by Danae Spencer
Most Americans assume that the United States contribution to foreign aid is a large percentage of the total national budget. However in reality the U.S. gives approximately 1% of its budget to foreign aid and a fraction of that goes toward global health. This is still a very large amount, however in the scheme of looming budget cuts many wonder what the true impact U.S. government funding has had internationally.
Last month a report entitled “Saving Lives and Creating Impact” answered this question. It concluded U.S. government agencies contribution to global health research and development (R&D) made definitive progress toward new global health products, diagnostics, and establishing the largest pipeline ever of global health products. Other bonuses to our contributions included positive sentiment about the U.S. in the global community, the jobs created in global health, and the positive impact on the economy.
Of the five federal agencies making major contributions to global health research and development (R&D), The National Institute of health (NIH) has been the largest, providing 40% of global R&D funding and 90% of the US government’s contribution. As a leader in new global health products the NIH has provided many firsts in the vaccine and diagnostic sectors: the first vaccine for children against typhoid fever; first vaccine against rotavirus; and first rapid diagnostic test for tuberculosis.
The Center for Disease Control and Prevention (CDC) focuses most of its global health R&D funding towards tuberculosis (TB), with 63% of it allocated for TB from 2000 to 2010. What many people consider a disease of the past continues to spread throughout developing countries. Tuberculosis treatments require several months and when the disease goes untreated it can develop resistance. These resistant strains lack adequate diagnostic tools for detection and these tools have been targeted for improvement in efficiency and availability in developing countries.
On the wake of the PEPFAR funding situation where over a billion dollars was found to be “stuck” in the pipeline, we may question if the need for more funding truly exists. This report proves it does. The U.S. has advanced global health in numerous ways, including its development of new TB diagnostic procedures and vaccines, which will save millions of lives around the world. This is all impossible without funding, particularly for new drug development which requires the most money in the clinical trial period. With two-thirds of funding going toward basic research and one-fifth towards clinical trials, the U.S. has been notorious in not providing consistent funding throughout the research process and perhaps this contradictory action should be reassessed.
So where do we go from here? I think we should continue helping our global community and indirectly helping ourselves. By recognizing the benefits the U.S. economy and foreign policy receives from our altruism, the continued funding of global health programs should not even be a question. We need to demand greater transparency, as taxpayers and interested parties in the progress of the infectious diseases internationally, to ensure that corruption and inefficiency is driven out of our financial institutions. As advocates we have the strength of numbers and the power to change the way the government spends and allocates its money.
Spending smarter could allow us to maintain funding levels, and spending efficiently could allow us to maintain funding and exceed expectations. Current issues with US spending habits are due to lack of consistency in investment. Low participation in product development partnerships (PDPs) slow and limit the ability to establish new products. If we establish few and specific goals while maintaining funding levels and increasing efficiency, funding and attaining these goals will be more feasible than striving to save every person with every disease.
World TB Day Congressional Briefing Tuberculosis
We Can Beat this Global Killer
Wednesday, March 21, 2012
A briefing and update on tuberculosis (TB), a disease that is curable but still takes the lives of 4,000 people each day and is the number one killer of people living with HIV. Special areas of focus of the briefing include US global leadership on TB, how communities are addressing the crisis, the threat of drug-resistant TB, and progress towards an effective vaccine, better medications and faster diagnostics.
Moderator: John Fawcett, Legislative Director, RESULTS Educational Fund Video
Speakers:
Ariel Pablos-Mendez, Assistant Administrator for Global Health at the U.S. Agency for International Development (USAID)
US Partnership in Advancing the Response to TB
Powerpoint
Carol Nyirenda, Executive Director of the Community Initiative for Tuberculosis (TB), HIV/AIDS and Malaria plus related diseases (CITAM +), Zambia African Leadership at all Levels Confronting TB and TB-HIV Powerpoint
Jennifer Woolley, Director of Advocacy, Aeras New Tools for TB: Investing in Long-Term Solutions
Powerpoint
Dr. Lucica Ditiu, Executive Secretary, Stop TB Partnership US leadership is crucial in winning the TB battle
Powerpoint
Co-sponsored by RESULTS Educational Fund, American Thoracic Society, Stop TB Partnership, Aeras, and Treatment Action Group
Guest blog, Crickett Nicovich, Senior Policy Associate, RESULTS Educational Fund
Every child goes through a series of “firsts.” Her first smile, his first step, and first birthdays to name a few... These are exciting milestones that are celebrated by the important people in the lives of a child.
Still there are 7.2 million children every year that miss out on so many of these “firsts” because they don’t reach their fifth birthdays. Most of these children live in developing countries and most of them die of completely treatable and preventable diseases. In fact, a majority of these child deaths (60 percent) occur in just 10 countries: India, Nigeria, Democratic Republic of Congo (DRC), Pakistan, Ethiopia, Tanzania, Uganda, Bangladesh, Kenya and Niger.
As RESULTS works to fight this health inequity by pushing for increased resources for child survival and vaccines, we celebrated a few “firsts” of our own this week. RESULTS celebrated the first ever World Immunization week by participating in the launch of USAID’s “5th Birthday” Campaign, and the United Nations Foundation’s launch of their Shot@Life Campaign. Both campaigns focus on the US’s role in child survival and both are committed to giving more children the opportunities to have more “firsts.”
USAID’s 5th Birthday Campaign focuses on how countries can work together to end preventable child deaths. That’s right. They are talking about ENDING preventable child deaths. That means bringing developing country child deaths to the same level as developed countries.
http://c1237762.r62.cf0.rackcdn.com/IMG_2170.JPG
The campaign is an effort to build momentum for USAID’s “Child Survival Call to Action” summit planned for June 2012 in Washington, DC. The Call to Action will bring together heads of states, development ministers, and health ministers from around the world with international civil society organizations and private sector companies to recommit international efforts to fight pneumonia, diarrhea, malaria, mother to child transmission of HIV/AIDS, and other leading child killers. At the launch USAID’s Campaign, Administrator Rajiv Shah held up a backpack full of health goodies to show the auditorium at the Kaiser Family Foundation some of the cost effective health interventions that can lead to the end of child deaths. He pulled out a package of plumpy nut and a sweet potato to talk about good nutrition, a dose of nevirapine that prevents the transmission of HIV from mother to child, zinc and oral rehydration therapy to treat cases of acute diarrhea which leads to severe dehydration, and basic and new vaccines like the GAVI funded pneumococcal and rotavirus vaccines that prevent and reduce pneumonia and diarrhea all together. All the life-saving interventions added up to just 30 dollars, but their benefits for saving children’s lives are priceless. RESULTS looks forward to this Call to Action and getting our activists involved in advocacy to encourage countries to live up to their commitments to end preventable child deaths.
USAID Administrator Raj Shah discusses the current status of child mortality and how to reframe the conversation to ensure every child has a 5th birthday.
Thursday, RESULTS helped to kick-off the UN Foundation’s Shot@Life Campaign at the Atlanta Aquarium with moms and health advocates. Accessing polio and measles vaccines and the new pneumococcal and rotavirus vaccines for a child in a developing country can give them a Shot@ all the “firsts” and milestones we hope for every child to achieve.
A young shot@life attendee checks out the rays at the Atlanta Aquarium.
The event featured Former First Lady Rosalynn Carter and the world-renowned photographer Anne Geddes speaking about the power of vaccines in protecting children. Mrs. Carter told the crowd, “Germs and disease don’t need passports.” She said that expanding access to vaccines globally also protects us in the United States. Anne Geddes added that it was our moral obligation to protect children and help them to reach their “firsts.” She said, "We are all responsible, for all the children, all the time."
Former First Lady Rosalynn Carter delivers a speech on her experience with immunization advocacy in the US with her organization, Every Child By Two.
RESULTS’ Atlanta activists volunteered at the event and talked about the power of vaccines with children and their parents as they toured the aquarium. They all were able to email and tweet to their members of Congress on site to tell them why vaccines mattered for children in developing countries. RESULTS even created our own Shot@Life poster saying, “I want to give more kids a Shot@ becoming an activist!” That’s definitely a “first” we want everyone to have the opportunity to have!
RESULTS Atlanta grassroots volunteers Rob Marshall, Katy Windschill, and Ben Herr lend a helping hand, and their pinkies at the Shot@Life launch. In many developing countries, children will get their pinky painted when they are vaccinated against polio.
PS: Check out some RESULTS staff on USAID's 5th Birthday website. Can you guess who these cute kiddies are?Guess 1, Guess 2. Guess 3. What do you wish for every child?
http://c1237762.r62.cf0.rackcdn.com/IMG_2170.JPG
Guest blog from our ACTION intern, Jessica Hoffner
I remember my 5th birthday pretty well – surrounded by balloons, pre-school friends, and cake - and all I wanted was to unwrap Malibu Barbie and her dream house.
After my semester working with ACTION, it seems ridiculous to have been so focused on Barbie when so many kids never even have a 5th birthday.
More than 7 million children will die this year before they reach their 5th birthday – that’s the entire population of New York City.
Even worse, most of these children will die from preventable causes.
But it’s even more ridiculous to compare myself to these children. I’m an American. In America we bury the elderly, not our children. In places like sub-saharan Africa, it can be the opposite. This is totally unacceptable.
One of the best investments we can make to fight preventable diseases and reduce child deaths is to improve routine immunization. Pneumonia and diarrhea are the leading global killers of children and vaccinations against these two deadly diseases can change this trend.
On Monday, USAID Administrator Dr. Rajiv Shah launched the Every Child Deserves a 5th Birthday campaign to educate Americans on the disparity in child survival rates and make them more aware of our ability to save children’s lives.
But raising awareness alone is not enough. The world needs to mobilize.
There is a missing link between what we know and what we are doing. Ending preventable child deaths is possible. My time spent as ACTION Global Intern has proved this to me, but it takes more than just knowing the facts. We need political will to ensure every child, no matter where they live reaches their 5th birthday and beyond.
So how do we get there? Here’s my oversimplified impression of how regular people like you and I can affect change:
Step 1: Know the facts. Spend 5 minutes on UNICEF’s website. Once you understand why innocent children are dying of preventable causes move on to Step 2: Take action. My colleagues at RESULTS have made it very easy to go on their website and do just this. Now you’re ready for Step 3: Talk to your congressperson! Tell them what you know and why they should care.
On July 25th I'll be blowing out 20 candles. I can't tell you what I'm going to wish for, but I bet you could guess.
Vaccines are one of the most impactful public health interventions of the 21st century.
According to the World Health Organization (WHO), vaccines save three million lives each year. World Immunization Week (WIW) happening April 21-28, is a time to acknowledge this achievement – and there are many good news stories to share.
In Canada, vaccines have been so successful that diseases like polio, diphtheria, mumps and measles are rarely ever seen. In fact, less than 5% of childhood deaths in Canada are attributed to vaccine preventable diseases.
Across the Atlantic in Ghana, pneumonia and diarrheal diseases each account for approximately 10% of under-five deaths in the country – the two biggest killers of Ghanaian children. Introducing vaccines to combat these two diseases will ensure that no child will suffer from diseases we have the power to protect them from. With support from the Global Alliance for Vaccines and Immunizations (GAVI Alliance), health care workers are gearing-up to introduce both pneumococcal and rotavirus, in an unprecedented double roll-out of these revolutionary vaccines.
WIW it is also an opportunity to reflect on the challenges ahead. In 2010, approximately 19.3 million children did not receive even the most basic vaccines (e.g., diphtheria, tetanus and pertussis). Nearly 70% of these children live in just ten countries, in some of the most remote regions of the world. Every year three million of the most vulnerable children die needlessly due to vaccine preventable diseases.
Canada has shown tremendous leadership in the area of maternal health and child survival. In 2010, Prime Minister Stephen Harper paved the way for an incredible $7.3 billion total investment to the Muskoka Initiative by G8 countries and has made good on Canada’s $1.1 billion promise.
We have seen the incredible impact of investments in child health. Over the last 50 years, child mortality has dropped by 70 percent world-wide. In the past two decades alone, child deaths have plummeted from 12 million in 1990 to 7.6 million in 2010. This rapid progress is largely due to high-impact, cost-effective interventions like vaccines. Canada’s contributions to these gains in child survival are definitely worth celebrating.
However, recent cuts to the Canadian International Development Agency (CIDA) in the 2012 Federal Budget are a cause for serious concern. Canadian-funded basic immunizations programs, such as the Canadian International Immunization Initiative (CIII), will be clawed back or left to expire, jeopardizing important gains in child survival, and undermining our investments in GAVI as well.
Canada has an opportunity to recommit to critical child survival interventions by protecting and renewing investments in life-saving programs such as CIII. On World Immunizations Week Canada should demonstrate to the world that it is still a country that cares about the protection of the world’s most vulnerable children.
Take ACTION with RESULTS Canada today!
Guest Blog: Bruno Rivalan, GHA France
Lancement historique au Ghana du vaccin antipneumococciques et antirotavirus: la volonté politique pierre angulaire pour l‘accès aux soins
Le 26 avril prochain, lors de la première Semaine mondiale de la vaccination organisée par l’OMS, le Ghana introduira simultanément deux nouveaux vaccins dans son programme national de vaccination une première pour un pays du Sud.
Les vaccins antipneumococciques et antirotavirus permettront de protéger les enfants ghanéens contre les principales causes de pneumonie et de diarrhée infantile sévère, les deux maladies les plus meurtrières pour les enfants dans les pays en développement.
A cette occasion, le ministère de la santé du Ghana, l’alliance GAVI l’Unicef, l’OMS et la société civile ont travaillé conjointement pour qu’à Accra les premiers enfants ghanéens soient vaccinés dès aujourd’hui. La video de 3 minutes réalisée par Ryan Youngblood et produite par Doune Porter nous montre habilement ce travail de planification et de coordination qu’a entrepris le Ghana pour assurer la réussite d’un lancement inédit.
C’est d’ailleurs grâce à la mobilisation de l’ensemble des acteurs que des progrès fulgurants ont été accomplis dans la réduction de la mortalité infantile ces dix dernières années. On considère que depuis la création de l’alliance GAVI plus de 288 millions d’enfants ont été vaccinés et que les programmes d’immunisation préviennent la mort de 2,5 millions de personnes chaque année.
Malgré ces progrès, l’OMS estime que 19,3 millions d’enfants n’ont toujours pas accès aux programmes de vaccination de base en 2010 et 1,5 millions d’entre eux continuent de mourir chaque année alors que ces maladies sont évitables.
En ces temps de crise économique, l’argument financier prend parfois l’ascendant sur le nombre de vies sauvées. Et puisque aujourd’hui nous définissons les politiques sociales (éducation, santé etc..) de coopération et d’aide au développement en fonction de concepts liés à la rentabilité économique - paradigme du value for money- il est donc utile de souligner que développer l’accès à l’immunisation aura un impact économique indéniable.
Une étude de la célèbre Johns Hopkins Bloomberg School of Public Health nous montre que l’augmentation de la couverture vaccinale dans les 72 pays les plus pauvres lors des 10 prochaines années permettrait d’économiser plus de 6,2 milliards de dollars en traitement. Sans un accès élargi plus de 145 milliards seraient perdus par le manque de productivité en raison d’une force de travail affaiblie (fort taux de mortalité infantile, handicap permanent lié aux maladies prévenues pas des vaccins), appliquant une logique assez simple : un enfants en bonne santé à la possibilité d’être scolarisé et de prétendre à un emploi (qualifié ?).
Déjà précurseur dans la mise en place d’une couverture maladie, le Ghana montre une nouvelle fois à la communauté internationale que la volonté politique reste l’étape indispensable pour améliorer l’accès aux soins des populations.
Alors que se creusent les inégalités d’accès entre et aux seins des pays du Sud, le renforcement du dialogue politique entre les bailleurs et les pays partenaires et l’implication de l’ensemble des parties prenantes notamment de la société civile locale et des parlements nationaux, est également un ingrédient nécessaire à l’objectif d’universalité. Cette participation ne sera efficace que si elle a lieu depuis la définition des plans de santé jusqu’ à leur mise en oeuvre et leur évaluation afin d’intégrer dans ces politiques les populations reculées, vulnérables et marginalisées.
Durant cette semaine mondiale de l’immunisation, ACTION continue de se mobiliser pour soutenir un accès élargi et équitable à la vaccination.
RESULTS UK
By RESULTS UK
The theme for this World Malaria Day is ‘sustain gains, save lives’. As with the other two diseases which have received a huge boost from the Global Fund to Fight AIDS, TB and Malaria, this disease is on the cusp of many breakthroughs in efforts to control it and the message coming from the millions of people who are every day at risk of contracting malaria is ‘don’t lose focus now’.
Last October a large-scale Phase III trial of RTS,S a malaria vaccine candidate, demonstrated its first positive results. The results showed young African children with significant protection against clinical and severe malaria. The results came after 40 years of scientists seeking to develop a vaccine for Malaria, a 30 month period of analysis in regard to the vaccine’s safety will bring results by 2014. Whilst the vaccine does not kill the malaria parasite it will boost the immune systems of those most vulnerable to the disease in order that they might more effectively fight it.
Such developments are only possible if there are the funds to invest in such innovative research and product development partnerships which harness the power of the private sector to invest as well as engaging the most affected communities in trials.
This World Malaria Day comes as the history of the response to the disease lies in the balance. The Global Fund to fight AIDS, TB and Malaria, which currently provides nearly a quarter of all international funding to fight AIDS, over half of the funding against malaria and more than four-fifths of all funding to fight TB is in crisis. Huge funding shortfalls meaning the cancellation of its 11th funding round threaten the progress made to date on malaria as well as presenting a risk that gains might be reversed as resistance to malaria drugs rises in key malaria hotspots.
Today a key faith leader in the UK, the Archbishop of Canterbury called for world leaders not to lose sight of our achievements to date and potential progress for the future. He noted that
“Local churches and other grassroots organisations have been key partners in enabling this progress, alongside a concerted effort from the international community through mechanisms such as the Global Fund to Fight AIDS, TB and Malaria.
Warning of the danger of reversing gains made he added:
“The current gap in global funding needed to fight malaria threatens to undo many of the hard won gains and risks allowing malaria to regain a hold on communities who are close to elimination.
On this World Malaria Day I urge governments to continue to invest in malaria programmes to prevent the unnecessary death of millions of vulnerable people. We have already come so far, let’s not lose momentum now.”
RESULTS UK with Dr Bakeera-Kitaka, a Ugandan visiting Paediatric Health specialist, recognising World Malaria Day at the UK Commonwealth Secretariat’s conference on the same theme.
Check out this press statement from religious leaders
ACTION asks our Kenyan partner 3 questions on the current status of immunizations in Kenya. See what he thinks!
