Tuberculosis
Today marks yet another moment in the “holidays without greeting cards” series: World Tuberculosis Day. Each year, there are 9 million new cases of TB and close to 2 million people die from the disease. An estimated 10 percent of people with TB also are co-infected with HIV, further compounding the diseases’ burden. Dr. Paul Nunn, a self-described “physician-turned-bureaucrat,” is responsible for coordinating TB control efforts throughout the WHO system — took some time to talk with me about his work on TB. I’ve taken the liberty of paraphrasing some of his answers below:
Today is World TB Day. What does that mean to you?
Travel! [Ed note: Dr. Nunn was off to mark World TB day with a speech at the Swiss Anti-Tuberculosis Association]. Besides that, I see it as a key advocacy moment to drive awareness of TB, highlight the progress we’ve made, and motivate the global community to do more on TB.
What sort of progress have we made on TB in the last decade?
There are still more than 9 million cases per year, but we have made significant progress. The incidence rate of TB flattened in 2004, and it has fallen (albeit fractionally) in the years since, in part thanks to the DOTS strategy. We’ve also significantly decreased the prevalence (total number of cases at any given time) and mortality from TB overall.
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Before departing for the weekend, we’re going to bump this blog post to the top of the feed. If you haven’t yet, please read it:
We’re big supporters of the Global Fund to Fight AIDS, TB, and Malaria here at ONE, with so many of our members helping raise awareness about the great work it’s doing to save lives. Despite fantastic results — providing AIDS treatment for 3 million people, anti-TB treatment for 7.7 million people, and 160 million insecticide-treated bed nets for prevention of malaria – the Global Fund is under attack.
Columnist Mike Gerson has just written an excellent column on this issue that’s published in today’s Washington Post. We encourage you to read it, and share it widely!
We at ONE have been working hard to respond to this wave of negative coverage of the Fund, which is based almost entirely on one initial press report that took incidents in a few countries where funding was misappropriated – incidents caught and identified by the Fund itself! – and twisted them to imply that fraud was widespread. We blogged here on this, joining other allies in trying to get out the facts. It’s been tough, with so many being all too willing to believe the worst.
We’re also pleased to hear that the Global Fund announced today that it is taking some extra measures to increase its vigilance, including an external review of all of its financial safety systems. Those already in place are robust, but this might help assuage the donors. The Global Fund needs to deal with this problem to be sure, but its most important work is to speed resources to countries fighting three raging epidemics and the sooner it can get back to that the better.
This post is also featured at the Huffington Post.
Over the weekend, the Associated Press filed a story about corruption involving a small number of grants made by the Global Fund, an international partnership that channels funds to fight AIDS, TB and malaria from donors, like the United States, to some of the poorest countries in the world. It’s always interesting to me when stories create news with misused facts and salacious headlines. So I thought it might be useful to have a little background and perspective from someone who’s spent a lot of time with the Global Fund.
The AP report was correct in saying that the Global Fund’s Inspector General has taken an aggressive approach to rooting out and publicizing incidents of fraud and abuse, but the story erred by extrapolating the findings in a few countries to tarnish the entire grant portfolio. Let’s put this to rest: there is absolutely no evidence that there is widespread fraud or corruption of Fund grants. On the contrary, of the $13 billion disbursed by the Global Fund to date, only a portion has been audited by the Global Fund’s inspector general, and of that only a relatively small amount — US $43 million — has been rescinded.
Now just because the percentage of grants found to be misused is relatively small doesn’t mean it’s okay — just the opposite. That’s still a lot of money, and it should piss off anyone who cares about the world’s poorest. We should not rest until all taxpayer supported programs can report no misuse of funds — including those administered right here at home.
While I was thinking about this over my morning coffee, I spied a New York Times front-page article that started, “Since the government took over Fannie Mae and Freddie Mac, taxpayers have spent more than $160 million defending the mortgage finance companies and their former top executives in civil lawsuits accusing them of fraud.” Now I’m willing to bet that all those gloating over the Global Fund stories won’t get nearly so exercised about this kind of pervasive corruption.
I also don’t want to fall into the trap of denying there are problems. We will undoubtedly hear about other instances of abuse. So I’m thankful that the Global Fund and its partners, especially the countries that desperately need the money, take this all very seriously.
There’s already lots of work underway to continue to make improvements. The Fund is pursuing suspected corruption aggressively, usually in close cooperation with local authorities: corrupt officials are going to jail, funds are being returned, new safeguards are being put in place. At the same time, the Global Fund is working hard to strike a balance, continuing its policy of zero tolerance for corruption while not becoming so risk adverse that it can’t get its job done.
So in the end what’s the conclusion? We should celebrate the openness of the Global Fund, even if the information it provides can be abused. We should fight hard to support programs that improve global health AND governance and transparency — fighting for funds needed to save lives and at the same time to build robust systems and checks and balances needed to guaranty their effective use. And we should feel proud that we’ve helped the Global Fund weather this storm and continue its amazing work to save lives.
David Bryden from the Center for Global Health Policy talks about the Xpert MTB/Rif test, a revolutionary technology that can diagnose whether a patient has TB in less than two hours.
Today is a day that will be long-remembered in the global battle to fight HIV/AIDS and tuberculosis (TB). After years of struggling with outdated technology, there is finally a new method for rapidly diagnosing TB, including TB in persons with HIV (which has special challenges) and drug-resistant tuberculosis.
