Dismay about the havoc that tuberculosis still wreaks, and a sincere drive to banish the disease once and for all, is what Dr Zsuzsanna Jakab, Regional Director of the WHO European Region and Dr Lucica Ditiu, Executive Secretary of the Stop TB Partnership, have in common. Both women are well aware of the impact of TB and determined to put an end to it.
“It is unacceptable that so many people are dying from TB. People affected by this disease deserve to have more of a voice and be seen, but most of them belong to poor and vulnerable groups” says Dr Lucica Ditiu. Sher was appointed Executive Secretary of the Stop TB Partnership in January2011. Having devoted her career to improving the lives of people affected by TB, she has made it her goal to make people think and talk about TB as much as possible. “I have always been dissatisfied with how little attention is given to TB. The TB community does great work, but somehow we have not been able to turn up the volume sufficiently on our message. The HIV community has so much energy and has succeeded in drawing the world’s attention to the need for vaccines and new drugs. I always have felt we can raise the profile of TB to this level too. Now is the time to make more noise.”
Dr Jakab looks at tuberculosis from a mainly European perspective. As a WHO Regional Director, she oversees a region consisting of 53 countries situated between the Atlantic and the Pacific Oceans. Tuberculosis is a serious problem in this region; so serious that in 2011 the WHO regional office rang the alarm on TB rates.
“TB knows no borders, which makes it a serious threat to all countries, high burden and low burden, rich and poor” says Dr Jabkab. “We need to mobilise all resources - human, technical and financial - to build strong partnership and solidarity. I want to see TB eliminated during my children’s lifetime, and as the WHO Regional Director for Europe, I will ensure that we continue to make TB control a high priority in Europe and elsewhere.”
Dr Ditiu says there is a clear need for people to express their outrage. “The number of people dying of TB is almost equal to the number of people dying of HIV/AIDS. We need to push. The only available vaccine for TB, was discovered in the 1920s and offers only limited protection. In most places we use the microscope – the same diagnostic tool that has been in use for nearly 100 years. And we use drugs that are 50 years old,” she says.
Another challenge we need to confront urgently, Dr Ditiu says, is that millions of people are not being provided with TB diagnosis and treatment. “There are so many people whose TB is never found. We are talking about roughly 3.5 million undetected cases every year worldwide. These are the people who are most vulnerable, and we need to develop innovative ways to reach them and get them high-quality treatment. Drug resistance is tragic too; the number of cases is outrageous. Again, we need to push case detection rates so we can push treatment.”
Although the incidence of TB has slowly declined in the European Region as a whole, the discrepancy between east and west is worrisome. Drug resistance rates are alarming and the European Region also has the fastest growing HIV epidemic in the world. Dr Jakab: “During recent years, the case detection rate in the European Region has been increased to 74% in 2010, the highest case detection rate worldwide. However, we have the poorest treatment outcomes in the world with less than 70% of new patients successfully treated. This is mainly due to drug-resistant TB, but also due to late diagnosis, poor treatment practices, lack of patient-centered approaches and lack of community support.” Dr Ditiu adds: “TB touches all Europeans. We have to be aware that it is here, on our own doorstep.”
In response to this situation, WHO has established a Special Project to Prevent and Combat MDR and XDR TB in the European Region. In collaboration with technical agencies, Member States, civil society organization and communities, a Consolidated Action Plan has been developed. The plan paves the way for strengthening the quality of implementation of essential tools such as rapid molecular detection, notification of all TB cases and adequate treatment with patient-centred models of care. The plan focuses on preventing the emergence and spread of drug-resistant TB by addressing the social determinants and health system weaknesses.
Development of new tools also plays an important role in the plan. Dr Jakab: “It is clear that TB elimination is not possible using the current tools, which are extremely old, some of them about 100 years. We need to find new and better tools to fight TB that can rapidly and effectively control this disease. More resources are needed to promote research and development and convert scientific discoveries into new and better drugs, diagnostics and vaccines.” Dr Ditiu agrees: “It is difficult to maintain this on the agenda, but we must. Without new diagnostics and drugs, our progress in achieving zero TB deaths will be stalled. Without new vaccines, we will not be able to eliminate TB. I can only urge donors to be open-minded and to invest.”
This article was published in TBVI’s 2011 Annual Report. More information about TBVI and tuberculosis vaccine development can be found here.
- WHO/Pierre Virot