International
Tuberculosis
Watch: 10 years of the Global Fund, 7.7 million lives saved
To celebrate 10 years of the Global Fund to Fight AIDS TB and Malaria, they have launched a video celebrating some of their achievements over the last decade:
If you feel inspired, please share!
Q&A: Dr. Paul Nunn of the WHO talks 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.
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?
An Inside Look at TB Vaccine Development
Last week, my colleagues Erin, Margaret and I (that’s us in the lab coats) went on a tour of the Aeras Global TB Vaccine facility in Rockville in the United States. We were there to learn more about the need for a new tuberculosis (TB) vaccine and to see how the vaccine development process works.
A new vaccine for TB is urgently needed. Every year, more than 9.4 million people become sick with TB and about 1.8 million people die from the disease, including 0.5 million people who are also HIV-positive. The existing BCG vaccine was first used in 1921, does not always protect people from getting TB, and is not safe for those with weakened immune systems, such as those living with HIV (a significant shortcoming as TB is the leading cause of death among persons infected with HIV in Africa). Our Aeras guides stressed the important of addressing TB in order to protect the historic progress achieved through recent investments in HIV/AIDS.
The Aeras Global TB Vaccine Foundation is a non-profit product development partnership dedicated to the development of safe and effective TB vaccine regimens that will prevent tuberculosis in all age groups and will be affordable, available and adopted worldwide. Our tour of the Aeras Global TB Vaccine facility involved a look at the following steps of TB vaccine development: vaccine discovery, molecular biology, process development, cell banks, manufacturing: shake flasks and 20 liter seed fermenter, manufacturing: 200 liter fermenter, manufacturing: harvest, quality control, spray drying for aerosol vaccines, and fill and finish. We also learned about the steps that come later, including shipping bulk product to manufacturing partners and delivery.
That’s just an overview, and if it sounds complicated, that’s because it is. Aeras scientists are well-trained and committed to developing safe and effective TB vaccine regimens, but vaccine development is a lengthy process and Aeras estimates that we are about ten years away from a vaccine that that has been thoroughly tested and can be delivered around the world. Aeras has four vaccine candidates currently in clinical trials in Africa, Europe and the U.S.
If you’d like to learn more about the great work the Aeras Global TB Vaccine Foundation is doing, you can visit their website at www.aeras.org.
More great news on the Global Fund
If you remember back in March, when we met with global leaders in The Hague, the Global Fund released some impressive reports detailing their work to combat HIV/AIDS, tuberculosis, and malaria. Now, just a few months later, they’ve released new data, and the results are astounding:
- 2.8 million people on life-saving AIDS treatment
- 7 million people treated for TB
- 122 million bednets distributed to protect families from malaria
Those are increases of 22%, 30%, and, 39% respectively just since June 2009! Additional results showed that 930,000 HIV-positive pregnant women have received treatment to reduce mother-to-child transmission of the virus; 120 million HIV counseling and testing sessions have been conducted; and 4.9 million basic care and support services have been provided to AIDS orphans and vulnerable children since the Global Fund started financing grants in 2003.
These new statistics are living proof that investments in the Global Fund are working; in fact, the Global Fund now estimates that it has saved 5.7 million lives.
But just throwing out statistics – even if they are impressive – can often be less impactful than the power of one person’s story. Watch how investments in the Global Fund saved the life of one young man in Cote D’Ivoire, and how he has since been inspired to give back to his community:
ONE urges donors to fully fund the Global Fund and GAVI
Donors have just met in The Hague to discuss the impacts, efficacy, and future resource needs for the Global Fund to Fight AIDS, Tuberculosis, and Malaria (the Global Fund) and the Global Alliance for Vaccines and Immunizations (GAVI).
ONE has long championed the transformational impact these mechanisms have had. Both the Global Fund and GAVI are even more critical now, as we enter the last stretch to the Millennium Development Goals (MDGs) deadline; if the Global Fund and GAVI are not fully financed during the next three years – the period covered by the Fund’s replenishment cycle—the MDGs will not be met and the mechanisms will be unable to scale up their life-saving work.
