First Stop TB Partners’ Forum
Evening Dispatch
Washington, DC, USA - Monday, 22 October 2001

Nearly 200 participants gathered in Washington DC today for the opening of the first World Bank-hosted Partners’ Forum to Stop TB, organized with WHO and co-sponsored by ten international and nongovernmental organizations (NGOs)*.

The welcome address by World Bank President James Wolfensohn depicting a ‘community seeking one world’ set the stage for a memorable keynote speech delivered by TB pioneer Sir John Crofton (aged 89) who celebrated the historic progress made in TB treatment and control over the past 50 years. The Forum then launched into the first of its eight sessions, highlighting progress made in the 18 months since the Amsterdam Conference in March 2000.

The first session revealed that despite remarkable progress since Amsterdam in expanding DOTS, the internationally recommended strategy for TB control, it was not enough. Worldwide, only 23% of all people with TB were treated with DOTS. Because coverage was not expanding quickly enough, TB had once again assumed epidemic proportions.

In summing up this first session, Sir George Alleyne, Executive Director of the Pan American Health Organization (PAHO), WHO’s Regional Office for the Americas, said that, while there was still need for more community awareness, in addition to more human and financial resources, the tendency to continually blame the faltering progress in TB control on a lack of political will was ‘a shibboleth behind which we hide’. He expressed optimism that cross-sectoral support would increase and concluded by citing the lyrics of a Mahalia Jackson song that said, ‘Good Lord, don’t move the mountain, just give me the strength to climb.’

The key message of the second session on the overlapping epidemics of TB/HIV was that new TB threats like HIV/AIDS co-infection and drug resistance must be confronted—and conquered. Presenters from South Africa and the US-based Centers for Disease Control and Prevention (CDC) stressed that HIV/AIDS threatened to undermine TB control since HIV dramatically fuelled the TB epidemic, especially in sub-Saharan Africa. And yet, they said, TB was treatable and curable, even in people living with HIV/AIDS. There must be a complementary response to the overlapping epidemics of TB/HIV.

Not only were there now more TB cases than ever before in history; the rising man-made spectre of multidrug-resistant (MDR-TB) would cause the TB epidemic to spin out of control if allowed to continue unchecked. The United States Agency for International Development (USAID) pointed out that, although there was now a brief window of opportunity, ‘windows have a way of closing—but these must not only be kept open but also opened wider’.

The third session focused on reinforcing global efforts to Stop TB, showing how the newly formed Global Partnership to Stop TB had been able to ‘expand, adapt, improve and strengthen’ the process, in part through the creation of a groundbreaking Global TB Drug Facility. The swift and successful global response over the past 18 months was summed up as follows:

Progress since Amsterdam
The call:

National Plans
Access to Drugs

The response:
Global DOTS Expansion Plan
Global TB Drug Facility
Global Alliance for TB Drug Development
Global Fund for Health and AIDS

Presentations were also made by representatives of the six Working Groups/Task Forces that focus respectively on DOTS Expansion, MDR-TB, TB-HIV, and prospects for new drugs, diagnostics and vaccines. It was suggested that, ‘in today’s world, we may need another acronym, another approach, in addition to DOTS. We may also need ‘CHIPS’: Complex Health Interventions in Poor Settings’.

In terms of new TB drugs so essential to stemming the current epidemic, it was noted that ‘science is progressing (e.g. genome sequencing) and there is today a new and better environment for TB investment’. The public and private sector should work together in an inclusive model with multiple. As for diagnostics, future priorities would include better case detection, reduced drug resistance and a better contained latent infection. Regarding vaccines, improved TB vaccines for the global community. As for new vaccines, it was emphasized that this was a very promising time, one in which a number of vaccine would be coming up for early human testing and efficacy trials by 2005 and that discovery of a new and more effective TB vaccine could entirely ‘change the name of the game’.

This first afternoon was devoted to two concurrent roundtables—one on financing, the other on partnerships—and each featuring country and partner presentations, as well as animated Q&A sessions. Those concerned with financing focused on mechanisms for channeling new resources and on health sector reform while the partnership track explored innovative means to promote partnerships and spur social mobilization.

Regarding mechanisms for channeling resources, three potential sources were presented: government, foundation and industry. While effective mechanisms existed, presenters from countries such as Kenya and Myanmar pointed out that there were still many unmet needs. Overall, a resource gap of some US$ 4.5 billion over the period 2001-2005 means that innovative bridging mechanisms will have to be found. In this context, the role of the Global TB Drug Facility in providing high-quality, low-priced drugs was also highlighted.

In terms of health sector reform, projects in Cambodia, Indonesia and the United Republic of Tanzania were presented. Decentralization appeared to be having both positive and negative effects, especially with programmes that had long been ‘vertical’. Basket funding would seem to permit better planning and resource allocation for national TB control programmes (NTPs). In addition, TB control has been incorporated into sector wide approaches. The United Republic of Tanzania presented some lessons learned (e.g. the importance of gradual phasing-in rather than abrupt superimposition, the need for planning and ensuring adequate financial capacity). There was consensus that TB control should be part of the national essential health package and that financial disbursements must be timely and transparent.

The partnership promotion track underscored this component as a ‘vital ingredient’ in the introduction and expansion of DOTS around the world. It stressed that, although governments were vital actors, they could not succeed—nor should they even try—to shoulder all the responsibility alone. Presentations from high-burden, high-population countries like Nigeria, Pakistan, and the Russian Federation revealed similar challenges but quite divergent approaches.

In terms of social mobilization, participants agreed that the purpose was initially educational: to raise public awareness; then change-oriented: to augment TB-specific access and outcomes, and finally capacity-building: to increase funding. It could also be rights-based, pushing the ‘right to health’, as well as the ‘right to know’ and ‘freedom from stigma’. Country examples from Brazil, Kosovo (Doctors of the World) and Zimbabwe showed that the spectrum of potential partners was wide, ranging from teachers and students in schools and in the family to health care workers and perhaps even to traditional healers. Social mobilization should not just be ‘doctor-driven’ it was felt. It should also be ‘demand-driven’ from the side of the patient since, at the very centre of every disease treatment partnership is one person—the patient.

Note: These ‘live’ reports from the Partners’ Forum will continue on Tuesday, the final day, as participants move to endorse the Stop TB Partnership Framework, the Global Plan to Stop TB and a draft Washington Commitment to carry implementation of the Amsterdam Declaration forward.

*American Thoracic Society, Canadian International Development Agency, Dutch Government, Open Society Institute, Rockefeller Foundation, Task Force for Child Survival and Development, USAID, US CDC, World Bank and WHO.