Lahore: A week before World TB Day is observed globally including Pakistan on 24th March 2013 for the second time with the slogan “Stop TB in my lifetime”, WHO is focusing on bridging the funding gaps for TB prevention and control efforts. The overall stress will be on increasing funding for TB prevention, care and control efforts, while enhancing awareness of key progress in TB interventions and actions required to ensure further progress. It is against this backdrop that today in Geneva the World Health Organization and the Global Fund to Fight AIDS, TB and Malaria (GFATM) said that strains of tuberculosis with resistance to multiple drugs could spread widely and highlight an annual need of at least US$ 1.6 billion in international funding for treatment and prevention of the disease.
Dr Margaret Chan, Director General of the WHO, and Dr Mark Dybul, Executive Director of the GFATM said that the only way to carry out the urgent work of identifying all new cases of tuberculosis, while simultaneously making progress against the most serious existing cases, will be to mobilize significant funding from international donors. With the overwhelming majority of international funding for tuberculosis coming through the Global Fund, they said, it is imperative that efforts to raise money be effective this year. Growing alarm about the threat of multi-drug resistant TB, also known as MDR-TB, is making that even more pressing.
“We are treading water at a time when we desperately need to scale up our response to MDR-TB,” said Dr Chan. “We have gained a lot of ground in TB control through international collaboration, but it can easily be lost if we do not act now.”
The WHO and the GFATM have identified an anticipated gap of US$1.6 billion in annual international support for the fight against tuberculosis in 118 low and middle income countries on top of an estimated US$3.2 billion that could be provided by the countries themselves. Filling this gap could enable full treatment for 17 million TB and multidrug-resistant TB patients and save 6 million lives between 2014-2016.
While the Millennium Development Goal of turning around the TB epidemic has already been met globally, the 2 percent decline in the number of people falling ill with TB each year remains too slow. WHO worked with the Global Fund and the Stop TB Partnership to support selected high TB burden countries in reviewing their priorities for the next three years and estimating available funding and gaps. In addition to the US$1.6 billion annual gap in international financing for the critical implementation interventions above, WHO and partners estimate that there is a US$ 1.3 billion annual gap for TB research and development during the period 2014-2016, including clinical trials for new TB drugs, diagnostics and vaccines.
Pakistan which has the fifth highest burden of Tuberculosis in the world and the fourth highest in terms of multi-drug resistant (MDR) Tuberculosis is working on many fronts to address the problem with the technical support of WHO, and financial support of GFATM, USAID, KNCV, JICA, DFID and a number of other development partners. A tripartite agreement between the National TB Control Program, WHO Pakistan and the Institute of Tropical Medicine Belgium has enabled the latter to act as a supra national laboratory for TB Control in Pakistan. WHO is also technically supporting the USAID funded prevalence survey, and also assisting in incidence and drug resistance surveys to know the exact burden of the disease in Pakistan alongside efforts to detect and cure patients of Tuberculosis. The current case detection rate of the program is 69% while the treatment success rate is 92%.
The WHO Representative in Pakistan Dr Ni’ma Saeed Abid has expressed satisfaction over the performance of the National and Provincial Tuberculosis Control Programs and hoped that with an increased pace of effort, the Millennium Development Goal relating to Tuberculosis may be at least partially achieved by 2015. He emphasized that WHO has remained a consistent technical partner of the program and has been supporting the program particularly in the areas of monitoring and evaluation, resource mobilization and operational research. He described Tuberculosis Control as one of the few success stories in Pakistan’s Health Sector.
Dr Abid described it as a fight both against the disease and time as the more the time is lost, the more difficult it will be to control the disease with the additional risk of developing multi-drug resistant strains of Tuberculosis. There was therefore no room for complacency in this regard, and a grand concerted effort was required to reach all the cases and provide them with quality treatment close to their doorsteps, while emphasizing the preventive aspects as well.
Giving details of the program’s performance, WHO’s National Professional officer for Tuberculosis Control Dr Ghulam Nabi Kazi pointed out that in 2012 over 284,000 cases of Tuberculosis had been detected and placed on treatment while this year the figure will touch around 300,000. He pointed out that around 420,000 new cases appeared in the country every year.
As regards drug resistant Tuberculosis or MDR-TB, Dr Kazi pointed out that the services of a regional MDR TB expert Dr Salem Barghout had been acquired to support the National TB Control Program in the area of drug management, developing a community based model of MDR-TB care based on ethical considerations, capacity building and preparing a pragmatic expansion plan.
Currently twelve tertiary care institutions including Lady Reading Hospital Peshawar, Ayub Medical College Hospital Abbottabad, Gulab Devi Hospital Lahore, Mayo Hospital Lahore, Leprosy Hospital Rawalpindi, Nishtar Medical College Hospital Multan, Samli Hospital Murree, Ojha Institute of Chest Diseases Karachi, Indus Hospital Karachi, Ghulam Muhammad Mahar Hospital Sukkur, Institute of Chest Diseases Kotri and Fatima Jinnah Hospital Quetta are providing MDR-TB services and currently 1,100 patients have been enrolled on treatment for a period of two years or more. Thus far 600 patients have completed treatment. However, now with the medicines in place with GFATM support, the expansion plan is being developed to enrol over 3,000 patients every year.
Dr Kazi expressed the hope that the long delayed process of project approval and release of funds for TB control would be resolved soon at the federal and provincial levels enabling the public sector to meet the core requirements of the program, and ensuring sustainability of the process without undue reliance on external agencies. It is time that the government translates its high level commitment in concrete terms and puts the activities of the TB control mechanisms on an even keel. Our deliberations with the Planning Commission, Ministry of Inter-Provincial Coordination, provincial Planning and Development and Health departments have been most positive thus far, he added.