By Jeorge Sampaio
So far H5N1 avian influenza has killed 166 persons according to
the World Health Organization (WHO). In contrast, HIV/AIDS,
tuberculosis (TB) and malaria combined kill 6 million people every
year. Though it is affordably curable, TB is still a worldwide
pandemic growing at 1 percent a year and killing 5,000 people every
day.
Despite good progress, TB is not going away. In 2005 more people
died from TB than in any year in history and predictably TB will
remain one of the world's top 10 causes of mortality in the next
decade, especially in Africa, the region hardest hit by this
disease.
Of 9 million new tuberculosis cases each year, 400,000 are
highly contagious multi-drug-resistant. MDR-TB results from
interrupted or incomplete treatment of standard tuberculosis or
from person-to-person transmission.
MDR-TB is growing worldwide, with the highest rates in countries
of the former Soviet Union around the European Union, in India and
China. MDR-TB does not respond to standard TB drugs and
predictably, if not properly treated, it can become extensively
drug-resistant (XDR-TB). XDR-TB strains have now been found in all
regions of the world.
So far, 26 countries have reported XDR-TB cases associated with
HIV infection, with an extremely high mortality rate.
MDR-TB and XDR-TB are entirely man-made and occur as a result of
poorly-managed TB care and control programs. They pose a critical
global health threat and require urgent global action on care and
prevention.
This is why we face a real emergency. It is past time for the
world political leaders to take extra action promoting global
public health, particularly in developing countries.
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In my personal view, four overarching but overdue issues deserve
immediate attention and call for strong extraordinary action by the
international community.
First, the fight against TB has to be kept high on the global
agenda. The emerging XDR-TB is a new major public health emergency
and requires appropriate measures.
In the early 1990s an outbreak of drug-resistant TB in New York
City cost US$1 billion to contain. Unfortunately, obvious lessons
were not learned and future outbreaks such as XDR-TB were not
prevented.
Research and development by G8 and other high-income countries
into new tools to effectively fight TB have been neglected and
under-funded over more than 40 years.
XDR-TB underlines the need for immediate and substantial
investment in prevention and in the development of new TB care as
the current available tools are outdated and insufficient. The Stop
TB Partnership's Global Plan to Stop TB (2006-15) has identified an
annual research funding requirement of US$900 million to deliver
urgently needed new diagnoses, drugs and a vaccine.
Moreover, without an overall increase in aid, by 2015 the
shortfall between aid needed to achieve the UN Millennium
Development Goals (MDGs) concerning TB and actual delivery will
stand at more than US$30 billion. It is obviously more affordable
to fill this gap than to pay for the human and economic losses
produced by the epidemics.
Second, improved coordination in the fight against AIDS and TB
is a critical point to improve health worldwide. HIV/AIDS and TB
together generate a noxious synergy that accelerates each other's
progression and has led to an explosion of TB cases in regions of
high HIV prevalence. In some Sub-Saharan regions up to 77 percent
of TB patients also have HIV. This is why curable TB remains the
leading killer among HIV-infected people.
In order to control TB in high HIV settings far more
collaboration between TB and HIV/AIDS programs must be implemented.
For instance, it is sobering to recognize that only 0.5 percent of
estimated HIV patients are currently tested for TB and only 7
percent of TB patients are tested for HIV worldwide. This is a
shockingly dramatic shortfall.
In this regard, I have put forward the idea of a meeting of the
influential stakeholders -- such as G8 countries, the European
Union, the World Bank, the Global Fund, UNAIDS, WHO, USAIDS, OGAC,
foundations, companies, associations, NGOs and governments of
high-burden countries to lay down concrete steps for global
coordination of TB and HIV activities. We still have to do a great
deal of work.
Third, Africa must be top priority on the international and
European agendas because it is not acceptable that Africa remains a
continent at risk.
Sub-Saharan Africa faces the greatest health challenges, with 11
percent of the world's population and 24 percent of the global
burden of disease, yet only 3 percent of the world's health
workers. Nearly two-thirds of the world's HIV-infected adults and
children live in Sub-Saharan Africa and 72 percent of all
AIDS-related deaths occurred there in 2006.
Africa accounts for a large proportion of all TB cases, with
some countries showing 300 cases per 100,000 inhabitants (compared
with 12.6 cases in EU and 4.6 in the US per 100,000). Last year, TB
was declared an emergency in the African region because of its
overall disruptive human, social and economic impact. According to
available data, in high-burden countries TB is estimated to cause
an economic loss of 4 percent of the GDP annually.
We must wake up, demand greater efforts of our governments and
ask world leaders to scale up political commitment to the fight
against the main infectious diseases plaguing Africa. Health is a
public global good and it has to be ensured for all.
Fourth, strengthening health systems should be a major
concern.
Promoting a global plan to strengthen health systems is a key
issue in achieving most of the health related MDGs. This requires
improving infrastructures and investing in laboratories. It also
involves addressing the lack of health workers facing many
developing countries.
Fifty-seven countries, most of them in Africa and Asia, face a
severe health work force crisis. WHO estimates that a total of more
than 4 million health-care workers, are needed to fill the gap.
Without prompt action, the shortage will worsen.
Efforts should focus on broad measures that affect population's
wellbeing. For instance, consideration should be given to the
adoption of a code of good practice in healthcare worker migration
to prevent a permanent brain drain from poor countries to rich
countries and to encourage the return of skilled migrants to their
own countries.
MDGs are intended to translate into concrete achievements some
basic human rights for all. As there are still millions of human
beings living and dying in the most dramatic poverty, achieving
these goals by 2015, as agreed, is a moral commitment and a
political responsibility for the international community.
The multilateral cooperation and coordination approach is very
important if we are to make policies work, to avoid or reduce
duplication and waste and to achieve the desired Millennium Goals
in time.
Three out of the eight MDGs concern health issues such as
reducing child mortality, improving maternal health and combating
HIV/AIDS, malaria, TB and other infectious diseases. Global health
is thus recognized as a matter of human rights and a key dimension
of human safety and development.
To realize these very basic rights worldwide, we cannot afford
further delays or work at cross-purposes. We need to double our
efforts, to do more and better.
Emergencies just won't wait.
The author, former President of Portugal, is UN
Secretary-General Special Envoy to Stop Tuberculosis.
(China Daily via agencies March 28, 2007)