Tuberculosis is an airborne, bacterial infection that is the single biggest killer of people living with HIV/AIDS.
Ever gotten a rapid HIV test? What would it be like if you had to wait as much as six weeks to get the result instead of minutes?
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Transforming TB care: The World Health Organization (WHO) gave its backing this week to a new molecular test for tuberculosis made by Cepheid, which can rapidly diagnose TB at a 75 percent price discount for poorer nations. The WHO said it was endorsing the test because it could “revolutionize” TB care and control by accurately diagnosing patients in about 100 minutes, compared to current tests that can take up to three months to give results.
What you need to know about smart phones: Canadian politician, Paul DeWar, highlights the burgeoning mining industry in the Democratic Republic of Congo that has helped finance a vicious war since 1998, centered on an obscure mineral, coltan. There is a voracious international appetite for the little-known coltan, thanks to its key role in smart phones. The issue is difficult to fight, however, due to there being no reliable means of ensuring that an electronic good was not made using conflict coltan.
An AIDS-free generation in reach: Eliminating mother-to-child transmission of HIV will not require new scientific breakthroughs, said Jimmy Kolker, HIV/AIDS chief of UNICEF, but rather, innovative financing and outreach are needed to enable people, especially women, youth and infants, to take advantage of available HIV prevention and treatment therapy. The recent introduction of UNICEF’s “mother-baby packs” could make it easier to bring ARV therapy to infants in remote areas.
The latest on the polio outbreak: Bad immunization strategy has been blamed for an outbreak of polio, which has killed nearly 200 and is believed to have caused paralysis in more than 2,000 others across Angola, Congo and the Democratic Republic of the Congo (DRC). A mass vaccination campaign has now been launched in the Congo and Angola, with the WHO placing neighboring countries on high alert in case the virus spreads across more borders. (Louise Redvers, Mail & Guardian)
Hundreds flee Ivory Coast: Hundreds of residents have fled Ivory Coast, UN officials said, as they began evacuating some 500 staffers after a contentious election that resulted in both candidates claiming the presidency. There were also new concerns emerging about whether ex-fighters from neighboring Liberia could be drawn into the growing crisis, due to their involvement in the country’s 2002 to 2003 war.
G20 to tackle US-China currency concerns: “Leaders of the G20 group of major economies have agreed to avoid “competitive devaluation” of currencies after a second day of difficult talks in the South Korean capital, Seoul.”
Nigeria may report Iran to UN over arms seized in Lagos: “Nigeria has said it will report Iran to the UN over an arms shipment seized in Lagos, if investigations show sanctions were broken. Iran is under UN sanctions because of its nuclear programme.” (BBC Africa)
Nigerian militants name seven foreign hostages: “A statement purporting to be from Nigeria’s main militant group MEND on Friday named seven foreign hostages it said were taken in an offshore attack this week, adding they were in good health.”
TB – Invest Now Or Pay Later: Unless the money needed for tuberculosis is invested now the world will face a drug-resistant epidemic that will affect everyone in the world, warned Dr Nils Billo, Executive Director of the International Union Against Tuberculosis and Lung Disease.
Each year, there are 9 million new cases of tuberculosis (TB), causing close to 2 million deaths worldwide. In order to address this epidemic, the Stop TB Partnership created the Global Plan to Stop TB 2006-2015, an action plan and list of required resources needed to halve the number of TB cases and related deaths by 2015. Now at the halfway point, the Stop TB Partnership recently released the Global Plan to Stop TB 2011-2015, an updated road map that outlines where we were, where we are now, and where we need to go in order to reach our TB goal by 2015.
In terms of where we were and where we are now, it is important to note that a lot of progress has been made since 2006. ONE members have joined in the fight to increase the U.S. commitment to combating TB through mechanisms such as PEPFAR and the Global Fund to Fight AIDS, Tuberculosis and Malaria. As a result of these efforts, the U.S. has mobilized more than half of its $4 billion pledge promised during the first five years of the plan towards TB research and development.
A global increase in funding has allowed for TB case detection rates to increase to between 55 to 67 percent. This funding has also helped health care providers gain access to a portfolio of new diagnostic tools, as well as allowed for the development of drugs essential to treating the disease.
That being said, a lot still needs to change in order for us to reach our 2015 goal. The report states that if no improvements to the current TB control strategy are made from 2010 onwards, 10 million people will die from TB. Part of the reason that we need to change our current strategy is due to the fact that the face of TB is changing. HIV has thrown a curve-ball into efforts to address the TB epidemic. HIV weakens the immune system, making individuals more susceptible to TB. As a result, the exponential rise in HIV cases—especially across Africa— has caused a considerable increase in TB cases as well. The emergence of drug-resistant strains of TB (frequently referred to as MDR-TB or XDR-TB) has also made addressing the TB epidemic more challenging. The new strategy must directly address both these phenomena, as well as the increase in related drug costs for treatment. A higher profile must also be given to laboratory strengthening and all levels of research.
If fully implemented, the Global Plan to Stop TB could save up to 5 million lives. As ONE members, we need to continue to pressure leaders to make the public health problems affecting the world’s poorest countries a priority, and for their control to be addressed in an integrated fashion.