Join the conversation: Follow @ACTION_Tweets and utilize the hashtag #vaccineswork.
Guest Blog: Mark Staniland, Vaccine Advocacy Coordinator RESULTS UK and Bruno Rivalan, Vaccine Advocacy Officer GHA France
On April 18th the European Parliament in Strasbourg hosted a breakfast debate to discuss the impact of immunisation programmes on the EU development aid landscape. As a pre-cursor to Immunisation Week, the forum, "The impact of immunisation programmes in the EU development aid landscape” highlighted immunisation as a central aspect of global health and development and the challenges in reaching every child.
Pictured from left to right: Alexzander Wollocombe, acting director for ONE Brussels, Marie-Ange Saraka Yao, Director of Programme Funding GAVI Alliance, Dr Clarisse Loe Loumou, Pediatrician and member of the GAVI CSO Steering Committee and CSO Francophone Platform, president of Alternative Santé and ACTION’s Bruno Rivalan, Vaccine Advocacy Officer for GHA France.
The panel included Thijs Berman, MEP, Rapporteur of the Development Committee (DEVE) who gave an opinion on the Development and Cooperation Instrument (DCI) for the next multi-annual financial framework; Walter Seidel, Head of the Health Sector, Unit "Education, Health, Research, Culture" of the Directorate-General Development and Cooperation, European Commission; Clarisse Loumou Loe, Pediatrician, President of Alter-Santé, Cameroon; and Marie-Ange Saraka-Yao, Director, Programme Funding, the GAVI Alliance, and was chaired by Sean Kelly MEP.
Those in attendance stressed the need to secure adequate funding for development aid with a sufficient share for health in the next multi-annual financial framework, immunisation being a high impact and cost-effective health intervention, challenges around the equity of access and how to reach the hard to reach, democratic ownership, and the need for new vaccines against poverty-related diseases.
The Value of Vaccines in the Aid Budget
MEPs acknowledged the power of vaccines and given the amount of money the EU spends on health, immunisation is one of the best ways to spend it. “For the price of a cup of coffee, a child can be vaccinated against five of the major childhood killers, including haemophilus influenza B, diphtheria and tetanus. Yet 20% of children are dying as a result of vaccine preventable diseases," said Sean Kelly, to kick off the discussion.
The panellists highlighted the need to monitor the future EU developments in the area as a it is on of the best way to save vulnerable children’s lives and that the EU must ensure funding is secured to protect children in developing countries.
Main Challenges in Immunisation: Equity
The discussion also focused on the main challenges ahead, how to reach the hard to reach. MEP Theocharous, voluntary surgeon in conflict and post conflict countries commented on the need for strong political dialogue with developing countries at the government and parliamentary levels. “In EU partner countries, parliaments often decide spending on health, but do not have the expertise to decide on specifics of where money should go” she said.
Dr Loe Loumou, paediatrician, member of the GAVI CSO Steering Committee and CSO Francophone platform, president of Alternative Santé raised the importance of civil society in addressing the equity issue, in terms of raising awareness, disseminating correct information to the population, and also as key partners in the design and evaluation of national immunization plans.
Middle-Income Country Support
MEPs also discussed middle-income countries, commenting on the EC proposal that aims to cut aid to 17 middle income countries. “Many of middle incomes countries are yet to achieve universal access to essential services such as basic immunisation. Of the 19.3 million children in the world who are not fully immunised with basic childhood vaccines, more than 7 million children live in India,” mentioned Marie Ange Saraka Yao from the GAVI Alliance.
“Differentiation in the EC proposal uses mainly GDP as its measurement, but with no consideration to regions or the Human Development Index,” said Mr Berman. “India has enormous numbers of unimmunised children. The EU therefore cannot abandon it, this would be unacceptable. We need to advocate for a phased approach to ensure the Indian government has time to take over the full responsibility of funding immunisation programmes.” He also highlighted that 20% for health and education has been a goal for the EU and that it must also be upheld in the next budget cycle.
MEP Commitment to Immunisations
All the MEPs participating in the debate are supporters of the open Written Declaration on this issue (4/2012) in the European Parliament currently tabled by MEP Mary Honeyball. Following the event, MEPS decided to pose next to giant syringe as a sign of their support to immunisation programmes in developing countries.
MEP Thijs Berman and MEP Françoise Castex - signatories of a written declaration on immunisation
The European Vaccine Advocacy Coalition (EUVAC), which includes ACTION partners GHA France and RESULTS UK, will release its position paper next week detailing their calls to action for World Immunization Week. ACTION partners in the EU hope to raise awareness of the need for continued and increased support for vaccinations and immunisation in the EU development aid budget.
Guest Blog: Rachel Achterstraat, ACTION Project Coordinator, RESULTS International (Australia)
Every 20 seconds, a baby or toddler will die from a disease that can be prevented by a simple vaccine. Most of these deaths happen in developing countries because children go without the immunisations and lack access to other health services that parents in wealthy nations take for granted.
As usual, it is the poorest children in the poorest countries who are least likely to be immunised, and it is those same children who are at the greatest risk of being exposed to life-threatening, preventable diseases like tetanus, polio and measles.
This week, April 21-28, is World Immunisation Week, and around the world we acknowledge that all children have the right to life and health, no matter where they live. And for a very small amount per dose (13c per life for a polio vaccine!) governments can make one of the smartest public health investments available today.
By helping kids to stay healthy, vaccines remove a major barrier to human development. Immunised children have higher cognitive abilities and are more likely to live to see their 5th birthday. Immunised kids are more likely to thrive at school and go on to be productive members of society. By reducing illness and long-term disability, vaccines also generate savings for health systems and families. Health workers are freed up to care for other needs and parents spend less time looking after sick children.
Given all this it is little wonder that the Australian Government dramatically scaled up its investment in immunisation programs last year. In June 2011 the Government announced a threefold increase in its commitment to the GAVI Alliance, an innovative public-private partnership focused on saving children's lives through increased access to vaccines.
This $200 million contribution was viewed by other donors as Australia ‘punching above its weight’ in the development arena and better yet, promises to help directly immunize some 7.7 million children from killer diseases over the next four years. 7.7 million children, that’s not a bad effort considering that we, as a country, gives slightly more than 1% of the total budget to foreign aid.
But now, just as Australia makes progress to meet our fair share of overseas aid, there are rumors that a tightening Federal budget is placing at risk the long-standing bipartisan promise to increase aid contributions to 0.5% of GNI by 2015.
The Government went to the last two elections with a commitment to lift overseas aid expenditure from the equivalent of 35 cents to 50 cents in every $100 dollars of our national income by 2015. This doesn’t quite meet the amount required to reach the targets set by the UN’s Millennium Development Goals, but it would bring our nation a whole lot closer.
Scaling back the commitment would be a giant leap backwards for Australian efforts to play our part in helping to lift people out of the devastating cycle of poverty. Almost one-fifth of infants, that’s 24 million children under the age of one, still miss out on life saving vaccinations. If organisations like GAVI do not continue to receive funding, there is a danger that its vital work to introduce new vaccines and expand existing ones will not reach those precious kids who are most at risk.
We must protect the aid budget from political posturing. We must continue to invest in effective, life-saving health interventions like vaccines. And above all, we mustn’t succumb to the temptation to secure a budget surplus when the greater and real deficit is the millions of lives at stake.
Why does ACTION advocate for vaccines?
Vaccines save lives. Approximately 2.5 million lives per year, that is. Vaccines provide people lifelong protection against devastating illnesses and when distributed equitably, keep people from getting sick and falling into poverty. On top of all this, vaccines are cheap to administer!
In the 1980s, there was a lot of momentum to provide vaccines to everyone around the world. But that momentum stagnated. More recently, an influx of new life-saving vaccines have become available-but people need to access them.
Seeing a need for advocacy, in 2011 ACTION got involved. Since then, we've been working to influence governments around the world to provide the resources and leadership needed to make vaccinations available to everybody-especially the poor, who otherwise would have no access.
Why should I care about vaccines?
No child should have to die. Yet each year 1.5 million children die from diseases that could have been prevented with vaccines1. These needless deaths are a profound loss of human potential.
New vaccines have recently become available that prevent pneumonia and severe diarrhea caused by rotavirus-two of the leading killers of children under five. Together, pneumococcal and rotavirus vaccines can prevent almost 3.9 million child deaths by 2015.
Vaccines are one of the most cost-effective ways to improve our well-being. In 2008, a group of the world's leading economists ranked "expanded immunization coverage for children" as the 4th most cost-effective solution to the most pressing global challenges.2
In addition to saving lives, expanding vaccine coverage in the world's 72 poorest countries would save $151 billion in treatment and lost productivity. The economic benefits of expanding vaccination coverage outweigh the costs by a factor of 3 to 18, depending on the country.3
What does ACTION do to increase people's access to vaccines?
Mobilize resources. We influence decision-makers in governments-the ones who have their hands on the purse-strings-to provide resources that are used to purchase and administer vaccines to millions of people in countries where the needs are greatest.
Shape policy. We work to shape the policies of governments and international institutions so that vaccines are distributed equitably. In other words, we help to ensure that even the poorest of the poor gain access to vaccines that can prevent illness and save their lives.
Raise the profile. Even though vaccines are a life-or-death issue, they're usually not the first thing on people's minds when they wake up every day. To help inform people that vaccines are an important issue requiring urgent action, we engage the media with newsworthy information and cultivate champions who help spread the word.
See what ACTION is doing for World Immunization Week.
Contact Alison Root (.(JavaScript must be enabled to view this email address)), Senior Associate for ACTION for more information.
1World Health Organization, 2012. http://www.who.int/immunization_monitoring/Global_Immunization_Data.pdf
2Copenhagen Consensus Center, 2008. http://www.copenhagenconsensus.com/Files/Filer/CC08/Presse%20%20result/CC08_results_FINAL.pdf
3Ozawa S, et al., 2011. During The ‘Decade Of Vaccines,' The Lives Of 6.4 Million Children Valued At $231 Billion Could Be Saved. Health Affairs, 30(6):1010-20.
Resources
Check out these important resources to learn more about vaccines:
Decade of Vaccines Collaboration
http://www.dovcollaboration.org/
Global Immunization Vision and Strategy
http://www.who.int/immunization/givs/en/index.html
Shot@Life
http://www.shotatlife.org/
PATH Vaccine Resource Library
http://www.path.org/projects/vaccine_resource_library.php
The GAVI Alliance
http://www.gavialliance.org/
Sabin Vaccine Institute
http://www.sabin.org/vaccine-advocacy-and-education
AERAS - Developing New Tuberculosis Vaccines for the World
http://ww.aeras.org
Tuberculosis Vaccine Initiative
http://www.tbvi.eu
Bill & Melinda Gates Foundation Vaccines Page
http://www.gatesfoundation.org/vaccines/Pages/default.aspx
World Health Organization Vaccines Page
http://www.who.int/topics/vaccines/en/
Global Immunization Vision and Strategy: 2006-2015 (WHO / UNICEF)
http://whqlibdoc.who.int/hq/2005/WHO_IVB_05.05.pdf
Global Vaccine Action Plan (Draft) (Decade of Vaccines Collaboration)
http://www.dovcollaboration.org/wp-content/uploads/2012/01/GVAP_english.pdf
A Fair Chance at Life: Why Equity Matters for Child Mortality (Save the Children UK)
http://www.savethechildren.org.uk/sites/default/files/docs/A_Fair_Chance_at_Life_1.pdf
Narrowing the Gaps to Meet the Goals (UNICEF)
http://www.unicef.org/rosa/Narrowing_the_Gaps_to_Meet_the_Goals_090310.pdf
Immunization: Unfinished Business (GAVI Alliance / IFRC)
http://www.ifrc.org/Global/Publications/Health/Immunization_Advocacy_Report2010_EN.pdf
For the first time ever, all regions of the world will celebrate World Immunization Week this April 21st through 28th. ACTION partners across the globe are utilizing this key opportunity to raise the profile of and commitment to immunization with policymakers and the public.
Our partners all over the world are taking ACTION this week. See how.
Join the conversation using #vaccineswork and follow @ACTION_tweets.
Read our blog to see what ACTION partners have to say about World Immunization Week!
See what ACTION is doing on vaccines
Contact Alison Root, Senior Associate with ACTION (.(JavaScript must be enabled to view this email address)) for more information.
On Monday, April 16, 2012, the Executive Board of the World Bank Group named Dr. Jim Yong Kim as its next president. Dr. Kim will assume the role on July 1, succeeding the Bank's current president, Robert Zoellick. ACTION Director Kolleen Bouchane issued the following statement in response.
Congratulations to Dr. Kim for being selected as the next president of the World Bank Group. The World Bank is the world's largest international development institution. The job is among the most important — and the most challenging — in the international development arena. As an individual who has dedicated his life to improving the wellbeing of poor communities around the world, Dr. Kim has the right leadership qualities and experience to succeed in the role.
Dr. Kim's trailblazing work at Partners in Health and the World Health Organization, where he proved that it was feasible to deliver world-class healthcare to impoverished communities in the most neglected and least developed places on the planet, demonstrates that he has both the vision and the drive to lead the Bank in this critical moment. His pioneering research in delivery science shows that he will focus the Bank's efforts on those activities that will deliver the greatest and most enduring impact. With Dr. Kim's appointment, today will no doubt be looked back upon as a landmark day in the long fight against extreme poverty. ACTION wishes him the best of success and stands ready to assist him in our capacity as advocates for global health.
World TB Day 2012 provided many great events for TB activists, survivors, lawmakers, and donors to unite and discuss the critical need for increased tuberculosis funding to improve and expand prevention, diagnostics, and treatment around the world. We at ACTION were excited to find that the day also inspired special acts to bring awareness to TB - in the form of dancing group "flash mobs!" from RESULTS Atlanta activists rocking out to Michael Jackson to a heartwarming group of kids on the streets of India giving onlookers their best Bollywood moves, these were fun and original ways to spread TB awareness on World TB Day.
Checked out the videos below and get inspired to rethink how you bring awareness to issues in your own advocacy!
RESULTS Atlanta World TB Day Flash Mob
World TB Day Children's Flash Mob in India
|
Country |
Percentage of TB resources from Global Fund |
Patients at risk |
|
|
Burundi |
100% |
11,082 |
|
| Cambodia | 36% | 11,791 | |
|
Malawi |
48% |
12,420 |
|
|
Mozambique |
68% |
51,502 |
|
|
Sierra Leone |
98% |
16,403 |
|
|
Tanzania |
30% |
45,637 |
|
|
Uzbekistan |
66% |
16,251 |
|
For personal accounts of the cancellation read http://qa.action.org/blog/post/from_romania_to_tanzania_the_ripple_effect_of_cuts_to_the_global_fund
*Source: unpublished data from the Stop TB Partnership
ACTION and ACTION Partners
ACTION is thrilled with the nomination of Dr. Jim Yong Kim to head the World Bank. Jim Kim possesses a deep commitment to addressing the political, social, and economic barriers to a more equitable and humane world.
With over two decades of experience serving the poor in developing countries, and with a powerful record of taking life-saving health strategies to scale, Jim Kim is uniquely well suited to lead the World Bank to deliver on its stated mission of lifting people out of poverty. Jim Kim a physician and anthropologist, was co-founder of Partners in Health a non-profit health care organization committed to providing community based health care, which has served more than 2.4 million people around the world.[1] In 2004 Kim directed the World Health Organization's HIV/AIDS department and led the "3x5" initiative, which set the bold target of putting three million people on AIDS anti-retroviral treatment by the end of 2005. Critics said it was impossible to expand treatment to millions of people in only a few years, but Kim maintained, "We need to bring a sense of urgency that matches the devastation of the epidemics that we face."[2] In no small part, because of Kim's early and visionary leadership, 6.6 million people in developing countries now have access to life-saving treatment.
Kim clearly shares ACTION's vision for global health equity - perhaps the most critical element to achieving the World Bank's mission to reduce global poverty. Kim is also well known for his contributions to fighting tuberculosis, demonstrating that quality, life-saving treatment could be effectively delivered in resource poor settings.
As we approach World TB Day - with proven TB treatment and powerful new tools still under-resourced, and millions still suffering needlessly from a curable disease - ACTION welcomes the opportunity to have such a visionary leader to help tackle the most important challenges of our time.
[1] Partners in Health 2011 Annual Report p.4 http://parthealth.3cdn.net/283c794b2e83589919_b4m62spy6.pdf
[2] http://www.hsph.harvard.edu/now-archive/mar17/
USAID
Voices of TB for World TB Day
Sponsored by USAID
March 22, 2012
This event featured the powerful stories and call to action by former tuberculosis (TB) patients from around the world, whose lives have felt the impact of this disease. It was moderated by photojournalist David Rochkind and included speakers:
Francis Apina, Kenya • Endalkchew Demmisse, Ethiopia • Andre Gariseb, Namibia • Pham Thu Hoa, Vietnam • Rachel Orduno, Mexico/USA • Rosalie Stephson, Philippines/USA • Faith Stephson, Philippines/USA
Speaker bios:
http://www.usaid.gov/our_work/global_health/id/tuberculosis/news/tbbrochure_web12.pdf
Summary of event by Science Speaks:
http://sciencespeaksblog.org/2012/04/02/the-voices-of-tb/#axzz1uZTNvQOv
Background: http://www.usaid.gov/our_work/global_health/id/tuberculosis/
Video of event:
PART 1 (15 min) – Introduction by David Rochkind; presentation by Francis Apina (Kenya)
PART 2 (19 min) – Presentation by Rosalie Stephson (USA) and Pham Thu Hoa (Vietnam)
PART 3 (8 min) – Presentation by Andre Gariseb (Namibia)
PART 4 (37 min) – Presentation by Endalkchew Demmisse (Ethiopia) and Rachel Orduno (USA)
PART 5 (26 min) – Questions and Answers
ACTION and ACTION Partners
March 22, 2012 - This World Tuberculosis (TB) Day, ACTION partners around the world will commemorate the day with their attention fixed squarely on world leaders and the need to end the funding crisis of the Global Fund to Fight AIDS, Tuberculosis and Malaria.
ACTION partner organizations and global health advocates from around the world have been calling for an emergency donor meeting ever since the Global Fund Board decided to cancel the next round of funding (Round 11) last November. The G20 Summit in Mexico in June could provide an important opportunity for the Global Fund's existing and new potential donors to convene and recommit to mobilizing sufficient resources for countries to maintain and scale up services.
For nearly a decade ACTION partners and allies have been working together to raise attention to the global TB epidemic. Our awareness raising on the problems of and solutions to TB has always included our moral outrage that a preventable and curable disease still takes the lives of nearly 2 million people each year. As Congressman Engel from New York noted Tuesday in a Congressional Briefing on Capitol Hill, "The fact that we have not eliminated TB yet is a sin."
