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.

Millennium Development Goal 6 set the target of reversing and reducing the incidence of TB along with AIDS, malaria, and other diseases — and for TB that has been achieved. The Stop TB Partnership also set additional goals by 2015: that we would halve the prevalence rate and mortality relative to 1990. It looks like we’re almost there on prevalence rate and may just barely achieve the mortality reduction treatment — although not for Africa specifically.

What work still needs to be done on TB? Where are we having the most difficulty, and what steps are in place to achieve progress?

The achievement of MDG 6 for TB is tempered by the fact that the absolute number of people getting TB continues to rise due to the rising overall world population. Africa also lags far behind many other regions when it comes to TB. The big challenge there is that HIV drives the TB epidemic, and the quality of health services overall is poor. We need to ensure that efforts to fight HIV in both prevention and treatment also take on TB. TB patients tend to be ignored — in part because TB is highly infectious in social settings, and thus stigmatizing — but it’s important that services for HIV and TB are integrated to reach those who are vulnerable and missed in the health system.

MDR-TB and XDR-TB are serious and growing threats to TB control. It’s estimated that there were 440,000 cases of MDR-TB last year, of which 67 percent were identified by the health care system; of those identified, we only managed to treat 30,475 cases (the WHO launched a new report on the topic this week). 69 countries have reported at least 1 case of XDR-TB through 2010, as well. Still, 95 percent of TB remains treatable with existing drugs—and that needs to be the primary focus.

Current tools to diagnose and prevent TB are outdated, but hope is on the horizon. A new diagnostic test Xpert (see our blog about it here) can tell within a few hours if someone has TB and whether the TB is multi-drug resistant. It’s already being used extensively in parts of the world, and we’re hoping to roll it out even further in the coming years, including through the Global Fund’s next round of grants. The currently existing TB vaccine, BCG, works to prevent the worst forms of childhood TB, but is too risky for many with compromised immune systems, including many who are HIV positive. New vaccines are still in the research phase; it’s likely we will go another 10 years before we see a new TB vaccine delivered to patients, yet it’s still an important future tool. Lastly, a few new drugs are nearly certified which, in 3-5 years, could be used to cure TB patients in high burden countries, especially those with MDR-TB.

Who are key partners working on TB around the world?
The Global Fund is key—it’s probably our most important partner—providing countries with financial support to do the work they need to do on TB. We also work closely with countries themselves, particularly those with high disease burdens. Technical agencies from many European capitals are strong partners, as well as the Gates Foundation and USAID, among others.

What messages about TB can advocates use that are the most compelling?

This month, we’ll be featuring blog posts that help illustrate how the Global Fund affects programs that fight AIDS, tuberculosis and malaria around the world. In this article, Dr. Joia Mukherjee of Partners in Health (PIH), who participated in our ONE Haiti conference call in January, highlights the partnership between the Fund and PIH.

It is hard to believe that it has been ten years since all 191 United Nations member states agreed to achieve the Millennium Development Goals (MDGs).

Yet the lack of progress on the final one — a global partnership for development — has hampered the achievement of all others. The one shining light in such a partnership for global development is the Global Fund to Fight AIDS, TB and Malaria.

The Global Fund was partly established by activists in the developed and developing world, otherwise known as the “global North and South.” Many of these activists were living with HIV and wanted to start an organization that could help achieve universal HIV/AIDS treatment.

The Fund is a novel mechanism; it is a multilateral fund, independent of the United Nations and financed by donors from the government and private sector. Its structure has allowed even some of the poorest countries to expand treatment for HIV, tuberculosis and malaria as a basic right for free, largely through the public sector, with support from non-government organizations and the private sector.

The Fund has put more money into the public health sector than any previous initiative, and a consortium convened by the World Health Organization documented the positive synergies that this money has had not just on MDG 6 — combating AIDS, malaria and other diseases — but the health sector in general.

My organization, PIH, has been working to provide health care and improve the social determinants of health for the destitute for more than 20 years. As one of the recipients of first-round Global Fund monies in Haiti, we set out to build public sector health systems and tackle poverty as a critical component to our HIV response.

This work, supported by the Global Fund since its inception, has resulted in the rehabilitation and revitalization of 52 public facilities in ten countries around the globe. The public sector-NGO community partnership that has developed in the course of this work is poised to meet 4 and 5, the other health-related MDGs as well.

As the 2010 MDG summit approaches and the challenges to achieve the MDGs are addressed, it is critical to note the importance that dedicated funding for MDG 6 has had not only in achieving the right to HIV, TB and malaria treatment, but in improving the systems to deliver health care around the world.

We’ve dedicated a lot of space on this blog to rotavirus — a disease that is the most common form of childhood diarrhea.

Diarrhea is something we often think of as gross or annoying, but it’s easy to forget that diarrhea is deadly, causing nearly 500,000 deaths each year primarily in Asia and Africa.

We’ve also dedicated a lot of blog posts to the GAVI Alliance, because among other things, they’ve been a driving force behind an effort to accelerate access to a vaccine for rotavirus to children in the developing world, alongside partners like Merck, GlaxoSmithKline, PATH, the WHO and the CDC.

