UN and WHO Failing at Fight Against TB, New Strategies Needed

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More than 9 million people were infected with tuberculosis (TB) last year, despite global efforts to control the disease by the United Nations and the World Health Organization. Experts in the British medical journal Lancet, have found that there is more tuberculosis now than at any other time in history, and radical new approaches are needed.

Pulmonary tuberculosis is a contagious bacterial infection that mainly involves the lungs, but can spread to other organs. Early stages of the disease do not have symptoms, but later a cough that produces phlegm or blood, excessive sweating, fatigue, and unintentional weight loss can occur. The goal of treatment is to cure the infection with a combination of four drugs which usually lasts about 6 months or longer.

Those at increased risk for contracting TB include the elderly, infants, and others with weakened immune systems, such as those with HIV/AIDS, persons on chemotherapy, or patients who have had an organ transplant. The risk increases with frequent contact with infected persons, poor and unsanitary living conditions, and malnutrition.

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Because TB is “intertwined with poverty”, programs to fight the disease need to go beyond the health care sector and include areas such as housing, education, and transportation. According to Philip Stevens, health policy expert at International Policy Network, “TB cannot be tackled in isolation.”

Another key issue is the spread of the disease by “migrants”, or people who leave one area to settle in another. A commentary by Henry M. Blumberg MD, professor of medicine (infectious diseases) at Emory University School of Medicine, entitled “TB on the Move” states that “Migrants are disproportionately affected by TB, a reflection of the high rate of disease in their country of origin due to poverty and made worse by limited health-care and public health infrastructure.” Dr. Blumberg says by enacting government policies to ensure that all patients have easy access to diagnosis and treatment, the spread and severity of tuberculosis will decrease.

Thirdly, drug-resistant TB is emerging because patients do not finish their pills or take substandard drugs. A 2007 report from the Global Fund to fight AIDS, Tuberculosis and Malaria found that half of the drugs bought for poor countries did not comply with drug quality standards. There is also a lack of basic data on the global outbreak of drug-resistant strains. "It is surprising how much data we're lacking," said Pamela Das, executive editor at Lancet. "There are so many gaps that we don't really know what's going on."

"Tuberculosis can no longer be the neglected sister of HIV and malaria," the Lancet authors say, pointing out that the US National Institutes of Health (NIH) spend about seven percent as much on TB research as for HIV, even though both diseases kill roughly the same number of people worldwide.

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