BEIJING -- Health ministers from countries with the greatest burdens of drug-resistant tuberculosis (TB) have agreed to a series of actions to accelerate efforts to halt and reverse the global epidemic of the disease.
Global leaders, including WHO director-general Dr. Margaret Chan and the co-chair of the Bill and Melinda Gates Foundation, Bill Gates, were joined by the vice premier of the People's Republic of China, Li Keqiang, and ministers and high-level representatives of 27 countries with high burden, at a three-day meeting organized by WHO.
The governments present issued a Call for Action at the conclusion of the opening day of the meeting. The Call for Action, which was supported by senior representatives from international health and aid agencies and non-governmental organizations, asserts that all countries would move:
-- toward universal access to M/XDR-TB diagnosis and treatment by 2015;
-- to ensure removal of financial barriers to TB care;
-- to ensure development of a comprehensive M/XDR-TB management and care framework;
-- to ensure sufficient staff are trained and deployed;
-- to strengthen laboratory systems;
-- to ensure collaboration with all partners;
-- to ensure development and implementation of airborne infection control policies;
-- to ensure a sufficient supply of high-quality anti-TB drugs;
-- strengthen mechanisms to ensure availability of TB medicines is regulated;
to ensure advocacy and communication and social mobilization are included in policies and plans; and
-- to develop the new tools needed to combat M/XDR-TB.
Chan said preventing and managing drug-resistant TB was a global health imperative. "We need high-level political attention because national TB programmes cannot by themselves manage these new threats. The problem has become too great," she said.
Gates urged all countries to invest in innovative methods to fight TB. "Every country should feel the urgency, whether it is suffering from TB or not. Every country is capable of innovation, whether it is has a high-tech economy or not. And every country can adapt its systems to use the best innovations of others."
The Call for Action signals a major step forward in coordinated planning for M/XDR-TB prevention, treatment and care and a commitment to achieve universal access to diagnosis and treatment for MDR-TB patients by 2015.
The final two days of the meeting will be spent outlining the technical implications of the Call for Action for governments and stakeholders.
Four of the countries represented at the three-day meeting - China, India, the Russian Federation and South Africa -- account for 60 percent of the global number of MDR-TB cases and have increased their financing for TB control. Still, only 3 percent of the half million MDR-TB cases estimated to emerge each year worldwide are known to be receiving treatment according to WHO guidelines.
Participants committed to help mobilize the estimated US$ 15 billion needed to finance the TB and M/XDR-TB response from both domestic and international resources through to 2015, and called for increased investment in the research and development of new TB diagnostics, drugs and vaccines. They asked for WHO and the Stop TB Partnership to ensure there is the necessary technical support needed to implement the M/XDR-TB response plans.
These further commitments are expected to have a significant impact in these and other countries in saving lives, enabling care for those in need, and 'turning off the tap' that produces M/XDR-TB.
M/XDR-TB in high-burden countries
Multidrug-resistant tuberculosis (MDR-TB) is defined as resistance to the two most powerful first-line anti-TB drugs (isoniazid and rifampicin). Extensively drug-resistant tuberculosis (XDR-TB) is defined as MDR-TB plus resistance to the most powerful second-line anti-TB drugs (any fluoroquinolone and any of the three injectable drugs: amikacin, capreomycin and kanamycin). MDR-TB and XDR-TB together are defined as M/XDR-TB.
There are 27 countries with a high burden of M/XDR-TB: Armenia, Azerbaijan, Bangladesh, Belarus, Bulgaria, China, DR Congo, Estonia, Ethiopia, Georgia, India, Indonesia, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, Rep of Moldova, Myanmar, Nigeria, Philippines, Russian Federation, Pakistan, South Africa, Tajikistan, Ukraine, Uzbekistan, Viet Nam. A high burden country is defined as one where there 4000 or more new cases of drug-resistant TB per year, or where 10 percent of new TB cases are drug resistant.