Never has the outrage of ACTION organizations and other global health advocates been so strong as in the months since the November cancellation of the next round of funding for the Global Fund.
"We would like World TB Day to be an annual celebration of progress," notes ACTION Director Kolleen Bouchane. "However, the increasing fragility of continued progress makes such celebration difficult. Instead, organizations in the ACTION partnership continue to press their leaders to end the Global Fund's funding crisis and to change the conversation from the limits of resources to what we can be doing to actually end these diseases."
CITAM+, ACTION'S PARTNER in Zambia, reports that the impact on people living with TB-HIV could be devastating. In Zambia approximately 80 percent of people with TB are coinfected with HIV. In 2010 alone more than 45,000 Zambians were infected with TB[1], an airborne killer that does not discriminate.
Though Zambia made progress in their TB-HIV response, with 39 percent of co-infected patients receiving treatment, this will be greatly hampered when the country's Global Fund TB grant comes to an end in June 2013.[2] Patients currently on treatment are at risk, and Zambia will not be able to diagnose and treat more people or scale up preventative therapy.
Carol Nyirenda, Executive Director of CITAM+ noted that "Community organizations in Zambia that play a critical role in the disease response are at risk of closing, leaving thousands without treatment or support services and many without jobs. Hospices that care for HIV+ people will completely shut down without the Global Fund, leaving people literally without the care they have come to depend on. Community health care workers, who help people adhere to treatment and provide support will also be gone. This will increase the risk for drug resistance for people who are currently being treated."
In total, more than 10,000 TB patients and more than 130,000 HIV patients are at risk in Zambia due to the Global Fund funding crisis.[3]
And that is just one country.
But there is some progress. Tuesday, in the same Capitol Hill briefing as Representative Engel, Dr. Mario Raviglione of the Stop TB Department at the World Health Organization affirmed that our "next TB target should be zero," and in recent months key donors such as the U.S., UK, Japan, Germany, and Spain have expressed renewed interest in convening to reconfirm their existing pledges and make new commitments to the Global Fund. Without this meeting and a new funding opportunity, it is unclear how disaster can be averted in countries like Zambia.
This World TB Day, we need to be reminded that zero deaths from TB, the largest killer of those with HIV/AIDS, is within the limits of science. The limits ACTION partner organizations and others continue to push are those of political will and resources. We need to acknowledge the science, change the conversation, eliminate the global health inequities, and save more lives. We need to fund the largest funder or TB programs, The Global Fund to Fight AIDS, Tuberculosis and Malaria.
[1] Unpublished dates STOP TB partnership www.stoptb.org
[2] Ibid
[3] International HIV/AIDS Alliance (2012). Don't Stop Now: How Underfunding the Global Fund to Fight AIDS, Tuberculosis and Malaria Impacts the HIV response. < http://www.aidsalliance.org/includes/Publication/Alliance%20global%20fund%20report_V6.pdf>
Last June Radut Stefan's life turned upside-down. He became very ill, was forced to leave his job and delay his wedding. Stefan was diagnosed with multidrug resistant TB (MDR-TB), which requires two years of treatment. He has endured terrible side effects from the medication in hopes of making a full recovery. Now he's terrified it was all in vain.
Stefan lives in Romania, which relies on the Global Fund to Fight AIDS, Tuberculosis and Malaria to supply anti-TB medication. In six months Romania's grant will run out. Stefan fears the medicine will run out as well.
Facing a $2 billion USD shortfall, the Global Fund decided to cancel Round 11, its upcoming funding round. The Fund has set up transitional funding for programs facing disruption in low income countries. But countries considered middle income are unable to apply. Luckily, Romania is able to apply for TB funding because of its high disease burden, but there are no guarantees it will be approved and cannot be used to expand treatment.
Despite being classified as an upper-middle income country, many Romanians still live in extreme poverty. The country's health system is grossly underfunded and without support of the Global Fund Stefan worries patients like him will lose access to life saving TB treatment. "This will be a disaster," he declares. "It will be like we went through torture for nothing. I will be TB positive again. In a few years I'll die."
Silvia Asandi, the head of Romanian Angel Appeal Foundation, a non-profit organization supporting orphans and vulnerable children, believes people in middle income countries will be the first casualties of the Round 11 cancellation. Middle income countries in Eastern Europe are home to the fastest growing epidemic of drug-resistant TB. Without new funding to combat disease, rates of MDR-TB are likely to skyrocket. Without new funding, Asandi estimates at least 1,000 people with MDR-TB will go undiagnosed, and continue to spread the disease amongst their community. She's unaware of other groups who could fill the gap, "no other donors apart from the Global Fund are providing financial support for our TB program."
***
Eight thousand miles away in Tanzania, clinician Leah Mtui faces the same concerns- how will her patients be affected by the Round 11 cancellation? Mtui works at Pasada, a faith-based NGO that provides free TB and HIV care. She says the need for services is increasing, "We were planning to scale up services through Global Fund support."
The Global Fund finances 39 percent of Tanzania's TB programs. The current grant runs out in November. While Tanzania is eligible to apply for transitional funding, without money to scale up treatment, hundreds of thousands of lives are at stake. Without new resources, an estimated 68,000[1] TB cases in Tanzania will go undiagnosed and 260,000[2] people won't have access to life saving AIDS medication.
At Pasada, the supply of services can barely keep up with the demand for treatment. Last year Pasada treated over 1200 people with TB. But Mtui warns, "TB is infectious. Each infectious case can transmit to up to ten people - that's a lot of people we're not treating." She was hoping to use Round 11 funding to scale up diagnosing and treating TB and HIV. Now they might be forced to scale back. This does not sit well for Mtui and her colleagues. Pasada's staff, most of whom are unpaid volunteers, often use their own money to help patients when funds are low.
Despite the enormous effort by Pasada and other groups, many patients go without lifesaving care. "My patients have to choose between taking medicine [and] having food," Mtui explains. She pauses for a moment, and then tells donors, "Please don't make them choose."
Mtui extends an invitation for international donors to visit her clinic. She wishes she had the opportunity to meet with donors face to face and ask them why they cancelled funding. "This World TB Day the message is ‘stop TB in my lifetime' - to let people living in a world without TB," she declares. "If we want to meet this target, [we need] to increase funding rather than cancel it."
For more information about the human impact of the Round 11 cancellation visit http://qa.action.org/blog/post/human_impact_of_global_fund_round_11_cancellation
See ACTION'S press release calling for an Emergency Donor Meeting This World TB Day, Global Fund Emergency Donor Meeting Critical for Continued TB Successes
[1] Source: unpublished data from the Stop TB Partnership
[2] Source: unpublished data from Tanzania Ministry of Health
The Global Fund to Fight AIDS, Tuberculosis and Malaria
13 March 2012
Highest Contribution Ever Made by Japan, Leading Supporter of the Global Fund
Geneva - The Global Fund to Fight AIDS, Tuberculosis and Malaria today welcomed a $340 million contribution by Japan, the highest amount that Japan has ever made in 10 years of vigorous support for the Global Fund. Japan is now making its first payment of US$ 216 million for its 2012 contribution.
"Japan has always been a leader in the fight against disease, but this is a great vote of confidence in our commitment to saving lives," said Gabriel Jaramillo, General Manager of the Global Fund. "We recognize Japan's determination to see real advances in global health, and we are equally determined to deliver."
This new contribution represents a significant increase over Japan's previous highest contribution of US$ 246 million in 2010. In 2011, Japan's contribution was reduced to US $114 million following the earthquake and tsunami that devastated northeast Japan in March of last year, but this new contribution demonstrates that Japan's commitment to the Global Fund remains steadfast.
Former Prime Minister Naoto Kan announced in January at the World Economic Forum in Davos, Switzerland, that Japan would contribute US $340 million as part of its pledge of US$ 800 million to the Global Fund announced at the third Replenishment Conference in 2010.
Japan's leadership in the Global Fund began when a summit of G8 nations called for the creation of such a global financing organization in 2000 in Okinawa, Japan.
The contribution received this week raises Japan's contributions to the Global Fund to more than US$ 1.6 billion since its creation in 2002.
*****
The Global Fund is a unique, public-private partnership and international financing institution dedicated to attracting and disbursing additional resources to prevent and treat HIV and AIDS, TB and malaria. This partnership between governments, civil society, the private sector and affected communities represents an innovative approach to international health financing. The Global Fund's model is based on the concepts of country ownership and performance-based funding, which means that people in countries implement their own programs based on their priorities and the Global Fund provides financing on the condition that verifiable results are achieved.
Since its creation in 2002, the Global Fund has become the main financier of programs to fight AIDS, TB and malaria, with approved funding of US$ 22.6 billion for more than 1,000 programs in 150 countries (as of 1 December 2011). To date, programs supported by the Global Fund are providing AIDS treatment for 3.3 million people, anti-tuberculosis treatment for 8.6 million people and 230 million insecticide-treated nets for the prevention of malaria. The Global Fund works in close collaboration with other bilateral and multilateral organizations to supplement existing efforts in dealing with the three diseases.
For more information, please contact:
ANDREW HURST
Acting Communications Director
Mobile: +41 79 561 6807
E-mail: andrew.hurst@theglobalfund.org
March 7, 2012
Today CORE Group held a webinar with guest speaker Dr. Jeffrey Starke, professor of Pediatrics at Baylor of Medicine and the director of the Children's Tuberculosis Clinic at Texas Children's Hospital. During the webinar, Dr. Starke spoke of the upcoming World TB Day's focus on children and TB and the unique importance of focusing on children with regard to TB diagnosis and treatment. Watch the full webinar here. Let us know what you think on Twitter by following @ACTION_Tweets.
By Andrea Brush
There are an estimated 1.2 million people in the United States living with HIV. African Americans make up just 14% of the American population, yet they account for approximately half of all new HIV diagnoses in the United States. African American women are 23 times more likely to be diagnosed with HIV than white American women.
23 times. According to the CDC, there were an estimated 11,200 new HIV cases in 2009 among women. Of that total, 57% of the cases were in black women and 21% in whites.
Among African American women aged 25-44, HIV is the number one killer. And it has been for the past 11 years.
The District of Columbia, perhaps the worst affected region in the country, holds a 3.2% prevalence rate, which is far and above the WHO recommended 1% for a generalized epidemic. The rates of HIV in DC rival those in sub-Saharan Africa, which is where most people's minds jump to when they hear HIV epidemic. Globally, there are 34 million people living with HIV, 60% of those 34 million live in sub-Saharan Africa. South Africa, the worst affected country in the world, holds a prevalence rate of 17.8%, and has 5.6 million people living with HIV.
Perhaps the biggest strike against HIV prevention is lack of leadership, at high government levels but also among citizens. South Africa's epidemic was fueled by a campaign of denialism led by President Mbkei's administration who firmly believed that HIV was caused by poverty, that it was not an epidemic, and that he had in fact never met anyone with HIV. (There were 5.5 million South Africans living with HIV during his presidency.)
A lack in leadership is not just an international phenomenon. It is affecting people living with HIV here in the United States. One of the greatest examples of this was during the 2004 vice presidential debate between Dick Cheney and Jonathon Edwards. The debate moderator, Gwen Ifill, asked what the government's role in helping to end the epidemic in the United States should be. Cheney responded by saying he didn't know there was an epidemic in this country. Edwards tried to answer but instead brought up the devastating effect the epidemic has had on other countries in the world, and did not even mention the epidemic in the United States.
Not only are leaders seemingly ignoring the growing epidemic, but policies are being put in place that exacerbates it. One-third of all HIV cases come from the sharing of dirty needles. A previous ban on congressional funding for needle exchange programs has recently been re-evaluated. Further, the United States crack down on street-level drug offenders increased the prison population by enormous numbers. It also led to an HIV infection rate in the prisons that was five times higher than outside. Archaic rules on condoms and health care in the prison system all add fuel to the epidemic. Condoms are not allowed within prisons because that would be admitting that there are sexual relations between prisoners. In addition, prisons discourage HIV testing because then the system would have to pay for treatment.
Is HIV spreading around the world because of a calculated silence? Signs point to yes. Take it upon yourself to learn the facts and speak out against silence both domestically and internationally.
Providence Journal
March 1, 2012
Fund to fight key diseases running low
Richard Feachem
San Francisco -- A study just published in the Lancet, a British medical journal, found that malaria killed 1.2 million people in 2010. That is nearly double the World Health Organization's official estimate.
Compounding this tragic news is that the Global Fund to Fight AIDS, Tuberculosis and Malaria - the largest and arguably the most effective financier of malaria control - is running out of money. It has suspended new grants until 2014 - grants that would have provided millions of families with protective bed nets, life-saving medicines and vital health-care services.
Unless we make a concerted and immediate effort to support the Global Fund, the tremendous gains it has made in the past decade will be lost. The United States should convene an emergency donor meeting to address the Global Fund's resource gaps and ensure that it can operate at full capacity.
Ten years ago, HIV/AIDS, tuberculosis and malaria were crushing burdens on development, killing over 6 million people a year and draining billions of dollars from the global economy. In the developing world, HIV was a death sentence. Only about 50,000 Africans were on anti-retroviral treatment. After five decades of spotty results, aid was still primarily directed by Western technocrats with little accountability for results.
The Global Fund was created in 2002 to change all of this. It had two fundamental goals: to mobilize massive new resources against HIV/AIDS, tuberculosis and malaria, and to shatter old development-assistance models by being transparent, accountable and demand-driven. On both, the Global Fund has been an unambiguous success.
To date, the Global Fund has disbursed $15 billion to programs in 150 countries. These grants have provided 230 million insecticide-treated bed nets and 170 million antimalarial treatments. While the new data have counted adult malaria deaths, increasing the total number of deaths reported, it also shows that these investments have saved more than half a million lives. Taking everything into account, malaria deaths actually decreased, from 1.8 million in 2004 to 1.2 million in 2010.
Global Fund investments have also provided antiretroviral treatment for 3.3 million people living with HIV/AIDS. Nearly half of all people currently on AIDS treatment in low- and middle-income countries depend in some way on the Global Fund to stay alive.
Further, its grants have let health officials treat 8.6 million cases of tuberculosis, saving more than 4 million lives. Thanks in large part to these efforts, the number of tuberculosis deaths has reached lowest point in 10 years.
Through all of this, the Global Fund has remained true to its founding principles. Grant recipients - not donors - lead the process of identifying and addressing national health challenges. Civil-society groups, public officials and the private sector are equal partners in developing sound proposals and implementing effective programs. Scores of sensitive documents are published online, including extensive and detailed financial information.
This is why the Global Fund's model has been consistently validated by diverse organizations. Just last month, Publish What You Fund, a project of the nonprofit Global Campaign for Aid Transparency, ranked the Global Fund second among 58 donors surveyed for its commitment to transparency. And last year, the Global Fund earned top marks in the Department for International Development's aid review for its "excellent track record for delivering results" that provided, "very good value to the ... taxpayer."
The news of malaria's revised death toll, and the striking downward trend in annual deaths, show that we need the Global Fund now more than ever. Yet instead of planning to end malaria, we are praying that our families and friends survive the next rainy season.
Instead of creating the AIDS-free generation that President Obama envisions, we face scenarios in which millions now on treatment may be left for dead. Instead of modeling the elimination of tuberculosis, we are worrying about the rising tide of drug resistance.
It is time for governments to take an honest look at their foreign-aid programs. They would be hard-pressed to find a better return on investment than what we have seen from the Global Fund. After 10 years, the Global Fund has unequivocally proven to be responsive, innovative and highly effective in its approach to aid. The United States should convene an emergency donor conference to mobilize new resources for the Global Fund. This is an investment we must continue to make.
Richard Feachem, M.D.(FeachemR@globalhealth.ucsf.edu) is director of the Global Health Group at the University of California at San Francisco and formerly the founding executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria.
This article ran on page B6 in the print edition of the Providence Journal on March 1, 2012.
Guest blog from Jackson Ndegwa, Vaccine Advocacy Officer, KANCO
February 14th does not only mark a day of love, but more importantly, an exciting day in child health for Kenya. On the one year anniversary of the life-saving pneumococcal vaccine introduction in Kenya, KANCO hosted a breakfast commemorating the progress made to date and addressing the challenges left to be faced.
The breakfast hosted over 33 people in attendance including representative from the Division of Vaccines and Immunizations, the private sector, civil society and the media. Unfortunately, the government was not prepared to announce statistics about the uptake, but the impact of the vaccine has been felt in Kenya.
Joined by a mother who lost a child to pneumonia just months before the vaccine was rolled out in Kenya, Allan Ragi, executive director of KANCO and a representative of Catholic Relief Services who is the Grants Manager -GAVI CSO Constituency in Kenya, gave remarks on the tremendous progress and significant challenges facing Kenya's immunization program.
As Kenyan civil society, we felt it important to acknowledge and thank those who were involved in financing, securing and delivering the vaccine - donors who helped to finance the Advance Market Commitment, GAVI, the Kenyan government and health providers. Because of them, the vaccine is free for all Kenyan children.
But despite our celebration, there was also some concern. Without addressing key system-wide barriers to delivering the vaccine in remote areas to all Kenyan children, it will be hard for the pneumococcal vaccine to make a real impact on pneumonia deaths. Furthermore, it is concerning if the government does not address these barriers given their plan to launch the diarrhea (rotavirus) vaccine at the end of the year or in early 2013. Finally, civil society, the government and communities need to work together to address vaccine hesitancy among some faith communities and areas with poor uptake.
Valentine's Day is a special day in Kenya - especially now that we can show our children how much we love them by ensuring they are protected against the leading causes of death among children.
See some of our media coverage from our commemoration event!
By Jessica Hoffner, ACTION Intern
Here's what I can tell you about Super Bowl XLVI: next to nothing. I don't know the rules of football, and I certainly don't have a favorite team. But I did tune in on Sunday along with 111.3 million other people. And this is what I remember - the advertisements and a 50-something-year-old singer dressed like a Viking.
So what did it cost NBC to leave me with such fond memories? Let's just say they should start calling it the Super Expensive Bowl.
A 30-second ad spot in this year's Super Bowl cost an average of $3.5 million - $116,667 a second. That's an 84% increase from 10 years ago, and the highest amount advertisers have ever had to pay. This is quite the price hike, but it reflects the growth in TV audience, which has almost doubled over the past decade.
Do you know what else has happened in the past decade? The Global Fund to Fight AIDS, Tuberculosis, and Malaria.
Over the last 10 years, the Global Fund has proved to be one of the most successful efforts in the history of public health. Millions of lives have been saved in some 150 countries. Today in middle- and low-income countries, there are 6.6 million people on life-saving antiretrovirals for AIDS; that's up from just a few hundred thousand 10 years ago. The Global Fund has prevented an estimated 4.1 million deaths from tuberculosis and is responsible for providing 82% of donor financing for TB. Through the distribution of hundreds of millions of bed nets and anti-malarial medicine, deaths from malaria are down 25% globally in the last 10 years, and malaria deaths have been halved in some African countries.
