The marriage between tuberculosis and HIV must be recognised and treated as a union of social — and not medical — diseases if the goal of eliminating tuberculosis in humans is to be achieved, says the head of the World Health Organisation’s Stop TB Partnership.
Marcos Espinal was speaking at a symposium in Cape Town after visiting TB research facilities where the South African TB Vaccine Initiative is testing, or about to test, the six leading candidates for an effective vaccine against the disease.
He said lack of potential profit had for decades stifled private sector research into TB vaccines, because the disease was so heavily concentrated in developing countries. This attitude was changing because of a growing understanding of the risk TB poses to all countries, not just those carrying the burden of disease.
But, he said, the TB community needed to learn about social and political mobilisation, as well as how to attract funding from Aids activists. The massive worldwide TB epidemic was a ‘disgrace†particularly for a disease that, unlike HIV, is curable if properly treated.
‘We made mistakes. The international community concentrated on technical issues; we didn’t concentrate on advocacy that needed to be in place — TB control is the responsibility of government plus others — the private sector, civil society and communities,†he said.
In South Africa it is estimated that only about 58% of people treated are cured of TB. The WHO pushes Dots — directly observed therapy, a treatment that includes supervision of the patient physically taking medication — to encourage adherence to the six- to nine-month course of antibiotics needed to cure the disease.
Espinal said Dots varies in quality around the world: some countries achieved a 50% cure rate, while others had a rate exceeding 85%. He advised South Africa to engage in more operational research.
The primary goal of the Stop TB Partnership is to cut the number of new TB cases in half by 2015, and to eliminate the disease by 2050 — to have less than one case per million people worldwide. The strategic plan, the Global Plan to Stop TB, was launched in 2006 and runs until 2015. Estimates are that, if the plan is implemented, about 50-million people will be treated for TB and about 14-million lives will be saved.
In 2006 1,6-million people are estimated to have died from the disease. The two regions with the heaviest disease burden are South East Asia, with 34% of the world total, and Africa with 28%. Various factors explain the geographical variation. In Africa TB and HIV ‘run in parallel, they are marriedâ€, said Espinal, with each fuelling the other.
In Asia the TB epidemic is driven to a greater extent by the demographic explosion, while Eastern Europe has seen the spread of the drug-resistant disease because the healthcare systems that used to hospitalise every patient collapsed.
It is estimated that the plan will require $55-billion to be implemented, with about $5,5-billion a year spent on diagnosis and treatment of TB.
A forthcoming UN report that analyses TB in 134 countries will show that the number of new infections is falling fastest in those countries that score best on the human development index, have lower child mortality and better access to sanitation.
‘TB is a disease of the poor,†said Espinal, especially in overcrowded environments that provide a ‘nice recipe†for transmitting drug-resistant TB.
There are two TB drugs far along the development pipeline and Espinal hopes that a new, truly short course of one to two months will be available by 2010. A vaccine against the disease is pencilled in for 2015/16.