But developing a new vaccine for resource-limited settings is a challenging process that takes years of hard work and a lot of money — and it’s a process that’s certainly not guaranteed to work. Which is why today we’re celebrating big news out of medical journal The Lancet: two sets of clinical trials in Asia and Africa showed that new rotavirus vaccines can significantly reduce child deaths.

The Asian trial took place in Bangladesh and Vietnam, testing the efficacy of the vaccine (essentially, how well it protects against disease) in more than 2,000 infants. The study showed that the vaccine had 48.3 percent efficacy against severe disease. When combined with other efforts to improve child survival — oral rehydration salts, zinc, exclusive breastfeeding and improved hygiene and sanitation — diarrheal deaths could be reduced even more.

The African trial, which took place in Ghana, Kenya and Mali, also demonstrated that the rotavirus vaccine offered significant protection for young children. In fact, vaccination reduced severe cases of rotavirus by 64 percent in the first year of life. These findings were consistent with those from a previous study conducted in Malawi and South Africa.

While the percentages from the studies may not seem overwhelmingly high (We’re using a vaccine that works only half to 60 percent of the time?), the vaccine actually represents a critical tool that will help control one of the major killers of children around the world. Even with these lower efficacy rates, we have to remember that the rotavirus vaccines will still have a huge impact on reducing severe disease in Africa and Asia because so many more children are dealing with disease there than in the United States or Europe.

But how well a vaccine prevents against disease doesn’t tell the whole story, either, because the health care systems in the developed and developing world are vastly different. If a child gets diarrhea in the U.S., a parent can easily access medicines to treat him or her and — in worst case scenarios — take their child to the hospital for emergency care. But because medicines and health facilities are tough to access in much of the developing world, rotavirus vaccination can be a child’s only chance at survival against diarrhea in Africa and Asia.

Major congratulations are due to all who have worked on rotavirus vaccine development and studies to date, and an additional debt of gratitude is owed to the parents who volunteered their children for the trials. We’re thrilled at the news and for what it means for the health of children and families across the developing world. We’ll keep you posted with more on the vaccine and efforts to deliver it in the field in the coming months!

We must do better against malaria, says President – Following this week’s African Union summit, Tanzanian President, Jakaya Mrisho Kikwete, asserts that leaders must do more to eliminate all preventable malaria deaths, starting with the goal of reaching universal mosquito-net coverage by the end of this year. (The Guardian)

New TB test must reach more people, says WHO – A new diagnostic tool that reduces to two hours the time needed to detect drug-resistant tuberculosis must be made available to populations vulnerable to the disease, a World Health Organization expert said. “These tools are very expensive, but the scale up should be carefully planned,” said one WHO adviser. (Reuters)

Millions awarded for TB and HIV/AIDS fight in Uganda – The Elizabeth Glaser Pediatric AIDS Foundation has been awarded $38 million by USAID to provide integrated TB and HIV/AIDS services in the southwest region of Uganda. The new program seeks to support health service delivery at the district level to provide comprehensive services in the region.” (Rosebell Kagumire, The Independent)

African leaders must focus on maternal health – Ex-Irish president Mary Robinson urged African leaders to boost support for maternal health, during a visit to Sierra Leone where mortality rates are among the highest in the world. “If the African Union succeeds in fulfilling its commitment to maternal health, it will benefit the economies of countries to have healthy populations,” she said. (AFP)

Flower power in Kenya – Slate explores the burgeoning flower industry in Kenya’s Rift Valley, where ambitious plans of turning the country into a global powerhouse are blooming into reality. Though environmentalists may disagree with some of the growing methods, one farmer asserts, “We are branding ourselves as a flower-growing country.”  (Alexis Okeowo, Slate)

Opening remarks from WHO Director-General Dr. Margaret Chan

• She noted the impressive successes achieved through investments in global health including the drop in under-five child deaths to below 9 million, the increase in the number of people receiving antiretroviral therapy for AIDS to more than 4 million, early signs that tuberculosis and malaria cases are declining, and the value of vaccines which currently prevent an estimated 2 to 3 million deaths each year
• She relayed the urgency in the homestretch for reaching MDGs, especially for the world’s poorest
• She urged participants to scale up delivery of interventions, while also strengthening fundamental capacities needed to do so.

Case studies from country representatives on MDGs 4, 5, and 6
Noting the impact of the financial crisis on health, participants emphasized the importance of sustaining investments in health. Speakers highlighted the need for better coordination of funding mechanisms, global financing alignment with local priorities and national health plans, and mutual accountability for both the donors and the recipient governments.

Participants also noted the importance of:

• strengthening health systems, including the quality and quantity of health care workers;
• focusing on primary health care and integrated delivery;
• strengthening the aid architecture to improve effectiveness and national ownership in the development agenda; and
• making use of innovations including information communication technology in addressing MDGs.