Here's the game-changer: projected funding shortfalls threaten this progress. And last November, the Global Fund board canceled the next funding round and essentially suspended new grant opportunities until 2014. This is an unacceptable setback to the fight against these diseases, and donors must mobilize to fill this funding gap. We're at the 50 yard line; we can't afford to move backwards now.
The U.S. and other donors can fix this situation. If the U.S., the U.K., and even a handful of other key donors join together for an emergency donors meeting in advance of the AIDS conference this July and commit to meeting their pledges in some cases, topping them up in others, and with even a few new or renewing donors showing up, we can find the $2 billion in resources needed to have a new Global Fund funding opportunity this year and reverse this devastating setback.
The fight against AIDS is being pushed in exactly the opposite direction of where science is leading it, and this cancellation of new funding opportunities will also be devastating to countries' capacity to take up new game-changing technologies like TB and malaria diagnostics that could greatly advance that fight. And we're not just in danger of slowing progress, but actually reversing it.
My colleagues at ACTION are calling for the U.S. to host an emergency donor conference to mobilize the resources needed to reverse the situation and provide for a new funding opportunity in 2012 and 2013. We strongly believe that if the U.S. hosts this emergency donor's conference, other donors will join in. We're also calling on the United States to convene donors before the International AIDS Conference, which takes place this July in Washington, D.C.
Two billion dollars seems like a lot of money until you consider the expected $10 billion that was bet on this year's Super Bowl according to ESPN. If you bet on a team, you could have a 50/50 shot at winning; if you bet on the Global Fund, you can guarantee a win for global health.
Whooping cough, like many other diseases, seems like something from the past. Which is why I was rather shocked when my boss, a fellow global health advocate, was diagnosed with whooping cough (pertussis) for the second time in five years.
Pertussis has an extremely effective vaccine that has been around for decades. Despite relatively high immunization rates in the U.S., pertussis cases have been on the rise in the U.S. with over twelve states reporting an increase in cases already this year. When outbreaks happen, communities are activated to head down to their local clinic to get vaccinated which is the most effective way to prevent pertussis by boosting immunity in adults, and reach previously unvaccinated populations.
Though my boss had a pretty dismal few weeks, I wondered if she felt a bit like a method actor by experiencing one of the diseases we advocate to prevent globally by living through it. It made me think of a few things:
Firstly, it reminded me of the importance of basic vaccines. When I say basic, I'm referring to the traditional group of immunizations recommended worldwide and introduced as a "package" by the WHO in 1974. Amongst many of us, these basic vaccines have lost their shiny, brand new luster when compared to new and exciting vaccines against leading killers of children worldwide: pneumonia and diarrhea. After all, most people don't know what pertussis, diphtheria, and other diseases really are - which is a credit to the effectiveness of vaccines. But their success may also be a downfall. Decreasing importance in the public arena can lead to a sense of complacency that "things are completed and over." In reality, new babies are born every day that need to be vaccinated - and they are usually the most at risk for dying of these diseases. The WHO estimates that the "basic" vaccines prevent close to 2.5 million deaths each year. Without them, our work would certainly not be done.
Secondly, though mini-outbreaks of pertussis may not be extremely deadly in America, they can be for children around the world without access to the vaccine. The WHO estimates that almost 200,000 child deaths due to pertussis could have been prevented by the vaccine in 2008. This is in part because while most American children may be vaccinated against pertussis and other basic diseases as a part of a routine check-up, 19.3 million children worldwide did not receive full vaccination against pertussis (as a part of a diphtheria-tetanus-pertussis vaccine). These children may lack access to basic vaccines due to poverty or how far they live from a health facility, amongst many.
While it is unfortunate as an adult to come across a relatively obscure disease like pertussis, it is more unfortunate that millions of children each year do not have access to the fundamental form of protection against these diseases. As a result, 1.7 million children die of a vaccine preventable death each year, which makes up 20% of child deaths worldwide. What is even more troubling is that if these children are unable to access basic vaccines in their first years of life, are we sure they'd be able to reach treatment should be infected? Troubling thoughts indeed.
While my boss has finished her course treatment to get rid of her pesky cough, I'm reinvigorated to continue ACTION's advocacy on vaccines - not just the shiny and new, but the older, tried and true ones as well. No child should die from a disease which could have been prevented by a vaccine.
Aeras
Aeras leverages US government clinical trial networks designed for HIV research to support TB vaccine development
ROCKVILLE, MD, USA, January 31, 2012 — Aeras announces today that the National Institute of Allergy and Infectious Diseases (NIAID), part of the United States National Institutes of Health (NIH), has joined as a partner for a Phase II proof-of-concept clinical trial of a tuberculosis vaccine candidate jointly developed by Aeras and Dutch biopharmaceutical company Crucell.
NIH has a long history of supporting TB vaccine development. However, this is the first time that NIH is leveraging its HIV/AIDS clinical trial networks to advance a tuberculosis vaccine candidate. Along with the recent announcement of NIAID's new partnership in a Phase III TB drug trial, this collaboration follows the NIAID plan to leverage infrastructure originally intended for HIV-related clinical trials to also advance tuberculosis vaccine and therapeutic research for both HIV uninfected and infected populations.
One-third of the world's population is infected with tuberculosis. Infants and people who are immune compromised, including those with HIV infection, are at higher risk of developing active TB. Safe and effective vaccines hold promise for protecting these at-risk populations.
"NIAID's involvement in this important clinical trial will maximize return on U.S. government investment in clinical research infrastructure while accelerating progress against the world's deadliest infectious disease after HIV/AIDS," said Mary Woolley, CEO and President of Research!America, the nation's largest not-for-profit public education and advocacy alliance committed to research.
The clinical trial, which began in October 2010, has already enrolled infants at three sites in Kenya, South Africa and Mozambique. The goal of the trial is to evaluate the safety and efficacy of vaccine candidate AERAS-402/Crucell Ad35 in HIV-uninfected infants. Significant support for the trial is also provided by the European and Developing Countries Clinical Trials Partnership (EDCTP) and European Member States.
The first NIAID-supported site to join the clinical trial is the Perinatal HIV Research Unit (PHRU) located in Soweto, South Africa at the Chris Hani Baragwanath Hospital. The research site is a member of NIAID-funded clinical trial networks including the HIV Vaccine Trials Network (HVTN), the HIV Prevention Trials Network (HPTN) and the International Maternal Pediatric Adolescent AIDS Clinical Trials Network (IMPAACT).
"Our novel collaboration with NIAID comes as multiple TB vaccine candidates are poised to enter efficacy trials requiring thousands of participants and significant investment, as well as complex infrastructure and sophisticated expertise," said Jim Connolly, President and CEO of Aeras.
"We are grateful for the partnership of one of the most well-respected biomedical research institutes in the world, and the opportunity to utilize well-established clinical sites," he added.
###
About the Clinical Trial Field Sites
The clinical trial is also ongoing in Kenya led by KEMRI/CDC; in South Africa led by the South African Tuberculosis Vaccine Initiative (SATVI); and in Mozambique led by the Manhica Health Research Centre (CISM). To learn more click on their names to view their websites.
Follow this link to read more about Phase IIb clinical trials.
About AERAS-402/Crucell Ad35
In 2004, Aeras and Crucell began joint development of this vaccine candidate. AERAS-402/Crucell Ad35 has been tested in 13 completed or ongoing early-stage clinical trials. These trials include healthy adults and infants as well as adults with HIV infection and adults with recently treated pulmonary tuberculosis. The vaccine candidate has been shown to be immunogenic and to have an acceptable safety profile in these studies.
About Tuberculosis
Tuberculosis is the world's second deadliest infectious disease, with 8.8 million new cases diagnosed in 2010. According to the World Health Organization (WHO), an estimated 1.4 million people died from TB in 2010. An estimated one-third of the world's population has been infected with the TB bacillus. Current guidelines require a minimum of six to nine months of treatment. The current TB vaccine, Bacille Calmette-Guérin (BCG), developed 90 years ago and given to newborn infants, reduces the risk of severe forms of TB in early childhood but is not very effective in preventing pulmonary TB in adolescents and adults - the populations with the highest rates of TB disease. TB is changing and evolving, making new vaccines more crucial for controlling the pandemic. Tuberculosis is now the leading cause of death for people living with HIV/AIDS, particularly in Africa. Multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) are hampering treatment and control efforts.
About Aeras
Aeras (www.aeras.org) is a non-profit product development organization dedicated to the development of effective vaccines and biologics to prevent TB across all age groups in an affordable and sustainable manner. Aeras has invented or supported the development of six TB vaccine candidates, which are undergoing Phase I and Phase II clinical testing in Africa, Asia, North America and Europe. Aeras receives funding from the Bill & Melinda Gates Foundation, other private foundations, and governments. Aeras is based in Rockville, Maryland, USA where it operates a state-of-the-art manufacturing and laboratory facility, and Cape Town, South Africa.
About the National Institute of Allergy and Infectious Diseases
NIAID conducts and supports research-at the US National Institutes of Health, throughout the United States, and worldwide-to study the causes of infectious and immune-mediated diseases, and to develop better means of preventing, diagnosing and treating these illnesses. For more information about NIAID visit www.niaid.nih.gov/.
By Andrea Brush, ACTION intern
January 12, 2010 is one of those days that I will never forget. I remember exactly where I was and the moments after the news broke of the devastating earthquake that shook the island nation of Haiti to its core. I was sitting in my office gathering my things to head home for the day and talking with my boss, who is Haitian, about the meetings we were preparing for the following day. Her phone began ringing, everything fell silent and the mood in the room instantly changed. I have never felt so helpless in my life. Fast-forward two years and I am weeks away from earning a Master's degree in Public Health; a decision that was made before January 2010, but was cemented as the correct one after that day in my office.
During my coursework, I have laid out a focus area of displaced and vulnerable populations; the humanitarian side of public health has always intrigued me. Therefore, when the opportunity to attend a talk entitled, "Addressing the Evolving Needs of Haiti's Women and Children Two Years After the Earthquake," I knew I had to attend. I am firm believer in "The Girl Effect", micro-credit loans (especially for women), and involving women in community decisions. If a woman is in charge of a family's finances, more money is put towards the health and welfare of her children, the same is true for education. As the saying goes, "If you educate a woman, you educate an entire village."
A panel of experts gave the talk on Haiti's women and children. They were from Management Sciences for Health, the Haitian Ministry of Health, USAID, PSI, and UNFPA. The panel discussed how NGO's in Haiti (pre- and post-earthquake) can, and should, align their work with the Ministry of Health in order to achieve better outcomes in maternal and child health, emergency obstetrics, and decrease the amount of gender-based violence. The points that were really driven home were the need for more trained, skilled birth attendants and a strengthening of family planning services.
A larger cadre of birth attendants, a strengthening in health services and coordination between NGOs and the Ministry of Health would lead to a more stabilized Haiti. Putting women and children first would lead to a more stabilized Haiti. Educating girls and young women would lead to a more stabilized Haiti. In my future as a public health professional, I hope to advocate that "change starts with a twelve-year-old girl" and that I can be a part of something as grand as collaborating with a ministry of health in order to provide better access to and quality health care for all. Throughout it all, however, I will never forget the silence that hit my office on January 12, 2010.
By Andrea Brush, ACTION intern
"To go fast, go alone. To go far, go together" - African proverb
Last Friday, I had the opportunity to attend an event at the Center for Strategic and International Studies titled, "PepsiCo & World Food Program: A Public-Private Partnership to Transform Nutrition across Africa." I am very interested in this topic because I studied childhood malnutrition throughout Africa, and follow the projects of the World Food Program. I was particularly interested in how the public and private sectors can best work together to combat issues such as malnutrition, but also anything ranging from vaccine campaigns to education. The future of innovation may lie in the development of partnerships between the public and private sectors. It seems logical to think that with the varied directions the world's economy is moving in, partnerships between publically and privately funded organizations will become commonplace.
In light of this thought, when I heard that the World Food Program and USAID were teaming up with PepsiCo, I was initially taken aback. I couldn't understand why a monstrous, multi-billion dollar company like PepsiCo would want to work with a program that bases itself on providing food for free. I have since learned that PepsiCo has a much greater humanitarian side than previously imagined. The partnership formed between WFP, USAID, and PepsiCo aims to increase chickpea production in Ethiopia. The program is aptly called Enterprise EthioPEA. The aim of the program is to create a locally produced, ready to eat food (RUF) to assist in warding off malnutrition in close to 40,000 children. In addition, the program will help 10,000 local farmers produce better quality, and a higher quantity, of chickpeas. PepsiCo has stated that the goal of the partnership is to provide long-term sustainability to local farmers by providing them with better quality seeds and farming techniques. While the initial goal in Ethiopia is to make a nutritional, chickpea-based RUF to stop the increase of malnutrition, both PepsiCo and the WFP would like to eventually see farmers making a profit off of the chickpea production by increasing the amount of chickpeas exported globally.
To me, the most interesting aspect of this partnership is the changing face of large-scale, private companies. It takes courage for a food production company to make nutritious food cheaper, and that PepsiCo's decision to be a part of EthioPEA may help change the direction of how the world is nourished. Rightly so, WFP's Executive Director, Josette Sheeran stated, "With the ingenuity, power and reach of the private sector, we can make great strides in ending the malnutrition and hunger that is threatening the lives of millions...Enterprise EthioPEA will change the lives of tens of thousands of children and will chart the course for future partnerships to help stamp out hunger around the globe."
Hopefully more private sector companies take note from PepsiCo and forge innovative partnerships with the public sector to combat things such as hunger, malnutrition, and other health-related issues.
I, personally, am very excited to see how the partnership between the WFP and PepsiCo pans out and hopefully watch the resounding success of EthioPEA. This program is positioned to change thousands of lives in Ethiopia and beyond. It would be wonderful to see the success of PepsiCo's eagerness to be a part of a partnership with the public sector inspire other large-scale companies to do the same. These partnerships have the potential to change the course of millions of lives, in my lifetime. If private sector corporations are willing to part with large sums of money for the global good of the world, it would stand to reason that "diseases of poverty" could be easily eradicated. EthioPEA's fight to end childhood malnutrition is a huge step in the right direction, as well-nourished children are less likely to succumb to deadly diseases later in life. For the time being, I'll simply continue to imagine a world in which, perhaps Wal-Mart Stores, Inc. teams up with an organization such as The Global Fund to Fight AIDS, Tuberculosis and Malaria to once and for all put an end to those diseases, and malnutrition while they're at it!
By Jessica Hoffner, ACTION intern
My dad has always taught me, "Charity starts at home." And during the State of the Union address, President Obama stressed nation building at home over nation building abroad. The president made it very clear that nation building overseas is no longer a U.S. priority. So if my own father and the President of the United States think a strong home matters most, how did I end up working in global health advocacy? After all, I don't live in Africa so why should I care about what happens there? And if I didn't care, then why should the U.S.?
And then it hit me.
If you live in a beautiful home but your neighbors are living in thatched-roof shacks, a realtor will have a bit of trouble selling your house. Why? Because a good home in a bad neighborhood isn't worth much more than the houses next to it.
I think I understand what my father and Obama are saying, and yes, it's important to have a nice, strong home. But we must not forget that our home resides in a neighborhood.
So why care about global health? Well, the United States is part of a global neighborhood. We're only as strong as our neighbors - we're all interconnected.
Take, for example, TB (a contagious lung disease that spreads through the air). What would you do if your neighbors had TB and it was spreading like wildfire in their cramped quarters? Would you help your neighbors? What if your nice home couldn't protect you against this disease? What would that mean for your neighborhood? The bottom line - if one person in your neighborhood suffers, the rest suffer.
Disease doesn't know the difference between your house and your neighbors. And it doesn't know the difference between the U.S. and Zambia. People travel across borders - so does disease. In order to address global health issues such as TB, you can't focus on only one country. TB is curable - we just need new tools for detection, better drug regimens and better integration of TB-HIV services.
My colleagues at ACTION don't like to use fear as a motivator for getting people to care about TB or any of the global health issues we work on. TB is scary; it's a silent killer that we have created ourselves with our inattention -- with a lack of political will and resources to take on tuberculosis. But here's what's worse - those who are infected are your neighbors. They may not live down the street - instead across the ocean- but they are your neighbors nonetheless.
So yes - a strong nation is good. And yes - charity starts at home. But a strong nation needs strong neighbors. So if you don't consider this your moral obligation or neighborly duty, then consider this a way to increase the value of your home.
By Joanne Carter, executive director of RESULTS Educational Fund, a partner and host of the ACTION Secretariat
This blog was first published in The Huffington Post on Friday, January 27, 2012
This week marks the 10th anniversary of The Global Fund to Fight AIDS, Tuberculosis, and Malaria. The last 10 years, the Global Fund has proved to be one of the most successful efforts in the history of public health. Millions of lives have been saved in some 150 countries. But projected funding shortfalls threaten this progress. And last November, the Global Fund board canceled the next funding round and essentially suspended new grant opportunities until 2014. This is a devastating and unacceptable setback to the fight against these diseases, and donors must mobilize to fill this funding gap.
We're calling for an emergency donor conference to mobilize the resources needed to reverse the situation and provide for a new funding opportunity in 2012 and 2013. We're also calling on the United States to convene donors before the International AIDS Conference, which takes place this July in Washington, D.C.
At the World Economic Forum in Davos, two key donors cast votes of confidence with their checkbooks. Bill Gates announced a $750 million promissory note to the fund and urged support for the fund. And Japan, despite an earthquake, tsunami, and a nuclear crisis, reconfirmed its $800 million pledge. These contributions are a strong endorsement of the Global Fund's impact and effectiveness and a challenge to other donors to step up.
This week marks 10 years since the Global Fund opened its doors. Its achievements over the last decade have been extraordinary. Today in middle- and low-income countries, there are 6.6 million people on life-saving antiretrovirals for AIDS; that's up from just a few hundred thousand 10 years ago. The Global Fund has prevented an estimated 4.1 million deaths from tuberculosis and is responsible for providing 82 percent of donor financing for TB.
As someone who's worked on this issue for well over a decade, I can tell you that before the Global Fund, donor financing for TB was miniscule, and TB patients and programs were dying from neglect, and that has changed.
Through the distribution of hundreds of millions of bed nets and anti-malarial medicine, deaths from malaria are down 25 percent globally in the last 10 years, and malaria deaths have been halved in some African countries.