“We know these mechanisms are effective and cost-effective,” said Josh Lozman, ONE’s Chief of Staff and Senior Global Health Policy Advisor. “Only if they are fully financed between now and 2015 can we eliminate malaria as a major public health problem in the world, ensure no child is born with HIV, and prevent more than 4.2 million future child deaths through vaccination. In spite of the economic climate, investments in these mechanisms will allow us to achieve major milestones in global health.”
Both mechanisms have achieved impressive results through their partnership together and with donors, recipient countries, and civil society:
- Global Fund-supported programs save an estimated 3,600 lives every day. The Global Fund supports anti-retroviral drugs for HIV/AIDS for 2.5 million people, treatment for tuberculosis for 6 million people, and bed nets to prevent malaria for 104 million people.
- GAVI-supported work has averted an estimated 5.4 million deaths by vaccinating more than 257 million children.
The Global Fund will hold a pledging conference in October 2010 during which donors will commit to funding levels for the next three years; GAVI’s funding will be decided through annual budget processes in donor countries. Full funding of these two mechanisms is one of ONE’s top priorities and will be the focus of campaigning efforts during this year.
Live from The Hague
This week in The Hague, the major donors for both the Global Fund and GAVI have come together to discuss the impact to-date and financial needs of both mechanisms. Josh Lozman and I—part of ONE’s health policy team—are here to listen, learn, and provide support as donors consider their respective contributions in the years ahead. In anticipation of these meetings, both mechanisms have released new data demonstrating just how impactful they have been. The Global Fund has funded impressive programs in 140 countries that has provided antiretroviral treatment for 2.5 million people with HIV, DOTS treatment for 6 million patients with TB, and 104 million insecticide-treated bed nets to protect families from malaria. GAVI has made major strides in aggregating demand for vaccines and driving down vaccine prices, and has saved an estimated 5.4 million children’s lives.
These results have come in partnership with national governments and local groups across the developing world, but also through the significant investments made by donor countries. 2010 marks a critical year for both mechanisms as they look to secure new commitments from donors to both continue and advance their critical work around infectious disease and maternal and child health; the Global Fund enters into this replenishment period (during which donors will make pledges for funding to the Global Fund over the next three years) having projected a need of roughly $17-20 billion, and GAVI estimates that it needs an additional $4.3 billion by 2015. In a time of intense fiscal restraint, these numbers are worthy but massive, and so as advocates we have our work cut out for us as we encourage donors to contribute their fair share.
In our first day here, we’ve been able to participate in a pre-replenishment meeting of civil society organizations focused on the Global Fund, and it’s been fascinating to hear the perspectives of groups from all over the world. While there is a lot on which we don’t agree, there is also a sense of great potential if we can harness the collective energy and core competencies of these groups to push our members and governments toward a common purpose—fully funding the Global Fund.
Stay tuned this week as we send you updates from each day of the meeting—tomorrow’s focus will be specifically on the Global Fund, Thursday will focus on a unique joint Global Fund/GAVI session, and Friday will focus on GAVI and will suggest what we’ve learned and how to move it forward as ONE in the remainder of the year.
36 Million Cured of TB
The 2009 WHO Global Tuberculosis Update was launched earlier this month, providing the latest information on the state of the epidemic around the world. The report shows that in the last 15 years, 36 million people have been cured of tuberculosis, and eight million cases have been prevented. This progress attests to the effectiveness of the Stop TB Strategy and DOTS in the fight against tuberculosis.
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.
Progress in search of a cure for TB?
Here’s a little good news for your Friday: two FDA-approved drugs were found to block the growth of certain strains of extremely drug resistant Tuberculosis (XDR TB). While this chance discovery occurred in the lab, clinical trials on humans are now being planned in South Korea and South Africa.
Excerpts below, full article here
Scientists have reported their breakthrough in the latest issue of the ‘Science’ journal. Speaking to TOI, Dr John Blanchard, professor of biochemistry at Einstein and senior author of the paper, said that in the lab, scientists successfully killed all XDR TB bacteria in less than two weeks time.
Dr Blanchard said, “The entire discovery happened by chance. We didn’t set out to see whether these two drugs, alone or in combination, fought TB. Now, after three years of lab research, Clavulanate was found to be highly effective in inhibiting the crucial enzyme that shields TB bacteria while Meropenem was highly effective in killing the TB organism completely.”
He added, “Normally, it takes two years of continuous therapy to treat drug resistant TB strains. If this combination works in humans, we will be able to completely eliminate the organism within two weeks time.”