Pneumonia
Member States adopted a resolution on the treatment and prevention of pneumonia–the number one killer of children under five years globally. The resolution makes it clear that intensified efforts to address pneumonia are imperative if the achievement of MDG 4 is to be achieved. The resolution also provides critical momentum to a broader effort to deliver vaccines and immunizations across the developing world, particularly in the lead up to the G8 Summit in Canada this summer which will be focused on maternal and child health.

Polio
Member States welcomed the new Global Polio Eradication Initiative Strategic Plan 2010-2012. The new Plan addresses the barriers to eradicating polio from the remaining few areas which had not yet stopped the disease, using a combination of new area- and population-specific approaches to reach chronically missed children using an effective new oral polio vaccine. The delegates expressed serious concern that insufficient financing for the new Plan will inhibit its full implementation, as $1.3 billion is still needed for the period 2010-2012. The dangers of not completing the job of polio eradication are underscored by the confirmation in April of a large new polio outbreak following an importation into Tajikistan (in a region which had been certified as polio-free in 2002).

The alarming news from this report is that in some areas of the world, one in four people who were infected with tuberculosis became ill with a form of the disease that can no longer be treated with standard drug regimens. A region in Russia reported that 28% of those diagnosed with TB had the multidrug-resistant form – the highest level ever reported to WHO.

As background, multidrug-resistant tuberculosis (MDR-TB) is difficult and expensive to treat, frequently failing to respond to standard first-line drugs. Extensively drug-resistant tuberculosis (XDR-TB) is a deadlier strain, resistant to even more of the existing tuberculosis treatment.

Of the estimated 9.4 million new TB cases in 2008, approximately 440,000 were MDR-TB, and a third of those infected with this form died. It is estimated that 69,000 cases of MDR-TB occurred in Africa, with the vast majority going undiagnosed due partly to limited labratory capacity. There are no official estimated on the number of XDR-TB cases, but the WHO still suggests it may be around 25,000 annually with most cases being fatal. 58 countries have reported at least one case of XDR-TB since 2006.

Strong tuberculosis programs can have a significant impact on reducing MDR-TB rates, as seen in countries like Estonia, Latvia, the U.S. and China, Hong Kong Special Administrative Region. Additionally, new technologies that can cut the diagnosis time to two days from up to four months, offer hope in the fight against TB.

As we observe World TB Day 2010, it’s important to reflect on the progress being made in combating this disease (36 million people have been cured of tuberculosis in the last fifteen years), while acknowledging the challenges that remain, particularly in the growing area of drug resistance.

You can download the full report here.

Margaret Chan has made Africa one of her top priorities since she was elected to be Director-General of the World Health Organization in November 2006.

Although improvements have been made, she says African health remains on the critical list. She says communicable and non-communicable diseases continue to disable and shorten peoples’ lives.

Despite this, she notes good progress has been made in tackling certain diseases, such as malaria. WHO reports malaria kills nearly one million children every year. The vast majority in Africa.

Chan reports the number of malaria deaths among African children has been cut in half. She attributes this to treatment of the disease with the combination drug, ACT, and the widespread use of insecticide treated bed nets.

During the latest 12-month reporting period, 2.3 million infectious patients were cured, more than ever before in that time frame. Still, not enough people are accessing the treatment they need, and about 1.8 million people died of tuberculosis in 2008.

There were an estimated 9.27 million incident cases of TB in 2007 (of which, 15% percent were among individuals who were also HIV-positive), a slight increase from 9.24 million in 2006. However, while the total number of TB cases is up due to population growth, the number of cases per capita is actually down 1%.

The report shows further progress in addressing the deadly combination of TB and HIV. TB remains the leading cause of death for those with HIV, but testing TB patients for HIV is on the rise, and more patients are receiving appropriate treatment.

The report also notes that there has been little progress in stopping multi-drug resistant tuberculosis (MDR-TB) and extensively drug-resistant TB (XDR-TB), an even more dangerous and resistant to treatment form of TB.

To learn more, you can read the full report, as well as the WHO’s press release.

Polio eradication resonates strongly with Mr. Perlman, who contracted the disease at age four and overcame serious physical challenges to become one of the world’s most celebrated musicians. Mr. Perlman is a winner of 15 Grammy Awards, including a Lifetime Achievement Award in 2008. In this historic, one-night-only performance Perlman will help Rotary in its effort to raise $200 million to match a $355 million challenge grant from the Bill & Melinda Gates Foundation. All of the money raised will fund critical eradication activities in countries where polio still threatens children.

Rotary International, the World Health Organization, UNICEF, and the Centers for Disease Control and Prevention launched an initiative to make polio only the second disease to be eradicated. At the time (1988), there were 350,000 polio cases a year. Last year, there were less than 2,000. Worldwide, the number of polio cases has been slashed by 99 percent, preventing five million cases of childhood paralysis and 250,000 deaths. However, the final one percent of cases is the most difficult and expensive to prevent.

The one-night-only performance will be held on 2 December at 7:30 p.m. in New York City.
Learn how you can help at rotary.org/endpolio or purchase tickets for this historic event at nyphil.org/perlman.

-Petina Dixon, Rotary International