But these gains have not been earned by doing business as usual. In fact, the Global Fund is business unusual. For 10 years, the Global Fund has been on the cutting edge of innovation and effective aid delivery. The Global Fund empowers the countries and communities that benefit to determine how the aid is best used. In the country, ownership is complemented by rigorous accountability and unmatched transparency. The U.K.'s Multilateral Aid Review found the Global Fund among the highest-rated institutions offering strong value for money.
And the next decade holds remarkable promise. In particular, new evidence demonstrates that early initiation of AIDS treatment can massively reduce the spread of the virus to uninfected partners. This finding was named the 2011 breakthrough of the year by Science magazine and has actually allowed public health experts to credibly plot the end of the epidemic.
But just as science is telling us we can end AIDS within the next generation, making funding for scale-up for treatment and other proven prevention more critical and impactful than ever, this opportunity is jeopardized by the decision to halt new Global Fund scale-up opportunities until 2014. As many as seventy countries are beginning to feel the impact of funding cancellation. In Zambia, over 130,000 people won't have access to life-saving treatment. Without scale-up of prevention of mother-to-child treatment services, 25,000 mothers in Zimbabwe risk transmitting HIV to their unborn children.
The fight against AIDS is being pushed in exactly the opposite direction of where science is leading it, and this cancellation of new funding opportunities will also be devastating to countries' capacity to take up new game-changing technologies like TB and malaria diagnostics that could greatly advance that fight. And we're not just in danger of slowing progress, but actually reversing it.
The U.S. and other donors can fix this situation. If the U.S., the U.K., and even a handful of other key donors join together for an emergency donors meeting in advance of the AIDS conference this July and commit to meeting their pledges in some cases, topping them up in others, and with even a few new or renewing donors showing up, we can find the $2 billion in resources needed to have a new Global Fund funding opportunity this year and reverse this devastating setback.
So we're calling on the U.S. to host this meeting. We strongly believe that if the U.S. hosts this emergency donor's conference, other donors will join in. If we convene it, they will come.
The Obama administration, from Secretary Clinton to the president to Ambassador Goosby, our global AIDS coordinator, has reiterated their commitments to the Global Fund and to fulfilling the U.S.'s pledge. By doing this and by exerting U.S. leadership globally through convening an emergency meeting, the U.S. can lead the way in reversing this devastating setback.
The Global Fund has a decade-long track record of impact and innovation in the fight against AIDS, TB, and malaria, but these diseases won't wait around for the world to sort out its financial challenges. Now, if we don't advance against these epidemics, we're now moving backwards, and we don't want that to happen.
Follow Joanne Carter on Twitter: www.twitter.com/RESULTS_Tweets
January 27, 2012
Today, the leading German opposition parties - SPD and Greens/Alliance90 - issued powerful statements of support for the Global Fund to Fight AIDS, TB and Malaria to mark its tenth anniversary.
The SPD Party release was co-authored by MP Karin Roth and MP Heidemarie Wieczorek-Zeul, Former Minister for Economic Development and Cooperation. MP Wieczorek-Zeul was MP Dirk Niebel's predecessor and an instrumental figure in the German government when the Global Fund was launched in 2002. They have called on the German government to double its contribution to the Global Fund to 400m Euros annually.
Their sentiments were echoed by MP Uwe Kekeritz, Chairman of the Subcommittee on Health in Developing Countries for the Greens/Alliance90 Party, who urged the German government to reinstate a separate budget line-item for contributions to the Global Fund.
In response, MP Dirk Niebel, Federal Minister for Economic Cooperation and Development, issued a strong statement of support for the Global Fund, promising to reinvigorate his government's partnership with this tremendously effective organization.
Statement by the SPD Parliamentary Group for Economic Cooperation and Development
Ten Years of the Global Fund - Successful Work In Danger
In light of the 10th anniversary of the Global Fund for Aids, Tuberculosis and Malaria on January 28th, 2012, the responsible rapporteurs for the SPD parliamentary faction, Karin Roth, and the SPD Member of Parliament, Heidemarie Wieczorek-Zeul, declare:
The SPD parliamentary faction congratulates the Global Fund on its successful work over the past 10 years and requests that the German Federal Government does not only make available - without further preconditions - the 200 million Euro for 2012, but also increases its contribution to 400 million Euro in the coming years. This is exactly what the SPD faction requested during the most recent federal budget discussions in parliament.
10 years ago, the Global Fund for Aids, tuberculosis and malaria was founded under the leadership of the then SPD-led German Federal Government. The Global Fund constitutes the most successful vehicle for the improvement of the health and healthcare situation in disadvantaged countries. It is because of the programs run by the Global Fund that almost 8 million lives have been saved and 3.3 million people have gained access to HIV treatments. Additionally, 8.6 million cases of tuberculosis were treated, and 230 million insecticide-treated mosquito nets have been distributed.
We are poised to make even more substantial progress in the fight against Aids, tuberculosis and malaria. Yet, this progress is in jeopardy because some donors refuse to pay up. The Global Fund depends on those donors, and they must honor their stated financial commitments.
Federal Minister Niebel opened Pandora's Box when, shortly after taking office, he moved to cut the previously agreed upon contributions to the Global Fund. Most recently, he slowed down those payments based on allegations of corruption in 2011. And as a result, in the 2012 Federal Budget, the Global Fund is no longer included as a separate line item.
A number of donors have followed this example, reducing their contributions and breaking their stated promises. This has led, for the first time in the Global Fund's history, to the cancelation of a new round of financing. This means that until 2014, the Global Fund will not be able to undertake new treatment or prevention programs. This is a catastrophe for the poorest of the poor, and a major setback on the path to achieving the Millennium Development Goals.
_______________________________________________________________________________________________________________
Statement by the Greens/Alliance90 Party
Ten years of global HIV / AIDS fund - Congratulations
To mark the tenth anniversary of the Global Fund to Fight HIV / AIDS, Malaria and Tuberculosis (GFATM), Uwe Kekeritz MP, Chairman of the Subcommittee on Health in Developing Countries states the following:
Ten years of global HIV / AIDS Fund has resulted in nearly eight million lives saved in 150 countries. But despite these successes, the Global Fund and its work is at risk. A lack of financial resources means that for the first time in the history of the Fund, a new round of funding had to be canceled and no new programs can be initiated. Donors have a responsibility to change this, especially Germany.
Federal Minister Niebel must be true to his commitments and not question or delay payment at each and every turn. The Global Fund must again have a separate line item in Germany's Federal Budget. This is particularly true in light of the ongoing and necessary reform process inside the Global Fund, which requires reliable partners at its side and no Niebelesque denial tactics.
It is excellent that the Bill & Melinda Gates Foundation, are supporting the life-saving work of the Fund through a donation of 750 million U.S. dollars. Yet, it is shameful that some industrial nations have tried to solve their financial problems with cuts in this area. Since the appointment of Dirk Niebel, even Germany has become a completely insecure partner in the fight against HIV / AIDS, malaria and tuberculosis.
In 2002, fewer than 300,000 people in developing and emerging countries had access to antiretroviral therapy, today this number has climbed to over 6.6 million people, thanks to the Global Fund. We wish the Global Fund all the best in addressing these challenges and congratulations on ten years of existence. At the same time, we promise to exert massive pressure on Niebel, so that Germany will again become a reliable partner in the global fight against these insidious diseases.
_______________________________________________________________________________________________________________
Statement by MP Dirk Niebel, Federal Minister for Economic Cooperation and Development, for the tenth anniversary of the Global Fund
Dirk Niebel, Federal Minister for Economic Cooperation and Development, congratulates the Global Fund to Fight AIDS, Tuberculosis and Malaria as it marks its tenth anniversary.
Dirk Niebel: "The Global Fund is making a significant contribution to achieving the Millennium Development Goals - the fight against AIDS, Tuberculosis and Malaria, helping hundreds of thousands of people every year. Yet so far, the inefficient use of resources has limited the Global Fund's effectiveness. We therefore find ourselves in close dialogue with the Global Fund about a fresh start and overcoming the last year's crisis of confidence regarding the management of the Global Fund. We have the clear expectation that the reform decisions made at the end of 2011 will be implemented rapidly, completely and on schedule. Only then will the Global Fund be in a position to contribute to the future care of the sick - and only then will the federal government be in a position to continue to cooperate with the Global Fund. With its recent decisions, I see the Global Fund on track."
Germany is the fourth largest donor to the Global Fund after the U.S., France and Japan. Last year, after substantial allegations of corruption, Federal Minister Dirk Niebel had frozen contributions to the Global Fund. The funds for 2011 were released after the Global Fund had adopted a clear timetable for reform.
_______________________________________________________________________________________________________________
Statement by Beate Figgener, Spokesperson for Die Linke Party
Long-term and secure adequate funding for the Global Fund
"Development Minister Dirk Niebel is not allowed to withhold the much-need resources for the Fund to Fight AIDS, Tuberculosis and Malaria" said MP Niema Movassat, chairman of the Subcommittee on Health indeveloping countries for the Group of the Left, on the occasion of the tenth anniversary of the Global Fund. Movassat further:
"The fund has saved countless lives. The Fund deserves for Niebel to stop holding up its work. Instead of cutting resources for the Fund because of isolated cases of corruption which have been addressed and resolved, the Minister should - given his own proven nepotism - first and foremost clean up in front of his own doorstep. Instead, he continues to discredit himself.
It is long overdue that the federal government ensures long-term, reliable and adequate funding for the Global Fund. The Left Party has for years been calling for a separate budget item for the Global Fund and increased funding from 200 million to 400 million euros a year."
_______________________________________________________________________________________________________________
Action against AIDS Germany statement on the Global Fund
10 Years Global Fund - a successful fight against HIV/Aids, Tuberculosis and Malaria with an uncertain future?
Ten years ago, only about 250,000 people in poorer countries had access to life-saving HIV / AIDS therapy. By late 2010, the figure had risen to 6.6 million people. One of the main drivers of this positive development is undoubtedly the Global Fund. Its programs have been supplying 3.3 million people with HIV drugs to treat 8.6 million TB cases, and distributed 230 million insecticide-treated mosquito nets. "The success of the Fund is unprecedented and a clear message: It needs to be extended! Instead, however, a abrupt halt is on the horizon, "says Astrid Berner-Rodoreda, spokeswoman for the campaign against AIDS.
The Fund is dependent on donor funding. Those donors - for 2011 through 2013 - have only pledged half of the required funding. "For some of those financial commitments, it is also unclear ,in some cases, if and when those will be honored," writes Joachim Rueppel, spokesman for the campaign against AIDS. The Fund was already forced to cancel already-initiated rounds of financing, without alternative possibilities for the expansion of its efforts.
This means that no earlier than 2014 will the Fund be in a position to begin additional prevention and treatment programs. "This is a catastrophe for more than 7 million people, still waiting on life-saving HIV treatment," said Gisela Schneider, member of the Speakers' Circle for Action Alliance against AIDS. "It was not until June 2011 that the United Nations have agreed on a target to ensure that by 2015 a total of 15 million people will have access to HIV treatment. This is now moving into distant future, "said Schneider. Even Germany is not living up to her responsibilities. Even the financial commitment of € 200 million per year is less than half of the appropriate contribution level. In addition, it is left in the discretion of the minister what will actually be paid out to the Fund.
Action against AIDS and Childrens Help have therefore launched the campaign "Keep the Promise!". The campaign asks the federal government to consistently support the Global Fund. "In practical terms this means to at least include the annually pledged € 200 million in its own title in the federal budget. By 2013 at the latest, these contributions would have to be increased to the appropriate level, which is at least € 400 million, "said Ruppel. Only then can Germany's meet its responsibilities for global health.
What is TDR-TB?
The term totally drug resistant tuberculosis was invented by Iranian researchers in 2009 to describe a strain of TB that didn't respond to treatment. Whereas people with MDR-TB (resistance to 2+ first line drugs) have a 30 percent chance of dying and people with XDR-TB (resistance to all first line and most second line drugs) have a 60 percent chance of dying, its believed that people with TDR-TB have a 100 percent chance of dying.
Is it really totally drug resistant?
It depends on who you ask. Many researchers say we can't be sure it's totally resistant because (1) there may be problems with drug susceptibility tests, (2) there is no standard protocol for diagnosing this strain, and (3) there are drugs currently in the pipeline that could potentially be effective against the strains of TDR-TB. However, researchers in India say their patients are resistant to all known forms of TB medication and therefore qualify as being ‘totally' resistant.
Is there a WHO definition of TDR?
WHO does not have an official definition for TDR-TB, instead saying it's probably best described as extra XDR-TB (hence XXDR-TB). The WHO plans to meet in March to discuss TB programs and potentially define TDR-TB and/or XXDR-TB.
Is the spread of infection any different?
No. People with pulmonary TB infect an estimated 10-15 people per year regardless of drug-resistance. TB has a higher chance of being spread when there is a higher concentration of people in places with poor ventilation, such as crowded houses, hospitals, or prisons.
What causes TDR-TB?
People with TDR-TB likely originally head XDR-TB that developed into a more resistant strain, possibly when a drug regimen was misused or mismanaged. Drug resistance can develop anywhere, but is more common in places TB control programs are managed poorly: poor patient support, low-quality health care, patients prescribed wrong treatment/wrong dose/wrong amount of time on treatment, insufficient supply of drugs, and insufficient quality of drugs.
Why now, why India?
India is home to 1/5 of the world's TB cases, killing an estimated 1,000 people a day. While it's National TB Program has been successful providing first line drugs to patients, many people in India seek health care from the unregulated private sector. One study showed only 5 of 106 private physicians prescribed appropriate drugs. Even if proper drugs are prescribed, many factors lead to people defaulting on their treatment. This is particularly in an issue for rural populations.
What can be done?
TB programs and strengthening and scaled up. Currently, TB programs all over the world face an $800 million funding gap - just for 2012. Eighty-six percent of TB financing comes from domestic budgets. The remaining 14 percent comes from donors. The Global Fund to Fight AIDS, Tuberculosis and Malaria is the largest external financer of TB programs. This week, as the Global Fund celebrates its 10th anniversary, its experiencing a major financing shortfall. We're calling for an emergency donor conference to mobilize the resources needed to reverse the situation and provide for a new funding opportunity in 2012 and 2013. We're also calling on the United States to convene donors before the International AIDS Conference, which takes place this July in Washington, D.C.
Click here to take action in Canada United Kingdom United States
What's it like to be a small fish in a big pond? I'll tell you - I started my internship with ACTION just under a week ago, so I would say I'm a fairly small fish in the global health advocacy pond. On my third day at the office, I attended a Global Health Council event to discuss the Institute for Health Metrics and Evaluation's (IHME) report on global health financing. While other college sophomores were sitting in class, I was sitting next to big fish in global health, and I couldn't have been more excited to get a glimpse into the complicated world of global health financing.
Global health financing is a complex issue, and there is much that has yet to be achieved in global health, but with effective strategies (along with financing), we can work towards achieving the MDG's and beyond. ACTION focuses on TB and childhood immunizations, so I was particularly interested in financing trends for those two health topics. What I found most interesting was the significreportant role the GAVI Alliance (GAVI) plays not only in vaccination, but in overall global health financing.
Two things stood out to me:
Firstly, GAVI plays a significant and increasingly important role in financing development assistance for health (DAH). GAVI is much newer compared to more traditional institutions such as UN agencies, and since its establishment in 2000 has experienced sustained growth. The amount of DAH flowing through GAVI became especially pronounced in 2007 and despite the recession, DAH from GAVI has continued to grow. The IHME estimates that its growth rate increased 31% between 2010 and 2011, rising from $893.84 million to $1.17 billion. In many ways, this is a result of successful advocacy by ACTION partners and others to raise the profile and political support for GAVI. These funds have helped GAVI to support the immunization of 326 million additional children, who might not otherwise have had access to vaccines, and will prevent over five million future deaths.
Secondly, the World Bank's International Bank for Reconstruction and Development accounted for the largest share of expansion ($796.77 million) in DAH between 2010 and 2011 in the form of loans. Some in the global health community contest whether these loans should be counted as DAH, as they are targeted to provide economic stimulus primarily and have to be paid back by governments.
Despite concerns over cutbacks in foreign aid, IHME surprisingly found that DAH continues to grow (but at a much slower rate). Panelists at the Global Health Council event expressed concern over donor preference for "quick wins", and stressed the negative impact that reduced funding and short-term thinking could have on long-term health systems strengthening. In moving forward, we must identify how to best target limited resources. Developing countries need new tools to better evaluate and address ongoing burdens of infectious diseases. MDG 4, 5, and 6 depend on the trajectory of DAH growth and this requires transparency, accountability, better data gathering, and more thorough impact evaluations.
As I continue my internship with ACTION, I look forward to seeing how global health advocates can help to ensure DAH continues to grow so that it stops tuberculosis and increases vaccine access and uptake for all children around the world.
Whenever someone visited their home village in Zambia, they would be afraid to ask the whereabouts of friends and relatives. Often times the answer was, “Didn't you hear?” Nothing else needed to be said. This grim scene changed when the Global Fund started supporting programs that provided treatment for people with AIDS and TB. Now when people in Zambia return to their village or town and asks, “Where's John?” the answer is not “Didn't you hear?” The response is more likely to be, “He went to Botswana for work” or “He went to South Africa to go to school.”
— Winstone Zulu, Zambia TB-HIV Advocate (1964-2011)
Within a decade the Global Fund stopped the terror that was draining the life out of societies, cultures, and economies around the world. Below are facts and figures that highlight the Global Fund’s successes and encourage critical reflection on global efforts to eradicate diseases of poverty.
Click image to expand
4.1 million
Over the last decade the Global Fund has prevented 4.1 million TB deaths. Source: The Global Fund 2011
4,000
Every day Global Fund programs save 4,000 lives. Source: The Global Fund 2011
6.6 million
Worldwide, 6.6 million people in low and middle-income countries are on AIDS treatment, up from 200,000 a decade ago. Source: UNAIDS Data Tables 2011
3000%
Access to AIDS treatment has increased over 3000% since the beginning of the Global Fund.
230 million
Since 2002 the Global Fund has distributed over 230 million insecticide-treated nets for the prevention of malaria. Source: The Global Fund 2011
25%
Malaria deaths have dropped 25% in the last decade. Source: Roll Back Malaria 2011
8.2 million
The Global fund has treated over 8.2 million cases of Tuberculosis since 2002. Source: The Global Fund 2011
48%
Forty-eight percent of all people on AIDS treatment depend on the Global Fund to receive their medication. Source: The Global Fund 2011
1.3 million
Between 2002 and the end of 2010, 1.3 million pregnant women with HIV received antiretroviral prophylaxis through prevention of mother-to-child transmission (PTMCT) programs supported by the Global Fund. Source: The Global Fund Results Report 2011
***
Now — a decade after the Fund’s creation — we have real hope about bringing an end to the world’s three most deadly infectious diseases. The tragic irony is that just as there is real hope to end disease; donors are forcing the Global Fund to stall its progress.
