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2002/10 TB (MEPs)
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BACKGROUND
BACKGROUND SHEET - OCTOBER 2002.
The Elimination of TB: Does Europe have the will?
The Global Plan to Stop Tuberculosis
Eliminate tuberculosis (TB) as a public health problem. That and nothing less is the goal of the Global Plan to Stop TB. The Plan assesses the threat of TB based on current global evidence and shows why TB can be controlled and eliminated. The Plan describes mechanisms and activities already in place, as well as details the resources that will be needed over the next 5 years to accelerate efforts to meet global TB-control targets.
The Tragedy of TB
Granville Cemetery, the largest in Zimbabwe, is a 250-acre plot on the outskirts of Harare. Two years ago, it was expected to provide sufficient space for 40 years; now, officials project that HIV will cause the cemetery to fill within 15 years. And the proximate cause of death for most of those laid to rest in Granville will be TB. In Zimbabwe, the terrible synergy between these two diseases takes as many as 3,000 lives a week. A quarter of that countries six million adults are believed to be infected with HIV, and 60% of those suffering from active TB are also HIV-infected. In Botswana over the last decade, average male life expectancy has dropped from 63.3 years to 39.5 years mainly as a result of HIV infection, exacerbated by TB co-infection. Most co-infected patients do not receive treatment for TB. Many are not aware that they have the disease. Even if they know, they may not realise that TB can be cured; they may not have access to drugs, and they may fear the stigma if their TB-HIV status becomes known. When they do seek help, the response is often inadequate, leaving patients chronically ill and their TB contagious to others. Prompt treatment would increase the length and quality of their lives, thus benefiting their families and communities.
Haikin, a 26-year-old street vendor from a town in Northern Sulawesi, Indonesia, had been coughing for about three years, visiting private doctors who prescribed variety of medicines. He spent a great deal of money on this treatment, borrowing substantial sums that he could not repay. His cash and credit resources exhausted, he finally went to a state health centre, where he was diagnosed with TB. After a six-month regimen of short-course chemotherapy (DOTS), he was declared cured.
The Cost of Controlling TB
Effective TB control in the next five years will cost an estimated US$9.1 billion. Most of this will be spent treating patients suffering TB, including multi-drug resistant TB and TB in patients co-infected with HIV. A significant amount (US$1.1 billion) will be spent on research and development of new diagnostic tools, new drugs and new TB vaccines. At current commitment levels, TB-burden nations will provide US$4.5 billion (85%) of the approximate US$5.3 billion in resources projected to be committed for TB control. The projected external resources are based on estimates of resources committed during year 2000.
The table below shows a summary of the costs of the Global Plan to Stop TB.
Summary Costs of the Global Plan to Stop TB ($ millions)
(Figures for 114 countries)
.....................................................................Current Resources
....................................................................-------------------------
.......................................................Costs....Nat’l...Ext’l...Subtot.....Gap
DOTS.Expansion............................6,225...4,300....359....4,659....1,566
Country.needs,.high.burden............4,560....3,300....250....3,550....1,010
Country.needs,.other.......................1,440....1,000........0....1,000.......440
DOTS.expansion.working.group.......225..........0.....109.......109......116
Adapting.&.improving.DOTS........1,728......230.......60.......290....1,438
TB/HIV..............................................642........30.........8.........38.......604
Country.needs....................................630.........30........6.........36.......594
TB/HIV.working.group......................12............0........2...........2.........10
MDR.TB..........................................1086........200.......52......252.......834
Country..needs................................1,070........200.......50......250.......820
MDR.TB.working.group.....................16............0.........2..........2.........14
Research.&.Development.Totals....1,098............0.....390......390.......708
New.diagnostics................................177............0.......53.......53........124
Research.needs..................................150............0.......47.......47........103
New.diagnostics.working.group..........27............0........6.........6...........21
New.drugs..........................................347............0.....136....136.........211
Research.needs...................................317............0.....130....130.........187
New.drugs.working.group...................30............0.........6.........6..........24
New.vaccines.....................................424............0.......96.......96........328
Research.needs..................................420.............0.......95.......95........325
New.vaccines.working.group................4.............0.........1.........1............3
Health.Policy.Systems.Research.......150.............0......105....105...........45
Partnership...........................................75.............0........10.....10............65
Partnership.secretariat.........................27.............0.........10.....10...........17
Advocacy* .........................................20..............0..........0.......0............20
Resource.development.&.financing*..13.............0...........0.......0...........13
Monitoring*........................................15..............0..........0.......0............15
Totals..............................................9,126.......4,530.....819..5,349......3,777
* Plans of partnership task forces for these initiatives are still being reviewed. Figures provide are rough estimates.
"I am proud to be a sponsor and catalyst of the Global Plan to Stop TB. By supporting the development of this model plan, the Open Society Institute advances its vision of promoting equity and global public good."
