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Tuberculosis control goals unlikely to be met by 2005
MEDICINE AND HEALTH POLICY
MEDICINE AND HEALTH POLICY
Tuberculosis control goals unlikely to be met by 2005
1122
Brazil, Ethiopia, and Nigeria have a huge TB burden, but are not making effective use of control strategies and consequently report little progress in improving the situation, according to an alliance of health groups headed by Geneva-based Massive Effort Campaign (MEC). Russia, Brazil, and Nigeria are curing fewer than 10% of their TB cases, and China
line drugs. Resistant disease places an extra burden on already scarce resources. The report included an estimate that an extra US$1 billion will be needed during the next 5 years just to treat MDR-TB cases. Another area of concern is the alarming rise in TB incidence in African countries with high HIV prevalence. However, although WHO
been treated under nonDOTS regimens”, said Rowan Gillies, president of MSF International. Urgent efforts are needed to develop TB drugs and vaccines that are easier to use, and to ensure that they are available at affordable prices, he noted. The forum’s working group on drug development reported that two new compounds for TB treatment
Rights were not granted to include this image in electronic media. Please refer to the printed journal.
AP
ith just 20 months to go before the World Health Assembly’s (WHA) tuberculosis (TB) treatment target is due to be met, it is clear that the deadline will not be reached. In May, 2000, the WHA pledged to combat TB— which infects 9 million people each year and kills 2 million—by setting goals that demand detection of 70% of cases of infectious TB, and treatment of 85% of these by December, 2005. But, new data announced at the second meeting of Stop TB Partners’ Forum (March 24–25, 2004; New Delhi, India), where WHO’s 2004 Global Tuberculosis Report was also released, confirmed fears that TB is still far from under control. Treatment is now successful in 82% of cases, just 3% shy of the cure target. But smear-positive case detection remains low at 37%—just over half the goal of 70%. “Although [these figures] reflect a big advance over the last decade, it also means that a tremendous effort is needed in the coming months”, said Lee Jongwook, WHO DirectorGeneral, speaking at the meeting. Based on current trends, WHO expects the casedetection rate to be around 50% by 2005. But going beyond 50% will be difficult since notification rates have been stable for years. The current challenge, Lee said, is to add another 1 million TB patients to DOTS (directly observed therapy, short course) programmes each year, particularly in Asia and Africa. The number of new cases of TB is growing rapidly in countries of the former Soviet Union where DOTS has only recently been implemented. Russia, China, Thailand,
W
Worldwide implementation of effective TB control strategies is essential for achieving cure targets
and Thailand are actually curing a smaller proportion of cases now than in previous years. The Partners’ Forum—a coalition of 22 countries with high TB burden, along with technical agencies and non-governmental organisations (NGOs)— expressed fears that progress achieved since 2001 could be reversed unless rapid action is taken to increase case detection rates. In its progress report, presented at the meeting, the forum also noted that multidrug resistant TB (MDRTB) has emerged all over the world, mainly due to inconsistent supplies and inadequate quality of first
and the forum are encouraging hard hit countries to implement DOTS, health charity Médecins Sans Frontières (MSF) said the approach is not good enough because of its over emphasis on patients with smear-positive pulmonary TB. MSF alleges that many people with active TB are excluded from schemes, even if the desired 70% of people with pulmonary TB are to be detected. “Because the focus is on smearpositive targets, smearnegative patients are deliberately not treated in some countries. In some cases, countries exclude patients that have previously
are going through preclinical testing and one of them is likely to enter clinical trials in 2005. Phase I testing of a new vaccine has already started in the USA, and two new vaccine candidates are predicted to be ready for clinical evaluation this year. In a pledge adopted at the end of the meeting, the partners summed up plans for the future: “We must expand outreach to include new partners, such as private practitioners, NGOs, the private sector, those at risk of, or already living with, HIV/AIDS, and step up efforts to mobilise more resources.” Dinesh C Sharma
THE LANCET • Vol 363 • April 3, 2004 • www.thelancet.com
For personal use. Only reproduce with permission from The Lancet.