1 million
We can prevent 1 million TB deaths among people living with HIV by 2015 by implementing existing tools and expanding services. Source: Stop TB Partnership 2011
12.2 million
New modeling shows that an increased investment of $6 billion for AIDS drugs will prevent 12.2 million new HIV infections by 2020. Source: UNAIDS 2011
7.4 million
New modeling shows that an increased investment of $6 billion for AIDS drugs will save 7.4 million people by 2020. Source: UNAIDS 2011
ACTION is excited to announce that Zambia-based Community Initiative for TB, HIV/AIDS & Malaria (CITAM+) has joined the ACTION partnership. With the addition of CITAM+, ACTION now consists of nine advocacy organizations based around the world that are dedicated to empowering ordinary people to become sophisticated advocates who profoundly affect their country's political process in order to improve health and save lives.
Executive Director of CITAM+ Carol Nyirenda is a leading international advocate and media spokesperson who has played an important role in advancing policies and increasing funding for TB and health programming in her home country of Zambia, on the African continent, and globally.
As a survivor of TB-HIV co-infection, Carol has tremendous knowledge of the critical needs and challenges faced by low- and middle-income populations. Carol's commitment and knowledge have propelled her into leadership positions on many national and international bodies, to help drive innovative solutions to address health challenges, and to give affected communities a voice and representation in the larger health community. She has represented affected communities on the boards of UNITAID, the Global Fund to Fight AIDS, TB and Malaria, and the International Union Against Lung Disease and Tuberculosis.
At the country-level, Carol sits on the Board of the Treatment Advocacy and Literacy Campaign (TALC), and is a founding member of both the Coalition of "Zambian Women Living" and "Act Up Lusaka". She also represents TB constituency on the Global Fund Country Coordinating Mechanism (CCM). Through these positions she spearheads national and international advocacy efforts around TB-HIV, one of which resulted in the Zambian government's ultimate decision to implement WHO recommendations for collaborative TB-HIV activities.
Carol worked to establish CITAM+ in 2005, which develops sustainable TB-HIV support groups in and around Lusaka. Through this organization, Carol was instrumental in developing a comprehensive TB-HIV plan, which included community outreach and policy analysis to help ensure HIV groups incorporate TB counseling and services into their programming, and become educated about the growing co-infection epidemic in Zambia. CITAM+ currently holds a seat on the TB/HIV Joint Collaborative Body hosted by the Zambian Ministry of Health.
With the addition of CITAM+, ACTION continues to expand its global reach and improve its ability to fight TB and other global health issues.
ACTION.org
By: Jove Oliver
ACTION is excited to announce that two members of the ACTION partnership, Joanne Carter, Executive Director of RESULTS Educational Fund, and Allan Ragi, Executive Director of the Kenya AIDS NGO Consortium, have been appointed to serve on newly created Global Fund committees. Joanne will act as the Developed Country NGO representative on the Strategy, Investment and Impact Committee (SIIC), while Allan will be the Developing Country NGOs representative on the Finance and Operational Performance Committee (FOPC).
The SIIC and FOPC are two of the three committees created at the Global Fund's Twenty-Fifth Board meeting in Accra, Ghana, as part of a continued effort to reform their governance structure and fully implement recommendations made by the High Level Panel to streamline the committee structure. The Finance and Operational Performance Committee (FOPC) is mandated to provide oversight of the Fund's financial resources and ensure optimal performance in the operations and corporate management of the Secretariat, while the Strategy, Investment, and Impact Committee (SIIC) is chartered to provide oversight of the strategic direction of the Global Fund and ensure the optimal impact and performance of its investments in health.
These appointments, as well as the selection of Lucy Cheshire, a close ACTION ally, as the Communities representative on the SIIC, are an exciting opportunity for ACTION to contribute to the Global Fund's work of increasing efficiency, inclusion, and effectiveness.
"Our ACTION partners have been committed to the life-saving work of the Global Fund since its inception a decade ago." said ACTION Director Kolleen Bouchane. "ACTION is excited to be represented on the new committees by Joanne Carter and Allan Ragi, brilliant leaders within our partnership and on global health. In this moment of funding uncertainly for the Global Fund, just as the end of AIDS has become a real possibility, their work - the work of all those committed to seeing the Global Fund sustain and scale-up - is absolutely critical."
To date, the Global Fund has committed US$ 22.6 billion in 150 countries to support large-scale prevention, treatment and care programs against AIDS, TB, and Malaria.
More information on these new committees can be found here
Andrew Speaker caused an international incident in 2007 when he boarded an international flight while infected with XDR-TB, a form of tuberculosis resistant to most available drugs. It was terrifying to imagine what could have happened if the flight had taken off. Was there anything scarier than flying next to a person with extensively resistant TB?
Apparently, there is.
This week doctors in India identified twelve cases of TB that are totally drug resistant (TDR-TB). Whereas XDR-TB is sixty percent fatal, this new form of TB is one hundred percent fatal. Researchers, policymakers, and patients are scrambling to make sense of it all. Although India's TB program has been successful, it fails to include patients with multi-drug resistant TB. Ninety-nine percent of Indians lack access to proper treatment for drug-resistance, which has fueled the rise in XDR and given root to this new form of totally resistant TB.
This new strain threatens to take us back sixty years ago when TB was incurable. But things have changed in the last sixty years. Now there's HIV.
It's terrifying to imagine the impact this new form of totally drug resistant TB could have if it combines with HIV. Sub-Saharan Africa has the highest rate of TB-HIV co-infection in the world. In some places like Swaziland, over eighty percent of people diagnosed with TB are also infected with HIV. Drug-resistant TB is particularly dangerous in this population because it preys on people with weakened immune systems.
"If we had a strain [of TB] for which there is no treatment... It would be mean mass devastation" says Carol Nyirenda, Zambian TB-HIV activist and patient advocate. Zambia is currently experiencing stock outs of anti-TB drugs - shortages that develop of drug-resistance. Emergence of TDR-TB would place even more strain on the already fragile health system. Laboratory capacity is another problem. "We don't have the capability to do that kind of testing," Nyirenda explains.
The threat of drug-resistant TB and HIV has been around for the last decade, but little has been done to address the problem. Dr. Jim Kim, co-founder of Partners in Health warned in PBS's documentary Rise of the Superbugs, "When drug-resistant TB and HIV collide, as it is right now in places like South Africa...it is going to be a disaster, the likes of which I think will surprise many of us. ... There is no reason we shouldn't be able to get it under control now, with resources that are pitiful compared to what we spend on so many other silly things."
It's time global leaders take immediate action to control and prevent the spread of TB. "We need to ensure a constant supply of anti-TB drugs and more education around TB," explains Nyirenda. This new form of totally drug-resistant TB must be taken very seriously. It won't be long before the new strain surfaces elsewhere. After all, TDR-TB is only a plane ride away.
By: Andrea Brush
As a public health graduate student, I jump at any chance I have to get involved in my future field. The other day, I was given an opportunity to visit Aeras and tour their facility. With an academic background that is strictly social science, I was initially intimidated by the hard science that would soon be thrown my way via chemical compounds, acronyms, and scientific processes used to develop Tuberculosis vaccines. But then I thought to myself, Tuberculosis vaccines! How can I pass on an opportunity to meet with people that could potentially save millions of lives (approximately 1.4 million per year, according to Aeras)? Bolstered by the fact that my classmates back in Oregon were jealous of my opportunity to visit a place that we had discussed in classes, I took my new found confidence to Rockville, Maryland.
The scientists and researchers that we met with at the Aeras facility were wonderful. It was a humbling experience to watch these brilliant minds try to contain their excitement about their work and also try to use terms that non-scientists would understand. Admittedly, there was quite a bit of information that went over my head, such as using a matched prime boost and an adenovirus as delivery vehicles. These words mean little to me. But enough of the tour made sense for me to be in awe for my entire time at the facility. The most fascinating thing that I took away - something I had no idea was even happening in the research world - is that Aeras uses equipment for lyophilization, or freeze drying. Freeze drying! An aerosol vaccine is the ultimate goal with this technology, which is an oral dosage that would be administered directly to the lungs for faster and more efficient outcomes. An aerosol vaccine would be given through an inhaler rather than a syringe which would lead to more cost-effective production, easier access of the vaccine to most of the world, and easier storage, in that a it would not need to be kept at a specific temperature. This technology, if successful, could also be used for future vaccinations against other infectious diseases as well. The benefit of having a vaccine that does not need to be refrigerated is integral for low-income nations that may not have access to refrigeration or are prone to sporadic power outages. The current BCG vaccine requires refrigeration and has shown varying degrees of protection against TB in certain areas of the world.
Something else that affected me while on the tour was the collection of photographs hanging on the walls in the hallway outside of the laboratories. The photos, taken by David Rochkind, documented several lives affected by TB in South Africa. There was one picture, of a doctor surrounded by white buckets holding up a bag. The caption said the bag contained the heart and lungs of a deceased TB patient. All the buckets contained them as well. Gold mine workers often have their hearts and lungs preserved and examined to determine if TB killed them so their families could receive compensation. Even though TB is the killer the majority of the time, very few families are compensated.
The facts and figures surrounding TB and the need for a new vaccine are astounding. There are around 2 billion people in the world infected with TB, and the current vaccine (Bacille Calmette-Guérin (BCG), created in 1921) has little impact on the pandemic. In addition, 90% of people living with HIV that contract TB will die within three months. These facts, coupled with the new findings of totally drug resistant-TB, should be enough for anyone to want to join the fight against TB, regardless of understanding the science behind the vaccine development.
 |
ACTION partner, Dr. Bobby John of Global Health Advocates India, reflects on one year since the last wild polio case was detected in India.
"Indian investment and global support have brought things to this critical watershed moment. The next challenge is to maintain another 24 months of polio free status to truly be able to say that endemic wild polio transmission in India is a thing of the past, and to use the experience and infrastructure to raise the rates of immunization coverage among all children for the other diseases for which vaccines are available." -- Dr. Bobby john
Sitting by a makeshift immunization booth in Baramati Taluka, Maharashtra, India, in an old government owned off-road vehicle with 4 vaccine carrier boxes, I was not thinking of halting wild polio transmission in India.
On that hot dusty day in 1995, it all seemed to be a great big “tamasha1”, especially to a newly minted medical graduate on his first field experience - running around with additional vaccine carrier boxes, checking the labels, ensuring all babies under 5 were being counted, coaxing people to come to the booth... yes, polio was preventable, with just a drop of the vaccine; indeed it needed to be, but did we have to do all of this? And in all of India at one go?
The answer slowly sank in: Yes, and much more, as the last 17 years of work has taught us. Tackling polio on a massive scale in a country that was not doing too well on its universal immunization program seemed counter-intuitive, but it has demonstrated what well thought out and funded programs can achieve at the grassroots level.
On the way, it enabled a better understanding of how communities need to be engaged in health programs, and how clear and honest communications formed the bedrock of relationships between a public health program and the beneficiary communities.
It also paved way for innovations in delivery of health services, from the use of micro-planning techniques, GPS technologies to track teams and vaccine consignments, team building and retention of talented people, and dedicated funding within the national budget. It showed what Indians and their government could do if they put their will to it. Through Rotary, thousands of middle class Indians came out onto the streets to be part of the delivery mechanism on pulse polio Sundays.
The proof is here today to see: A year has passed by since the last wild polio case was detected in India. Indian investment and global support have brought things so far, a critical watershed moment. The next challenge is to maintain another 24 months of polio free status to truly be able to say that endemic wild polio transmission in India is a thing of the past, and to use the experience and infrastructure to raise the rates of immunization coverage among all children for the other diseases for which vaccines are available.
Meeting this challenge with enthusiasm, both for maintaining wild polio free status and covering other vaccine preventable diseases will set India up on the path to reducing its infant mortality numbers.
Dr. Bobby John
Global Health Advocates India
1Tamasha: Hindi word for light hearted entertainment
I spend most of my day reading about TB. I go over statistics, case fatality rates, and co-infection with HIV. It's easy to get lost in the numbers. But every so often I hear a story from someone with TB that shakes me to my core. The personal stories illustrate how devastating TB is for people and their families and remind me why I do what I do. No story is more heartbreaking than that of someone suffering from drug-resistant TB.
People with drug-resistant forms of TB are forced to take more toxic second-line medication with horrifying side effects. They stay on treatment for two years and are often kept in isolation, away from their friends and family. If that is what it's like to have MDR or XDR-TB, I can't even imagine what it would be like to be diagnosed with a new form of TB that is completely resistant to all medication.
This past week doctors in India reported twelve cases of TDR - totally drug resistant TB. It's 100% fatal. I spent most of today trying to imagine what would it be like to get diagnosed with an airborne disease that has no cure? What if you had already spread the disease to the rest of your family?
In an attempt to gain further understanding, I re-read RESULTS UK's report Tuberculosis: Voices in the fight against the European epidemic. One of the most compelling stories was about a Romanian man named Iulien. When first diagnosed with TB, he took his medication regularly. But like so many others, he was forced to interrupt his treatment so he could go back to work and support his family. By the time he returned home to restart treatment the disease had become resistant - but the local dispensary had run out of one of the drugs required to treat MDR-TB. Taking incomplete treatment puts him at risk for developing XDR-TB, which is even more fatal.
Iulian explains: "I have this fear in my heart that I'm never going to get better. The pills, there are a lot of them, and they are very strong. They give you headaches, stomach aches, and make you feel like throwing up." He was isolated during treatment and wasn't able to help his wife raise their two children, which he says was the worst part about being sick.
Jonathan Stillo, a TB researcher, explains the impossible choices Iulian was forced to make. "He took his treatment conscientiously but had to go back to work in order to take care of his family. He knew it placed him at risk for a relapse and that is what happened...Given the choice between his own health and his family's well-being, he will choose them every time. It is a choice he shouldn't have to make."
Reading Iulian's story again made me wonder, if this is what it's like to have MDR-TB, what would it be like to have TB that is completely drug resistant?
I can't even imagine.
Stay tuned for Q&A on completely drug-resistant TB
http://www.realclearscience.com
Last week I joined heads of state, leading scientists and activists in Ethiopia's mountainous capitol city of Addis Ababa for Africa's largest gathering of leaders working to end the AIDS crisis. With access to HIV treatment at record highs and climbing, new infections falling, and recent scientific breakthroughs being put into practice, the spirit in Addis should have been one of hope and optimism. Instead, attendees saw what new research on financing for global health released yesterday confirms: unless we change course, a public health catastrophe looms directly ahead.
There's no magic bullet that will destroy the AIDS virus. But, implemented together, antiretroviral therapy (proven to reduce HIV transmission by 96% when initiated early), voluntary male circumcision (which reduces risk of infection by half), and stopping the transmission of HIV from mothers to their children during the birthing process suggest that the end of AIDS is finally within reach.
Yet there's a ghastly paradox. The funding needed to put this science to work has started disappearing. After more than a decade of gains, global AIDS funding fell for the first time in 2010, by about 10 percent (or $740 million) compared to 2009. Furthering the decline, last month the Global Fund to Fight AIDS, Tuberculosis and Malaria-the world's largest international funder to prevent and treat these three diseases-suspended all new grants until 2014, citing a lack of resources as the primary reason.
Responding to the Global Fund's announcement, Andrew Jack at the famously sober Financial Times wrote, "With donors seeking ways to cut support, billions of dollars and millions of lives are at stake."
No surprise then, that the requisite fanfare, traditional dancing and musical performances during ICASA's opening ceremony seemed an incongruent backdrop to the grave speeches delivered by the high-profile speakers.
Former U.S. President George W. Bush, who in 2003 launched the President's Emergency Plan for AIDS Relief, acknowledged the budget challenges posed by the global economic recession. Yet he insisted, "The US and other donors must set priorities and there is no greater priority than saving human lives."
Michel Sidibe, the Executive Director of UNAIDS, called on governments to provide emergency financing-currently estimated at $2 billion-to jumpstart the Global Fund and restore the AIDS funding trajectory. He admitted, "I am scared by unfolding events and that global HIV funding is declining for the first time. Once patients are off ARVs for six months, they die. If we don't pay now, we will pay forever."
Professor Peter Piot, Director of the London School of Hygiene and Tropical Medicine and co-discoverer of the Ebola virus (and a Belgian Baron to boot), warned that, "All precious gains will be wiped out unless funding comes forward."
Will funding come forward? Or will we retreat?
Depending on which of the half-dozen sessions on AIDS financing one attended in Addis, funding projections ranged from uncertain to dismal. Experts intoned that the coffers are drying. Budgets are strapped. The European debt crisis has ended a decade of flush global health financing.
Listening to these grim prognoses, I was reminded of a quote from Apple's Steve Jobs relayed in Walter Isaacson's enthralling new biography, which I impulsively purchased in the airport and tore through on my way from Dulles to Addis: "The best way to predict the future is to create it."
Jobs left a legacy forged by a tenacity and unwillingness to compromise that were so unyielding it bordered on the maniacal. Colleagues felt themselves sucked into Jobs's "reality distortion field," through which he utterly failed to recognize the possibility of failure despite whatever facts laid there before him.
Time and again, those around Jobs claimed to have watched him bend reality to his will and birth beautiful new technologies others swore were beyond reach. One Apple vice president explained that when caught in Jobs's reality distortion field, "You did the impossible, because you didn't realize it was impossible."
As the world plods on in this economic malaise, we're certain to hear further admonitions that we must postpone our vision of the end of AIDS and simply learn to get on with less.
When we do, I'll be thinking of Jobs. And I'll see a reality that he might have seen: we work hard, leaders lead, we mobilize the resources and re-establish the course.
Given the stakes, is there any other option?
Scientific Development
These workshops will help participants develop skills and collaborative learning around the latest scientific research, emerging technologies, and breakthroughs in policy and programming. It is a great opportunity to highlight advances in research and scale-up of evidence based approaches, including TB-HIV.
Leadership & Accountability Development
These workshops should provide participants with innovative skills to assess and measure the commitments and actions of leaders. Workshops should challenge individuals and organizations to consider the ways they go about developing leadership and accountability and what outcomes they hope to achieve by doing this.
Community Skills Development
This series of workshops will showcase effective community empowerment programs that add value to public health outcomes in treatment, prevention, care, and support. Participants will broaden their knowledge and skills to be able to implement effective programs in their communities.
