New global plan to halt TB
A new US$ 9.3 billion global plan for massive expansion of tuberculosis control has been launched by the Global Partnership to Stop TB in response to what the plan describes as "perhaps the gravest global public health crisis of this millennium". The partnership embraces about 120 public and private organizations, including the World Bank and the George Soros' Open Society Institute. Its secretariat is housed in WHO's Stop TB department.
Publicly unveiled at the World Bank in Washington DC in October, the plan is an attempt to stem the steadily mounting incidence of TB up by 9% between 1997 and 2000 from 8 million to 8.7 million new cases a year, according to the latest unpublished estimates. Of these 8.7 million cases, nearly 4 million are infectious (or "smear- positive") cases. Last year, by these same estimates, there were almost 2 million deaths from this ancient scourge more than in any previous year in history. Worldwide, an estimated 17.3 million people are currently sick with TB.
Dr Jong Wook Lee, who heads WHO's Stop TB department, said the increase in TB incidence was being fuelled by the rising tide of co-infection with HIV and TB, especially in sub-Saharan Africa. "Unless action is taken now to improve access to TB treatment," he told the Bulletin, "in some sub-Saharan African countries the number of active TB cases will have doubled in 10 years' time."
In South Africa, for example, which has more HIV cases than any other country in the world, Stop TB estimates that 60% of TB patients are infected with HIV. There were an estimated 228 000 new TB cases in South Africa last year 9% more than in the previous year. And this rate is expected to continue to rise until the HIV/AIDS epidemic has peaked.
WHO's Stop TB department says an estimated 13 million of the 34 million people living with HIV/AIDS worldwide are also infected with TB. Of these 13 million, it is likely that 3040% will develop the disease.
Meanwhile, health officials are concerned that the already high incidence of TB in Afghanistan and neighbouring Pakistan could increase due to population movements and overcrowding in refugee camps on both sides of the border. Over the past year, there were an estimated 70 000 new TB cases in Afghanistan and 19 000 deaths. In Pakistan, an estimated 247 000 people contracted the disease and 57 000 people died from it. The two countries are among the 22 that account for 80% of the global TB burden.
Lee anticipates "many more cases" of TB in this region especially among difficult-to-reach populations inside Afghanistan. The new plan says poor sanitation, malnutrition and crowding are "the great incubators of TB" and warns that TB diagnosis and treatment must be included in relief efforts during humanitarian emergencies.
The plan's target for 2005 is to ensure that 70% of new TB cases are found and properly diagnosed and managed, and that 85% of them are successfully treated. At present, fewer than one in four of the estimated 3.8 million people diagnosed with infectious TB every year receive treatment under DOTS the WHO-recommended TB control strategy. TB drugs costs as little as US$ 10 for a complete course for one patient.
The plan also provides for a four-year investment of about US$ 1 billion to tackle what it calls "the clear and present danger" of bacterial resistance to TB drugs, which could undermine the success of DOTS programmes worldwide. Overall, an estimated 3% of all new TB cases are now multidrug-resistant. But in some parts of Eastern Europe especially Estonia, Latvia, and parts of Russia over 10% of new cases are multidrug-resistant.
The plan, which will require donors to fill a current funding shortfall of US$4.5 billion, also calls for greater investment in the research and development of new tools to combat TB, including a more effective vaccine with longer-lasting protection than BCG, the current vaccine. New drugs are also needed to shorten the existing six-month treatment regimen. Better diagnostic tests are also high on the new plan's wish-list. 
Sheila Davey, Geneva, Switzerland