-Rena Pacheco-Theard
Highlights from Caceres: Mid-term Review of the Global Fund
We noted last week that donors met in Spain from March 31 to April 1 to review the progress and funding needs of the Global Fund to Fight AIDS, Tuberculosis, and Malaria. Here are some highlights from the communiqué.
Results show the Global Fund is having a significant impact: Michel Kazatchkine, the Global Fund’s Executive Director said that the Global Fund “is affecting the course of these three epidemics.” With commitments reaching $15 billion since inception in 2002, the Global Fund has provided support for more than 600 programs in 140 countries. The Minister of Health from Nigeria, the Honorable Babatunde Osotimehin, presented findings on Nigeria’s malaria prevention and control efforts, including contributions from the Global Fund of 4 million long-lasting insecticide treated nets and 18 million doses of ACTs. Burkina Faso’s Minister of Health, the Honorable Seydou Bouda, described many gains in malaria, tuberculosis, and HIV/AIDS supported by the Global Fund, including 1.2 million children under five receiving ACTs, among others. (Stay tuned for more on Global Fund results coming later this week!)
Donors agreed that with the growth of Global Fund programs, long-term sustainability becomes even more important. Increased domestic financing for health from Global Fund recipients was one area emphasized as a way to improve sustainability. Nigeria and Burkina Faso both pledged full commitment to this. On the Global Fund side, participants asked that cost effectiveness and efficiency opportunities be pursued so that results can be maximized with available funding.
Demand for funding has increased so much that the Global Fund now estimates there is a $4 billion gap between resources currently available and those needed to meet the $13.5 billion demand from countries for 2008-2010. With what is currently available, Round 8 could be fully funded, but there is only $0.9 billion for Round 9 and subsequent rounds. The Global Fund Board will begin approving new grants in November of this year, so there is an urgent need for donors to address the funding gap. Spain has already shown its commitment, and was congratulated for increasing its contribution to $213 million. Other donors confirmed that that they expect to meet the commitments made in Berlin 2007. ONE is hoping they will in fact follow through on their commitments so the Global Fund can continue to support countries in their efforts to fight AIDS, TB, and malaria.
-Lisa Fleisher
Meeting at the Global Health Council
ONE rubbed elbows with some of its many partners Friday at the Global Health Council’s community meeting with Dr. Christoph Benn, the Director of Partnerships, Communication and Resource Mobilization at the Global Fund to Fight AIDS, Tuberculosis and Malaria (a very lengthy title with an even longer list of responsibilities). The Global Fund is a partnership of many organizations created to increase and disburse performance-based grants to fight HIV/AIDS, TB, and Malaria, and it has helped drastically improve global health since its inception seven years ago. Nevertheless, many challenges remain. I had the opportunity to talk with Dr. Benn after the presentation, and he gladly accepted a ONE band to show his support.
Dr. Benn was proud to announce that HIV/AIDS treatment has expanded; however, prevention remains the dominant challenge. TB poses its own obstacles due to its extreme drug resistance and its complex/ expensive treatment. However, the Global Fund is beginning to see a decline in infection in Asia, though progress in Africa is slower. This may be in relation to the high prevalence of HIV in Africa; in effect weakening people’s immune systems and making them more susceptible to TB. Child mortality due to Malaria decreased 50- 70% in some countries thanks to mosquito net disbursement and increased access to affordable treatment and disease control mechanisms. We are making progress, and looking to the future, it is no secret that we are accelerating.
The demand for Global Fund grants is increasing at unprecedented levels, but with the global economic downturn tightening public budgets, the Fund is now facing critical funding gaps. As ONE members, will need to get out and make their voices heard!
-Ian McGroarty
- Previous Posts Older Entries
- Next Posts
 |
 |
 |
About the Blog
The International ONE Blog is a daily log of the anti-poverty movement. The site is operated by ONE staff, with guest contributions from ONE volunteers, members and allies.
The content of each post and each comment represents the views of that author and does not necessarily reflect the views of ONE. ONE does not support or oppose any candidate for elected office, and any post expressing support or opposition for a candidate is not endorsed by ONE.
TAGS: Global Fund, Health, HIV/AIDS, Malaria, Tuberculosis