George Soros, Chairman, Open Society Institute
ACTION SHEET
TAKE ACTION - OCTOBER 2002
The Elimination of TB: Does Europe have the will?
"We have a cure. We need to mobilise the world to use it."
Gro Harlem Brundtland, Director General, WHO
ACTION. Write a letter to each of your MEPs and include the following points:
1. Share your concern that today TB is reaching almost epidemic proportions in some of the poorest countries.
2. Acknowledge the European Commission for their recent communication on Health and Poverty Reduction in Developing Countries.
3. Express your support for the Global Plan to Stop TB.
4. Mention some of the key components of the Plan.
5. Ask how the EC intends to support fulfilment of this Plan.
6. Ask for a reply
BACKGROUND
Tuberculosis was presumed to be nearly eradicated in the 1970s. How wrong we were. Today:
* - TB kills 2 million people each year.
* - One-third of the world's population is currently infected with the TB bacterium.
* - About 8.8 million people become sick with active TB each year.
* - TB is today the single greatest infectious killer of women of reproductive age (15-44).
* - TB is the leading cause of death among people who are HIV-positive.
* - Multi-drug resistant TB is spreading rapidly and is threatening to make TB incurable and extremely expensive to treat.
THE SOLUTION
We know what is needed to control TB. We even have a plan. If we invest in this plan to expand access to treatment to all those sick with TB we can save 35 million lives and prevent hundreds of millions of deaths in the next two decades.
* - Drugs to cure standard TB cost just US$10; treatment has been shown to be up to 95% effective even in the poorest countries.
* - A new internationally agreed-upon plan, the Global Plan to Stop TB, lays out the amount of money the global community must spend and how and where we must spend it in order to reach global TB control targets for 2005.
THE PLAN
The Global Plan is the first comprehensive country-by-country effort to mobilise much needed resources to tackle TB. The Plan’s funding estimates are based on national TB control programme costs of the high-burden TB countries. Launched on October 23, 2001, the Plan aims to expand access to WHO’s recommended strategy for TB treatment - Directly Observed Treatment Short-course or DOTS - to all those infected and sick with TB. It also seeks to create other critical TB control mechanisms for addressing TB-HIV/AIDS co-infection, drug resistance and improving existing diagnostic tools, drugs and vaccines.
FINANCING THE PLAN
The Global Plan estimates the total five-year cost (2001-2005) of TB control to be US$9.126 billion. The estimated funding gap between resources currently available (mostly from developing countries themselves) or pledged and the five-year cost required, is US$3.777 billion or US$755.4 million per year. Much work is needed to mobilise more resources.
Does the EC have the political will to play their part in raising these resources?
THE EC COMMUNICATION
In March 2002, the EC released a Communication to the Council and the European Parliament: Health and Poverty Reduction in Developing Countries. In it the Commission says that "Health is a key determinant of economic growth and development while ill health is both a cause and effect of poverty."
It mentions that the most substantial proportion of the disease burden of the poor is represented by a continuing high toll of illness and premature death from a small number of preventable or manageable conditions. One of these is the communicable diseases. TB is one of the major communicable diseases and is also the major killer of those with HIV/AIDS.
It mentions that a heavy disease burden further limits the resources available to governments to invest in public health or poverty reduction efforts. The World Bank estimates that many African countries may lose up to 1.2% per capita growth annually due to HIV/AIDS alone. The Commission quotes the World Health Organisation's (WHO) calculations that at the very least US$168 billion per year in extra revenue could be released if there was a major effort to tackle avoidable diseases.
EC INVESTMENT IN HEALTH
In its communication the Commission mentions the need to "scale up investment and resources where possible". Recently the EC has made a contribution of US$106.9 million to the Global Fund to Fight AIDS, Tuberculosis and Malaria - some of which may find its way to help in the treatment of TB. We should acknowledge that, but at the same time recognise that it is a very small amount of money for such a large donor.
In 2001 the EC budget alone was US$5.91 billion (US$35 billion if you include the 15 European bilateral donors). This is 55% of world aid.
In a letter received from Commissioner Poul Nielson in May 2002, he says, "The global impact of tuberculosis warrants an extraordinary and sustained response from the international community. Effective TB control and treatment will require efforts to strengthen national health systems able to ensure uninterrupted supplies of essential drugs and diagnostics and scale up successful approaches to treatment. … DOTS is a key element of any successful national strategy…"
Now is the time to ask just how the EC will contribute to the fulfilment of the Global Plan to Stop TB. To ask if they really have the political will to tackle the global threat from TB.
The Global Plan needs just under US$4 billion over 5 years to provide treatment and control of TB - one of the world's biggest killers. It is not too much to ask the EC - with the world's largest development assistance programme - to play a significant role in the support and delivery of that Plan.
_______________________________________________________
This action sheet uses information from WHO, DAC, RESULTS USA and Canada, and the EC.
_______________________________________________________
RESULTS, 13 Dormer Place, Leamington Spa, CV32 5AA
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