For an example of a successful workshop proposal visit
http://www.aids2012.org/WebContent/File/AIDS2012_Guide_to_Submitting_a_Good_Workshop.pdf
Remarks by Stephen Lewis, Co-Director of AIDS-Free World, delivered at a plenary session at the 2011 ICASA
ADDIS ABABA, 7 December 2011 (ICASA 2011) -
"With your indulgence, I'm going to deviate from the assigned topic. I shall address the Millennium Development Goals, but not in the way that was anticipated. There are two reasons. First, I want to speak in an unusually personal way, and from the heart, and in a fashion that leaves no room for ambiguity. Second, I consider the attack on the Global Fund to be the most serious assault it has endured in its ten-year history. I would feel utterly delinquent to let the issue slide.
I am seized by frustration and impatience. Let me explain.
I'm thrilled when UNICEF tells us of the possibility of the virtual elimination of pediatric AIDS by 2015. But I know-as knowledgeable people in this audience know-that it remains an unlikely prospect, but more important, that we lost several precious years during the last decade where we simply didn't apply the knowledge we possessed to prevent vertical transmission. It was a terrible failure on the part of international agencies and governments. Worse, the mother barely factored into the so-called "PMTCT" equation at all. As we come to this thrilling moment of progress, I cannot forget the millions of infants who died unnecessarily and the women who were never given treatment.
I'm thrilled at the creation of UN Women, and the possibility, once they join as a formal co-sponsor of UNAIDS, that the focus on women will be given a new lease on life. But I can't dislodge from my mind the experience of my years in the role as Envoy, and subsequently working with AIDS-Free World, when it became clear that in every aspect of the pandemic women were rendered subordinate. Gender inequality doomed their lives. Sexual violence fed and feeds the virus. The entire survival of communities and families was placed on their shoulders. Men were the social determinants of women's health, and men simply didn't care. As we come to this thrilling moment of potential progress, I can't avoid the spectral faces of stigma, discrimination, isolation, and pain, and they are the faces of women. That doesn't mean that women aren't the core of courage and strength in this pandemic; it simply means that they have to struggle valiantly to challenge the phalanx of male privilege, of male hegemony. Just a few days ago, coincident with World AIDS Day, the Harvard School of Public Health held a symposium called AIDS@30 to assess the past and plot the future. The symposium had a Global Advisory Council of nineteen eminent experts on the pandemic: 17 men and 2 women. It is ever thus. It's the rare woman indeed who doesn't ultimately report to a man in the world of HIV, or who can command, ever-so-rarely, the place and presence that legions of men command automatically.
I'm thrilled when I hear animated talk of male circumcision. But I know that we didn't need to wait for the results of the three studies in Uganda, Kenya, and South Africa. Nothing would have been lost if we'd focused immediately on making circumcision safe and available for informed parents to choose for their male babies; it's a minor procedure that has been performed for centuries. Instead, during nearly a decade as the evidence piled up that circumcision was a defense against AIDS-evidence provided by experts in the field-we waited and waited and waited, in that self-justifying paralysis of excruciating scientific precision. As we come to this thrilling moment of progress I cannot forget the numbers of lives that might have been saved had we acted sooner.
I'm thrilled with all the talk of "Treatment as Prevention" and how it has suddenly become the mantra of the international AIDS community. But back in 2006, I sat beside Dr. Julio Montaner, about to become President of the International AIDS Society, when he first expounded the proposition at a press briefing at the International AIDS Conference in Toronto. His evidence and argument were rooted in science and common sense in equal measure. But he had to endure scorn and derision, and we had to endure a five-year delay until Treatment as Prevention was definitively authenticated by the National Institutes of Health in Washington. Julio's theory suddenly became the 96% solution five years later, and it doesn't-I emphasize-it doesn't apply only to discordant couples. As we come to this thrilling moment of progress, I cannot forget the numbers of lives that might have been prolonged if we hadn't waited nearly five years to create the momentum that now propels us.
I'm thrilled with the turnaround in South Africa. The dramatic roll-out of treatment is nothing short of miraculous. But I remember all those years of denialism, and not a single voice at the most senior levels of the United Nations-Under-Secretaries-General, the Secretary-General himself. Not one of them said publicly to Thabo Mbeki, "You're killing your people". Oh, to be sure, it was said in private by everyone. They took Thabo Mbeki aside and begged him to reverse course. He didn't budge an inch. Around him, in every community in South Africa, and in communities throughout a continent heavily influenced by South Africa, were the killing fields of AIDS. As we come to this thrilling moment of progress, I can't forget the millions who died on Thabo Mbeki's watch, while those who should have confronted him before the eyes of the world stood mute.
I'm thrilled by the embrace of the slogan "Know Your Epidemic; Know Your Response" and the current concentration on high-risk groups. But I note that there were many voices, over the years, not all of them eccentric, calling attention to concurrent sexual partners and discordant couples, to MSM and sex work and sexual violence, and particularly injecting drug use, and they were contemptuously dismissed. I cannot but remember that magnificent gay activist from the Caribbean, Robert Carr, who died such an untimely death ... back at the pre-conference on MSM in advance of Vienna last year, Robert made one of those speeches that leaves you gasping. When you hear what the experts say, said the normally tactful Robert, it's bullshit - and he repeated bullshit so many times in the course of thirty minutes that the crass word became a cry of mobilizing dignity. As we come to this thrilling moment of progress, I can't forget the casual delays in responding to vulnerable groups. Experts fiddled while human rights burned.
So if you sense a certain impatience in me, you're right. We don't have another day to lose. Peter Piot did the arithmetic yesterday ... 1,350,000 put on treatment in 2010; 2,700,000 new infections, exactly double the number in treatment in the same year. It works out to 7,397 new infections every day. And it's 2011, for God's sake. It's appalling that such numbers continue to haunt us; it's heart-breaking beyond endurance to contemplate further exponential agony. We cannot delay another minute in putting the ‘prevention combination' to work.
And I think, judging from the mood in the corridors, that's what seizes this conference. But right at the moment when we know, irrefutably, that we can defeat this pandemic, we're sucker-punched at the Global Fund.
What's a sucker punch? It's when a boxer in the ring gets a punch below the belt that he doesn't see coming. No one expected a complete cancellation of Round Eleven, with new money unavailable for implementation until 2014.
It's just the latest blow in a long list of betrayals on the part of the donor countries, in this instance the Europeans in particular. I've heard from several people that the politics of the Global Fund meeting in Accra two weeks ago, when the decision was made, were not just complicated, but amounted to miserable internecine warfare. Certain governments on the Board of the Global Fund simply discredited themselves. They give a soiled name to the principle of international solidarity. The Chair of the Board, in a remarkably convoluted effort, tried to explain things in a press release. He would have done far better to remain silent.
The decision on the part of the donor countries is unforgiveable. In a speech a few days ago, I addressed the Global Fund predicament by talking of the moral implications of a decision that you know will result in death ... death on the African continent.
I asked: "Do they regard Africa as a territorial piece of geographic obsolescence? Do they regard Africans themselves as casually expendable? Is it because the women and children of Africa are not comparable in the eyes of western governments to the women and children of Europe and North America? Is it because Africans are black and unacknowledged racism is at play? Is it because a fighter jet is worth so much more than human lives? Is it because defense budgets are more worthy of protection in an economic downturn than millions of human beings?"
These are not phrased as rhetorical questions. I mean each and every one of them.
Spare me, I beg of all the speakers ... spare me the economic crisis. Everyone knows that when it comes to financing wars, or bailing out the banks, or bailing out Greece, or reinstituting corporate bonuses, or even responding to natural disasters that threaten economies, there's always enough money. We're drowning in crocodile tears. It's not a matter of the financial crisis; it's a matter of human priorities. We have a right to ask the G8: what do you sanctify as governments: profits and greed or global public health?
That's especially true in the case of the United States. I was, like everyone else, delighted by President Obama's endorsement of the proposition that PEPFAR could treat a total of six million people rather than four million people by 2013 with the same money. And I congratulate Ambassador Goosby for seeing that through. It's wonderful. No one would take issue. How could you? There's no additional money involved: it's just greater efficiency and more targeted spending.
And then the President went on to affirm his support for the money that's supposed to be destined for the Global Fund ... $4 billion over three years, 2011-2013; $1.3 billion a year.
Now let me take you back a step. In 2010, when the three-year pledge for the Global Fund was being discussed, the activists in the United States were asking for $6 billion over three years, believing that this was a fair share for the United States and an inducement to all the other donors. They feared that the President would stay at $3 billion over the next three years ... roughly the previous allocation for the Global Fund. When he endorsed $4 billion, it was considered a partial victory.
In my respectful submission, it's time for the United States to take a hard look at $6 billion. Many American speeches glow with the words that the US is the largest donor to the Fund. Well of course they're the largest donor; they're the most dominant and wealthy economy in the world. I really think that apart from calling on the European governments to reverse their decision, President Obama should tell Congress he wants a full $6 billion.
I don't expect that anyone ever listens to me. But I do point out what was emphasized at the opening of the conference: money to do battle against HIV/AIDS is the singular non-partisan issue in Congress. Even those irascible philistines who want to cut foreign aid, or global health, have shown in the past that they're prepared to shore up funding for HIV/AIDS. It seems to me that President Obama should put his moral authority on the line, and ask Congress to raise the ceiling from $4 billion to $6 billion for the Global Fund.
It's not a matter of comparison with other countries; it's a matter of doing what's right. And that means doing your fair share regardless of whether others are doing theirs. There are many commentators who agree that the salvation of George Bush's presidency was PEPFAR. President Obama doesn't need salvation. But I can't imagine a greater act of statespersonship than to say to the world: I, Barack Obama, cannot stand the thought of another unnecessary death; if the United States of America has to bail out the Global Fund, we will.
Is the extra $2 billion dollars outrageous? The economist Jeffrey Sachs has answered that question. He points out that the United States defense budget amounts to $1.9 billion a day. In other words, we're asking that HIV/AIDS receive an additional amount, over three years, that equals American military spending in one day.
It seems to me that that's an argument that African political leaders can effectively pursue amongst the many arguments they should employ in dealing with the donor community. I agree with Michel Sidibe-who's given significant and visionary leadership to this struggle-that there must be a high-level crisis meeting, and that Prime Minister Meles should convene it.
We've waited for this moment for a long time. This is an opportunity for the African political leadership to show its muscle, and to demand that the Global Fund be restored to its intended level. Remember, at the last formal replenishment in 2010, the funding came in at a dismal $11.7 billion, far short of the $20 billion that the Global Fund really needed in order to scale up to meet universal access. Now we're being told that even the $11.7 billion is out of reach. It's unconscionable, indefensible, outrageous. It's murder, that's what it is: murder. And the donor countries expect to get away with it because there's a culture of fiscal impunity.
As I wind my way to a conclusion, let me relate an anecdote that I think is relevant.
When I left my diplomatic post at the United Nations in 1988, I took on a role as the Secretary-General's Advisor on Africa. (I admit that seems odd, but there is an explanation that more or less justifies the appointment.) There was an Inter-Agency Task Force established, and there was a kind of executive committee of four. The Chair was the noted African economist, Professor Adebayo Adedeji of Nigeria and at the time Executive Secretary of the Economic Commission for Africa; the Vice-Chair was the remarkable, brilliant Richard Jolly, Deputy-Executive Director of UNICEF; the Rapporteur was the accomplished economist Sadig Rasheed, also with the ECA, and I was the fourth, a sort of honorary post. (Note that then, as now, men were tapped to lead the way.)
We met, often in Addis - where the ECA was and still is located - with many of our colleague agencies working in Africa. The World Bank was almost always in attendance, and intermittently, the International Monetary Fund.
It was the height of "structural adjustment" programs. Every meeting was a battleground, filled with heated imprecations, accusations, and malice. Our little executive cabal of four detested the international financial institutions, and they detested us.
In the midst of endless angry discussions of conditionality, we looked carefully at the financial data, and suddenly realized a staggering truth: when you took into account the interest payments and some capital payments as well, and ran the statistics carefully, it became clear that Africa was paying out far more than it was taking in ... hundreds of millions more. The continent was financing the World Bank; the World Bank wasn't financing the continent.
And it continues to this day. Again, I remind you of Peter Piot's reference yesterday. I have a close friend who writes columns for the newspaper The Globe and Mail in Canada. Commenting on the study that Peter Piot referenced, the title of his column was, "Africa: The World's Most Generous Foreign Aid Donor". It confirms the fact that a study of nine African countries, Ethiopia, Kenya, Malawi, Nigeria, South Africa, Uganda, Tanzania, and Zimbabwe showed that they had exported doctors to Canada, the United States, the UK, and Australia, costing Africa between $2 billion and $13 billion in education and training, and saving the four western countries more than $4.5 billion in education and training. The nurses' financial ratios would be even higher.
This is an AIDS conference. We talk endlessly about capacity building. Africa desperately needs its doctors and nurses. Instead, in the vital field of health professionals, Africa loses billions in exporting its human resources.
I say all this to challenge the artificial debate on dependency. From slavery to today's extractive industries of minerals and oil, Africa is financing the world. The modern world's economy was built on Africa's human and natural resources, and it depends on them to this day. The money from the Global Fund and PEPFAR amount to partial reparations. Western donors are not engaged in some kind of financial philanthropy: we owe Africa what we give to Africa. And a hell of a lot more to boot.
That's the debate that Prime Minister Meles should induce. The donor countries to the Global Fund, having ransacked the continent for six hundred years, have no right to withdraw. They must be confronted. And all of you, who make up civil society in so many countries, must press your Presidents and Prime Ministers into action.
Let me end by coming full circle to the Millennium Development Goals. Africa will never reach the MDGs if AIDS is not vanquished. AIDS adds to the desolate state of poverty. Obviously, it affects both maternal and child health. It continues to leave children parentless (though the millions of orphans whose plight seemed a priority at past AIDS gatherings, increasingly, mysteriously, disappear from view). Gender equality is a mockery in the face of AIDS. And the so-called partnership between the haves and the have-nots is rendered laughable. Even sustainable development is influenced, because climate change feasts on weakened populations.
If the MDGs are as important as everyone says, then AIDS must be subdued.
As a last parting thought, in respect of the Global Fund, I beg you to mobilize as a truly civil society and stand up to the reckless nation-states who dare to decide whether Africans will live or die."
In July 2012 tens of thousands of HIV researchers, policy makers, and advocates will attend the 19th International AIDS Conference in Washington, D.C. We invite you to submit abstracts for symposia that will bring TB-HIV to the forefront of the conference agenda.
Track A: Basic Science
This track addresses basic science around disease progression, morbidity and mortality. It is a great opportunity to highlight advances in basic research on the influence of opportunistic infections, including TB, on HIV disease course and immune control. Emphasis is being placed on new technologies and diagnostic tools.
Track B: Clinical Science
This track focuses on the long-term goals of providing HIV care, treatment and prevention. Abstracts should focus on the latest research findings, complexities, and controversies related to the prevention, diagnosis and treatment of opportunistic infections, including TB.
Track C: Epidemiology and Prevention Science
This track addresses recent advances in the epidemiology of HIV/AIDS prevention. Sessions in this track will foSubmissions in this track examine the ways in which HIV programs affect both clinical and non-clinical outcomes including health indicators, economic growth, and health systems functioning. Science from this track may evaluate the impact of prevention, care and treatment program scale-up and implementation and aims to inform resource allocation among different sectors in the fight against HIV. cus on HIV prevention research at both individual and population levels. Topics of particular interest include HIV testing, treatment as prevention, pre-exposure prophylaxis, and microbicides.
Track D: Social Science Human Rights and Political Science
Track D encompasses a wide range of social and behavioral science disciplines. Abstracts should provide qualitative and quantitative assessments of social, political, behavioral and human rights factors that influence HIV risk, vulnerability, response and impact. Submissions from community-based program implementers and advocates are encouraged.
Track E: Implementation Science, Health Systems and Economics
Submissions in this track examine the ways in which HIV programs affect both clinical and non-clinical outcomes including health indicators, economic growth, and health systems functioning. Science from this track may evaluate the impact of prevention, care and treatment program scale-up and implementation and aims to inform resource allocation among different sectors in the fight against HIV.
DOWNLOAD A PDF OF THIS ABSTRACT HERE
ACTION and ACTION Partners
By: Jove Oliver
November 23, 2011 - As a consequence of donor governments' failure to fulfill their financial pledges to the Global Fund to Fight AIDS, Tuberculosis and Malaria, the fund's Board cancelled plans to fund new grants to fight the three pandemics until 2014. The Board also announced it does not have the cash on hand to fund some previously approved grants. This financing shortfall has created an emergency in the international fight against AIDS, tuberculosis, and malaria-the world's three leading infectious killers.
"Donors have triggered a genuine crisis in the response to the world's three biggest infectious disease pandemics," said ACTION Director Kolleen Bouchane. "Their failure to make good on their financial pledges to the Global Fund will absolutely mean lives lost. This is a devastating breach of responsibility that will greatly limit access to proven life-saving interventions. It is not clear that the scale of this potential tragedy is fully realized by political leaders."
The emergency comes immediately on the heels of an announcement from the administration of President Barack Obama, which made supporting the rise of an AIDS-free generation an official goal of U.S. policy. Secretary of State Hillary Clinton made the announcement in a high-profile speech on November 8. The U.S. Government is the biggest donor to the Global Fund, providing roughly a third of the fund's total resources.
"In the U.S., all eyes are now on President Obama to step in and respond to this emergency by rallying Congress and other donor governments to fulfill their obligations," said Bouchane. "It is outrageous that the commitments and progress made over the last decade may now be fatally undermined by this funding shortfall, just as we were all beginning to talk seriously about the end of AIDS."
The Global Fund is the world's largest international financier of programs to treat TB and malaria, and the second-largest for HIV/AIDS. January 2012 is the 10th anniversary of the Fund's existence.
In countries fighting these diseases around the world, governments and civic organizations were well into the process of developing proposals to submit to the Global Fund for its upcoming round of grant funding. Proposals were to be reviewed and approved in 2012. The cancellation of new grant-making until 2014 will effectively halt programs that provide basic services to treat AIDS, TB, and malaria in countries most ravaged by the diseases.
In a small country facing major health challenges like Burundi, the impact could prove catastrophic. The Burundi national TB program is almost entirely funded through early grants from the Global Fund and was slated to apply for renewal funding next year. Other countries that were set to apply for new funding to continue expanding services include Botswana, Tanzania, Zambia, Malawi, Guyana, and dozens of others. All will be negatively impacted.
"With the cancellation of new grant funding, the whole fight against tuberculosis in the East African country of Burundi is in danger," said Patrick Bertrand, of ACTION partner Global Health Advocates in France, which has ties to treatment programs across Francophone Africa. "People in Burundi will die unnecessarily from a curable disease as a consequence of this new funding suddenly evaporating. The ensuing drug shortages will almost certainly give rise to drug-resistant strains of TB, which no one will be able to stop from spreading."