MEDICINE AND HEALTH POLICY
Tuberculosis control goals unlikely to be met by 2005
1122
Brazil, Ethiopia, and Nigeria have a huge TB burden, but are not making effective use of control strategies and consequently report little progress in improving the situation, according to an alliance of health groups headed by Geneva-based Massive Effort Campaign (MEC). Russia, Brazil, and Nigeria are curing fewer than 10% of their TB cases, and China
line drugs. Resistant disease places an extra burden on already scarce resources. The report included an estimate that an extra US$1 billion will be needed during the next 5 years just to treat MDR-TB cases. Another area of concern is the alarming rise in TB incidence in African countries with high HIV prevalence. However, although WHO
been treated under nonDOTS regimens”, said Rowan Gillies, president of MSF International. Urgent efforts are needed to develop TB drugs and vaccines that are easier to use, and to ensure that they are available at affordable prices, he noted. The forum’s working group on drug development reported that two new compounds for TB treatment
Rights were not granted to include this image in electronic media. Please refer to the printed journal.
AP
ith just 20 months to go before the World Health Assembly’s (WHA) tuberculosis (TB) treatment target is due to be met, it is clear that the deadline will not be reached. In May, 2000, the WHA pledged to combat TB— which infects 9 million people each year and kills 2 million—by setting goals that demand detection of 70% of cases of infectious TB, and treatment of 85% of these by December, 2005. But, new data announced at the second meeting of Stop TB Partners’ Forum (March 24–25, 2004; New Delhi, India), where WHO’s 2004 Global Tuberculosis Report was also released, confirmed fears that TB is still far from under control. Treatment is now successful in 82% of cases, just 3% shy of the cure target. But smear-positive case detection remains low at 37%—just over half the goal of 70%. “Although [these figures] reflect a big advance over the last decade, it also means that a tremendous effort is needed in the coming months”, said Lee Jongwook, WHO DirectorGeneral, speaking at the meeting. Based on current trends, WHO expects the casedetection rate to be around 50% by 2005. But going beyond 50% will be difficult since notification rates have been stable for years. The current challenge, Lee said, is to add another 1 million TB patients to DOTS (directly observed therapy, short course) programmes each year, particularly in Asia and Africa. The number of new cases of TB is growing rapidly in countries of the former Soviet Union where DOTS has only recently been implemented. Russia, China, Thailand,
W
Worldwide implementation of effective TB control strategies is essential for achieving cure targets
and Thailand are actually curing a smaller proportion of cases now than in previous years. The Partners’ Forum—a coalition of 22 countries with high TB burden, along with technical agencies and non-governmental organisations (NGOs)— expressed fears that progress achieved since 2001 could be reversed unless rapid action is taken to increase case detection rates. In its progress report, presented at the meeting, the forum also noted that multidrug resistant TB (MDRTB) has emerged all over the world, mainly due to inconsistent supplies and inadequate quality of first
and the forum are encouraging hard hit countries to implement DOTS, health charity Médecins Sans Frontières (MSF) said the approach is not good enough because of its over emphasis on patients with smear-positive pulmonary TB. MSF alleges that many people with active TB are excluded from schemes, even if the desired 70% of people with pulmonary TB are to be detected. “Because the focus is on smearpositive targets, smearnegative patients are deliberately not treated in some countries. In some cases, countries exclude patients that have previously
are going through preclinical testing and one of them is likely to enter clinical trials in 2005. Phase I testing of a new vaccine has already started in the USA, and two new vaccine candidates are predicted to be ready for clinical evaluation this year. In a pledge adopted at the end of the meeting, the partners summed up plans for the future: “We must expand outreach to include new partners, such as private practitioners, NGOs, the private sector, those at risk of, or already living with, HIV/AIDS, and step up efforts to mobilise more resources.” Dinesh C Sharma
THE LANCET • Vol 363 • April 3, 2004 • www.thelancet.com
For personal use. Only reproduce with permission from The Lancet.