Experts: Decades of UN efforts to fight tuberculosis have flopped and new strategies required

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UN efforts to fight TB have flopped

GENEVA — Global efforts to control tuberculosis have failed and radical new approaches are needed, experts said Wednesday.

With more than 9 million people infected last year, including 2 million deaths, officials say there is more tuberculosis now than at any other time in history. In a special tuberculosis edition of the British medical journal Lancet published on Wednesday, experts said past failures prove new strategies are required.

For years, the World Health Organization and partners have fought TB largely with a program where health workers watch patients take their drugs — even though the agency acknowledged in a 2008 report that this treatment program didn’t significantly curb TB spread.

Experts said TB isn’t only a medical problem, but is intertwined with poverty, as it spreads widely among people living in overcrowded, dirty places. They said TB programs need to go beyond health and include other sectors like housing, education and transportation.

Some officials questioned whether continued U.N. programs could even combat TB. “The main priority for TB control is improved living conditions and economic growth, which is outside the control of the U.N.,” said Philip Stevens, a health policy expert at International Policy Network, a London-based think tank. “TB cannot be tackled in isolation.”

Stevens said the global health community also needs to be more vigilant about the drugs they buy for TB programs. According to a 2007 report from the Global Fund to fight AIDS, Tuberculosis and Malaria, half of the drugs the fund bought for poor countries didn’t comply with their own drug quality standards.

Dr. Mario Raviglione, head of WHO’s TB department, said the recent fall in TB was “very minor” and that the agency was trying to understand how better to fight the epidemic.

Still, WHO said their basic TB programs cured more than 36 million people between 1995 and 2008, and saved up to 6 million from dying of the potentially fatal lung disease.

But the recent spread of drug-resistant TB illustrates there have been major shortcomings. Drug-resistant TB emerges when patients don’t finish their pills or take substandard drugs — like many of those bought by the Global Fund.

One of the public health community’s biggest failings in fighting drug-resistant TB is the lack of basic data. In a WHO report published in March, the agency said it didn’t know whether the global outbreak of drug-resistant strains are getting bigger or smaller.

“It is surprising how much data we’re lacking,” said Pamela Das, executive editor at Lancet, who co-authored an accompanying commentary in the journal. “There are so many gaps that we don’t really know what’s going on.”

One of the Lancet papers called for the disease to be eliminated by 2050, while another said WHO guidelines on treating people infected with both TB and AIDS were not based on good evidence and needed to be revised.

Das said WHO and partners should be proud of drop in TB cases, but that the agency has failed to achieve its mandate and those gains could soon be reversed. She doubted the disease could be wiped out by 2050 unless current strategies addressed the poverty underlying much of TB.