patients have been cured by DOTS – more than 90 percent of them in developing countries. In recent years, DFID, the World Bank and other major donors have significantly increased funding to support the Global Plan to Stop TB.

Secretary of State Clare Short said: "There is good news today - curing 10 million TB patients is a massive achievement. But TB remains a significant problem for the world and hits poor communities very hard. We must make better progress. We can only do that by working in partnership with governments and other agencies to build sustainable systems that can deliver treatment to all."

But Dr Lee warned that while TB transmission had been reduced, the main drivers of the epidemic – HIV infection, population growth, poverty and migration – would capitalise on any letup in efforts:

"The TB epidemic is still growing unabated in Africa and the countries of the former Soviet Union, where it is linked with HIV/AIDS, poverty and social disruption. One third of the world's entire population is infected with TB bacilli, and when HIV hits a pool of latent TB infection it is like putting a match to petrol. We have seen this most clearly in sub-Saharan Africa, where TB rates have quadrupled in some high-HIV countries since the mid-1980s. Our greatest fear is that as HIV becomes entrenched, a new explosion of tuberculosis could be ignited."

As antiretrovirals are more widely used to extend the lives of people living with AIDS, DOTS must become part of the treatment package for people with TB and AIDS, he said. Treating their tuberculosis is the surest and most cost-effective way to increase life expectancy.

Among the main national success stories cited by WHO:

• In India, which alone accounts for nearly a quarter of the global burden, more than 1 million TB patients have been treated since DOTS expansion began in late 1998, and 50,000 new patients are now started on treatment every month. By early 2002, the DOTS program was credited with already saving 200,000 lives and more than US $400 million in indirect costs. In China, second on the list of high burden countries, 1.3 million people with infectious TB have been treated under DOTS over the last decade and 90 percent of them cured. As a result, active TB cases have fallen 35 percent in areas applying DOTS compared to a small increase in areas not covered. The DOTS expansion programs in both India and China have been supported with loans from the World Bank.
• Two high burden countries, Vietnam and Peru, have already exceeded the global TB control targets for 2005 of identifying 70 percent of infectious TB cases and curing 85 percent of those identified. As a result, Peru fell off the list of high burden countries in 2000 and TB cases are now falling by 6 percent annually.
• TB control programs in three other high burden countries -- the Philippines, Myanmar and Cambodia -- are making strong headway and within reach of the 2005 targets.

The steady expansion of DOTS at country level since 1993 has been accompanied by the creation of new international structures that have greatly improved co-ordination of TB strategy, operations, research and funding at the global level.

• The global Stop TB Partnership, launched by WHO in 1998, has grown to more than 250 members, including donor institutions like the World Bank, foundations, NGOs, universities, and organizations represented by George Soros and Bill Gates.
• The Global Drug Facility, an innovative mechanism operated by the Partnership to ensure access to TB drugs for low-income countries, has already made grants for 1.8 million TB patient treatments since its launch on World TB Day in 2001. It has also reduced the cost of TB drugs by 30% to less than $10 for a full treatment.
• The Green Light Committee, which assists country programs to treat multidrug-resistant TB (MDR-TB), has reduced the cost of second-line TB drugs by more than 95 percent through negotiations with the pharmaceutical industry.
• The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) has devoted nearly US $250 million in funding during its first two years to TB control programs in 16 of the 22 high burden countries.
• Most important, Stop TB partners have a shared strategic vision - the Global Plan to Stop TB. A unique document developed by 150 experts around the world, it sets clear targets with required inputs and measurable outcomes to cut the global TB burden in half by 2010 relative to 2000 levels.

Notes to editors

1. For more information please contact Becky Owens on 0207 733 9473/07779 260454 (mobile) or Sangeeta Haindl on 0208 761 5531/ 07786 542776 (mobile); Paul Sommerfeld, TB Alert, London on 0208 969 4830/07979 860266 (mobile); or Georgina Kenyon, WHO/Geneva, on 004122 791 3983.
2. Images of TB patients can be downloaded from the Stop TB Image Library at http://www.worldlungfoundation.org/library.html
3. The Stop TB Partnership was established by WHO in 1998 as a broad-based social movement to combat TB. In 2001 the Partnership launched the Global Plan to Stop TB, which aims to identify 70 percent of all people with infectious TB globally and ensure that 85 percent of those detected are successfully treated by the end of 2005. Over 250 organisations are now signed up to the Partnership.