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World-Class Adversary

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International Will Needed To Eradicate Tuberculosis

Tuberculosis (TB) is both preventable and curable. Yet, the mortality facts and figures worldwide are distressing. More than one and a half million people die annually from the respiratory disease.

Untreated, a person with active TB will infect an average of 10 to 15 other people over the course of a 12-month period. Equally disturbing is that a highly adaptive strain of the disease called extensively drug-resistant tuberculosis (XDR-TB) has recently been documented in 45 nations around the world. (XDR-TB is a type of multidrug-resistant tuberculosis (MDR-TB) but is more dangerous because it is resistant to both first- and second-line drugs and thus virtually untreatable.)

Our increasingly interconnected world, with frequent air travel and constant migration, is often blamed for spreading the disease. Although it is true that such cases exist, the vast majority of TB deaths can actually be prevented with more effective local health care and innovation in medicine.

This international interdependence, however, highlights the fact that combating tuberculosis is a shared responsibility and that innovation requires a worldwide strategy that must be multi-pronged, interdisciplinary and collaborative. These are a few steps that should be taken immediately to remove the barriers to better treatment.

First, governments must recommit to controlling the disease. In highly developed countries, they can do this by reducing the regulatory burdens and help to correct the market failure that makes manufacturing new TB drugs and vaccines unprofitable.

In less-developed countries where TB is more prevalent, governments should be building more effective public health systems so existing tools can be applied more effectively. Investors should also work with national governments to fund improvements to transportation infrastructure and storage capacity, which help reduce the cost of distribution.

Second, global businesses must engage in creative capitalism — a phrase coined by Microsoft founder Bill Gates — and find ways to give back by investing not just in science and technology, but also in community-based prevention and other ground-up solutions.

Third, philanthropy must be coordinated and targeted. Millions of dollars that are donated every year do not get spent in some countries because local administrators lack the technical and operational resources to manage philanthropic grants effectively. More funds need to go to intensive management training courses to fill these gaps. These are not the most high-profile projects, but they are absolutely vital to progress in TB.

Finally, the scientific and medical communities must engage themselves with government, private sector and donors to move forward. A truly collaborative effort can spark new ideas and discover new resources. New technologies can improve case detection by developing cost-effective and accurate diagnostic tools. Collaboration can result in the infrastructure to train a new generation of clinicians and caretakers, and it can provide the incentives to keep that talent working at the local level. As ever, the patient must be the center of the effort.

No doubt, significant progress in detection and treatment has been made across the globe in recent years. A recent survey showed that in 2005, the rate of new TB cases worldwide leveled off for the first time since the World Health Organization began collecting data about the disease. But this does not signal a time to relax our commitment to fighting this global killer. Indeed, it is a time to create the incentives that will lead to sustainable public health services, new vaccines and treatments with shorter regimens.

Treating and curing nearly all tuberculosis globally is within our reach, and we have never been in a better position to do so. Finding the political, corporate and community will to make this a reality is imperative. We can afford to do no less.

Editor’s note:The United Nations and other international organizations will convene a Global Leaders HIV/TB Forum scheduled for June 9 at the United Nations in New York to examine the relationship be-tween HIV and tuberculosis worldwide, with the goal of creating a strategy for the millions of people living with both diseases.

About the Author

Nils Billo is the executive director of the International Union Against Tuberculosis and Lung Disease (www.iuatld.org).

Last Edited on November 29, 1999