ACTION, founded to fight tuberculosis, is an international partnership of advocacy organizations working together to mobilize resources and influence policies to address urgent global health challenges.
Guest Blog From ACTION partner Global Health Advocates France - Bruno Rivalan
Toutes les 20 secondes un enfant meurt de la pneumonie
Voici le constat accablant qui démontre l'ampleur de la principale cause de mortalité chez les enfants de moins de cinq ans. Le 12 novembre a été désigné journée mondiale contre la pneumonie, une journée pour parler d'une maladie oubliée qui rime trop souvent avec pauvreté et vulnérabilité. L'occasion aussi d'appeler la communauté internationale à tous mettre en ouvre pour l'éradiquer.
Plus de 1,5 million d'enfants succombent chaque année à la pneumonie, soit plus que n'importe quelle autre maladie. Avec plus de 98% de décès dans les pays en développement, la pneumonie est un obstacle majeur à l'atteinte de l'OMD 4 (réduire de deux tiers la mortalité infantile d'ici 2015) et près d'un quart des enfants qui contractent et survivent à une méningite à pneumocoques souffriront de maladies chroniques invalidantes
Il existe pourtant aujourd'hui les outils comme la vaccination pour empêcher et protéger les enfants ou la prise d'antibiotiques pour traiter ceux qui souffrent de cette maladie. Malheureusement dans des pays ou les systèmes de santé sont faibles, et l'accès aux soins limités et moins de 30% d'enfants reçoivent des traitements antibiotiques contre la pneumonie. Le manque d'accès à un traitement rapide ne peut que renforcer l'importance de la prévention au moyen de la vaccination.
Les vaccins constituent en effet un élément essentiel des stratégies de santé intégrées qui peuvent sauver la vie d'enfants atteints de pneumonie. Selon une étude, l'immunisation permettrait de prévenir 80 % des infections à pneumocoques chez les enfants vaccinés.
Alors qu'il fallait habituellement entre 10 et 15 ans pour qu'un nouveau vaccin, après son introduction dans les pays industrialisés, arrive dans les pays pauvres, les vaccins contre la principale cause de pneumonie sont pratiquement administrés en même temps aux enfants des pays en développement et des pays riches. Aux Etats-Unis, les enfants ont reçu ce vaccin début 2010. Grace à l'Alliance pour la Vaccination (GAVI) et à ses partenaires moins d'un an après, les enfants de la Sierra Leone ont été protégés par le même vaccin.
Le déploiement des vaccins anti-pneumococciques dans les pays en développement, qui a débuté en décembre 2010 au Nicaragua, a été rendu possible grâce à des dons via un dispositif de financement innovant, appelé Garantie de marché (AMC), dont GAVI a été le pionnier. Avec plus 1,5 milliard US$ en provenance de l'Italie, du Royaume-Uni, du Canada, de la Russie, de la Norvège et de la Fondation Bill & Melinda Gates, et à l'engagement à hauteur de 1,3 milliard US$ de GAVI, l'AMC a permis de rendre le vaccin disponible en accélérant les capacités de production des fabricants de vaccins anti-pneumococciques recrutés jusqu'ici tout en réduisant les prix.
Selon les prévisions de l'OMS, 3,6 millions d'enfants auront été vaccinés contre l'infection pneumococcique fin 2011 dans les pays éligibles à l'aide financière de GAVI. ( un PIB de moins de 1500 $/ habitants).
Si on ne peut que se réjouir de tels résultats, des millions d'enfants n'ont toujours pas accès aux programmes de vaccination. En juin dernier lors de la conférence des donateurs de GAVI, un total de 4,3millions d'euros à été annoncé pour l'ensemble des contributions. Grâce à une partie des fonds, GAVI prévoit de vacciner 90 millions d'enfants contre les infections à pneumocoques d'ici 2015.Pour autant plusieurs conditions devront êtres remplis pour répondre aux objectifs fixés
Dans un contexte économique défavorable, un risque réel existe quant à l'absences de décaissement des fonds promis. Des pays donateurs pourraient en revenant sur leur promesse, entraîner une effet boule de neige et réduire dramatiquement les financements disponibles et donc les ambitions de GAVI, mais aussi des pays bénéficiaires ayant fait preuve d'efforts politiques et financiers considérables pour améliorer la santé de leur population . De telles décisions de la part des pays bailleurs aurait des conséquences mortelles pour des millions d'enfantsIl est donc primordial que les Etats tiennent leurs engagements trop souvent annoncés et peu souvent respectés.
Si le vaccin anti-pneumocoque est aujourd'hui disponible, les conditions pour son introduction et pour une immunisation massive dans de nombreux pays dépendra la capacité des systèmes de santé des pays à atteindre les populations les plus mal desservies, marginalisés et exclues des pratiques de soins. L'équité sera l'a pierre angulaire du succès des programmes de vaccination. Si Gavi à permis d'améliorer l'accès à la vaccination pour les pays à faible revenu, il existe aujourd'hui des disparités flagrantes aux seins d'un même pays, avec plus de 19 millions d'enfants non immunisés dans les pays GAVI-éligibles .
Sans l'implication de la société civile et plus particulièrement des organisations communautaires, l'universalité d'accès restera une utopie. Les vaccins sont là, le savoir faire existe et les fonds sont disponibles .
Continuons à agir collectivement pour rendre le doit à la santé un droit effectif et améliorer l'avenir de millions d'enfants.
Guest blog from Dr. Kate O'Brien
Pediatrician, epidemiologist, Deputy Director of the International Vaccine Access Center (IVAC), Johns Hopkins Bloomberg School of Public Health, USA,
Winner of the 2011 US Presidential Early Career Award for Scientists and Engineers
I'm a pediatrician, an infectious disease pediatrician at that. We're supposed to know what to do when a baby has pneumonia---apparently that's not always true. I've treated hundreds of such cases --- but this time was different. When it's your own infant none of that experience matters. Jack looked at me with what seemed like panic in his eyes. Coughing, crying, breathing fast, sleeping in fits and spurts. Babies aren't supposed to breath that fast. He lay beside me in bed. It was the day before Christmas and I just kept telling myself that we'd be better soon---apparently that's not true either. We both had influenza, I'm sure of that. If you've had it you'll know what I mean---I felt like hell, exhausted, muscle aches, every time I coughed it felt like sandpaper scraping over my trachea. But since I'm an infectious disease doc, of course we were vaccinated!---well, apparently that wasn't true this year. I had every intention of getting that done weeks earlier, but life got in the way.
The middle of the night always makes things worse, or at least things seem worse. So, we became ‘that family', calling our neighbors in the middle of the night to care for our two-year old while we drove to the hospital with Jack. So many times I was that doctor we were about to meet in the emergency room, scratching my head wondering, "Why did they wait the whole day at home and decide to finally come in at 2 in the morning?" Well, now I knew. Sometimes it doesn't get better. He had pneumonia on the chest x-ray and needed antibiotics.
Every day, of every year, millions of children get pneumonia and struggle to breath; more than a million of them don't get the treatment they need and die. Every day of every year something unimaginable to the mothers we are, happens to mothers we don't know, over 90% of them living in poor countries in Africa and Asia ---their child dies in front of their eyes from pneumonia. It's senseless. It's inhuman. Vaccines against the biggest pneumonia causing bacteria, Hib and pneumococcus, along with other simple strategies can prevent these deaths. So, this year on World Pneumonia Day, look at your kids and remember to get them vaccinated, remember to get yourself vaccinated and remember that not every mother is so lucky....yet. The GAVI Alliance is helping give those mothers the same opportunity for their kids, faster than ever before for any vaccine. At a time when the world seems to be more complicated than ever, this seems like a pretty sensible thing to do.
Despite being a preventable and treatable disease, one child dies from pneumonia every 20 seconds, almost 99% of whom live in the developing world[1]. As a result of this immense inequity, UNICEF has called pneumonia the "forgotten killer of children".
Tomorrow is the third World Pneumonia Day where we refuse to allow pneumonia to be forgotten as the leading killer of children under 5, and promise to prevent and treat the disease worldwide.
Thanks to institutions like the GAVI Alliance, life saving vaccines to prevent pneumonia are being rolled out to developing countries almost immediately after the vaccine was rolled out in the developed world. Children in the developing world are the ones who need vaccinations the most in order to protect themselves against potentially deadly cases of pneumonia.
GAVI supports the roll out of the pneumococcal and Haemophilus influenzae B (Hib) vaccines, which can prevent 49% of pneumonia infections.[2] The pneumococcal vaccine is now being used in 15 developing countries and has already reached more than 3 million children with another 10 million expected to receive the vaccine in 2012.
Countries that increase basic immunization coverage with vaccines against measles and pertussis can also help prevent pneumonia cases.
Prevention of serious cases of pneumonia can save children who are most at risk - those that live too far from health facilities, those living with HIV or those with poor nutrition. Vaccines are powerful tools that can not only prevent children from dying of disease like pneumonia, but save years of suffering and costly hospitalization fees which can sink families deeper into poverty.
This World Pneumonia Day is a time to celebrate the enormous progress we have made through supporting institutions like GAVI, but reminds us that our work is not done. Preventative interventions like vaccines must reach every child, including the most vulnerable, as a part of a broader package of interventions which can save children's lives like improving nutrition and sanitation, and breastfeeding in the first 6 months of life.
To find out more, check out this video.
To see what ACTION Partners are doing, meet our partners.
[1] World Health Organization. World health statistics 2006. Geneva: World Health Organization; 2006. http://www.who.int/whosis/whostat2006.pdf. Accessed September 6, 2009. AND Black R, Cousens S, Johnson H, et al. Global, regional, and national causes of child mortality in 2008: a systemic analysis. Lancet. 2010; 375:1969-87.
[2] Global Action Plan for Prevention and Control of Pneumonia (GAPP). World Health Organization and United Nations Children's Fund, 2009.
Houston Chronicle
After a frightful outbreak, Ennis High School students infected with tuberculosis have been allowed back to school. Thanks to the state's effective response - and cutting-edge medical technology and public health actions - the sick kids will almost certainly recover, and this crisis will soon be behind us.
The outbreak reminds us that tuberculosis is thriving in Texas and beyond our borders. Last year, there were 1,385 cases across the state, and 402 cases in the Houston area alone.
Worldwide, there will be almost 10 million tuberculosis cases causing 1.4 million deaths in 2011. An increasing number of tuberculosis germs have become resistant to the only available drugs. If we're ever going to end this disease, we must develop new tools for diagnosis and treatment - and we must do a better job of protecting children.
Tuberculosis is caused by bacteria that attack the lungs. The germs spread through the air when an infected person coughs or sneezes.
The traditional method of diagnosis in developing countries is for a sick patient to cough up phlegm, which a lab technician using a microscope visually searches through for the tiny bacteria.
This diagnostic method dates back to the turn of the century - the 20th century. More than 100 years later, it is still the foundation for controlling tuberculosis in most developing countries. It has never worked well, and it is even less effective with children, as they often have trouble producing phlegm and the germs are rarely seen.
Children also have less developed immune systems, so the bacteria tend to spread beyond their lungs, infecting the brain and other vital organs. These forms of tuberculosis are even harder to diagnose.
As a result, children receive little attention in tuberculosis control programs in countries where the most cases occur. This situation is just plain tragic. Because cases of childhood tuberculosis are massively underreported, official estimates are scarce and children are underrepresented in research and clinical trials for new diagnostic tests and drugs.
The World Health Organization published its annual global tuberculosis control report last week in Washington, D.C., and - shockingly - didn't say one word about the number of children infected or dying with tuberculosis. Estimates suggest that about 1 million children develop tuberculosis each year, and more than 250,000 die.
With foreign aid under threat, there is plenty that developing countries can do with limited resources. The experience at Ennis High School is instructive. If someone is diagnosed with tuberculosis, family members, close contacts and schoolmates should be proactively screened for the disease. Unfortunately, this rarely happens now where childhood tuberculosis occurs most frequently.
We must invest in better technologies to control - and end - tuberculosis here and abroad. We need better drugs, more accurate diagnostic tests and a better vaccine. The newest drug was developed before the first moon landing, and our only vaccine predates World War I. We must develop a rapid, accurate test to diagnose the disease in children. Tuberculosis in children will persist in Texas and worldwide if these advances do not occur.
It is heartening to see our health system mobilized so efficiently to protect the kids at Ennis High School and throughout Texas. But we can and must do more to help those affected by this disease beyond our borders. We cannot eliminate tuberculosis as a threat in Texas unless it is controlled throughout the world. Our safety depends upon it.
Starke is professor of pediatrics and director of the Children's Tuberculosis Clinic at Baylor College of Medicine in Houston
I'm sure we've all heard of the saying "saving for a rainy day." I try my best to put a little away every chance I get; you never know what opportunities or obstacles may be just around the corner. At this time in our history we have a really unique opportunity to begin to end the global AIDS epidemic, but some people don't quite see it that way. Here in the U.S. and abroad, you might be surprised at what counts for a "rainy day."
Between 2010 and 2012 it is estimated that $6 Billion dollars is expected to or has already been spent on sending a man to Mars, renovating airports, ethanol subsidies, and campaigning for the U.S. presidency. Let's spend that money on something that has a bit more impact. $6 Billion dollars is also how much it would take to begin to end the global AIDS epidemic and save millions of lives around the world. Just like in our personal lives, what our countries spend their money on reflects what their values are and where their priorities fall. Ending AIDS is something that CAN be done, if we put our money where our heads and hearts should already be.
Services will take place at 12.00 pm Lusaka time on Saturday, October 15 at the Cathedral of the Holy Cross and burial on the same day at Leopards Hill Memorial Park.
In addition, there is a candlelight vigil tonight (Friday October 14th, 2011) in Zambia - starting at 6.00 pm Zambia time and going throughout the night. Imagine Winstone looking down with that smile and seeing not only all the lights in Zambia but in the US, Canada, UK, Japan, France, Australia, India, Kenya and all the places in the world where he touched someone - which would literally be everywhere. Think about lighting a candle in your own home, office, or where you might be during this time so we can stand in solidarity with our brothers and sisters in Zambia!
President Sata (new President of Zambia) released an official statement today and there are several other statements coming out of Zambia.Llocal NGOs are hoping to film the funeral services and link to YouTube so you can keep an eye out for that on our videos page.
The number of people falling ill with tuberculosis or dying from the disease is declining around the world for the first time in 10 years, according to the World Health Organisation.
Data reported from 198 countries in the WHO 2011 Global Tuberculosis Control Report published yesterday, showed the number of people who fell ill with TB dropped to 8.8 million last year--down from a peak of 9 million in 2005.Deaths from TB fell from 1.8 million in 2003 to 1.4 million last year, a reduction of nearly 400,000. Between 1990 and last year, death rates from TB dropped 40%.
WHO concluded all regions, except Africa, were on track to reduce mortality by half by the year 2015.
It also warns that funding problems and drug resistance could hamper current progress.
Fewer dying, fewer ill
In 2009, 87% of patients treated were cured, with 46 million people successfully treated and seven million lives saved since 1995, according to the report.
United Nations secretary-general Ban Ki-Moon said the reduction in numbers of TB deaths and illness was a major progress, but insisted it was "no cause for complacency."
"Too many millions still develop TB each year, and too many die. I urge serious and sustained support for TB prevention and care, especially for the world's poorest and most vulnerable people," said Ban.
Serious decline was in large countries, including Kenya and Tanzania, where TB burden is estimated to have been falling for most of the last 10 years after a peak linked to HIV epidemic.Similar declines have also been reported in Brazil and China where TB deaths fell almost 80% in two decades--from 216,000 to 55,000.
WHO's director-general Margaret Chan said strong leadership and domestic financing, with robust support from donors, had started to make a "real difference" in combating TB.
She added, "The challenge now is to build on that commitment, to increase the global effort - and to pay particular attention to the growing threat of multidrug-resistant TB."
Domestic funding allocated to TB is expected to increase by 80% next year, though many low income countries still rely on external funding.
High burden of TB, HIV, drug resistance
Nigeria is among countries concluded to have a high burden of tuberculosis, along with HIV and cases of TB resistant to drugs--so-called multidrug-resistant TB (caused by resistance to the most effective anti-TB drugs isoniazid and rifampicin).
Mortality rate from TB alone stood at 21 per 100,000 population, nearly 33,000. But prevalence of TB combined with HIV averaged 320,000 last year.
Some 40% of all cases on average was detected in 2010. In all, there were 81,454 new cases, more than 1000 in children under age 15.
At least 2,667 cases of retreatment were reported--8% of them came from treatment after failure, another 18% from treatment after default.
Some 22% of the new cases reported were showed multi-drug resistance. Among patients under retreatment, multidrug-resistant TB accounted for 94%.
Funding shortages
WHO blames funding shortages for stalled progress in TB intervention. It said funding available for the programme in Nigeria--some $28 million--fell below $39 million budgeted.
Some $43 million is budgeted for TB next year, but only $26 million may be available for funding.
WHO suggests that the cost of treatment a patient under the DOTS programme will drop to nearly $200 next year in budgeting.DOTS is Directly Observed Treatment Short course, the recommended strategy for TB control.
Cost of treating multidrug-resistant will also drop, but remain far higher than regular TB. Each patient with resistant TB will require slightly less than $35,000.
Government funding of TB treatment for 2012 is expected to increase slightly over 2011, while funding from sources as Global Fund will shrink. But the highest proportion of funding is still expected to come from Global Fund and other grants.
WHO, however, spoke of developments in drugs, diagnostics and vaccines to combat TB. Results from three Phase III drugs are expected between 2012 and 2013 and could reduce time spent on treatment courses. Results of two other trials on multidrug-resistant TB are expected next year.
A memorial fund has been established at RESULTS, Inc. to provide financial support to Winstone's family. Winstone is survived by his wife, Vivian, and their four children, Michael, age 14; Waza, 11; Mwenda, 7; and Dan, 5. 100 percent of your generous contribution will go directly to Winstone's family in their time of need.
To contribute, please visit RESULTS, Inc. and choose your payment method. In order to alert RESULTS that your contribution is for the Winstone Zulu Memorial Fund, you must copy and paste "Winstone Zulu Memorial Fund" into the field that asks, "Who invited you to give to us?"
If you have any questions, please feel free to contact .(JavaScript must be enabled to view this email address)
RESULTS is a 501(c)(4) organization. Any contributions will not be tax-deductible.
"Winstone was among the most courageous, life-affirming advocates I have ever known. As the first person to go public with his HIV status in Zambia, Winstone encountered much prejudice and some outright violence in taking that stance. But he persisted and was in the forefront of efforts to change attitudes and mobilize a national and global response.
"Many of us at RESULTS know Winstone best for his passionate global advocacy to address the massive neglect of the dual epidemic of TB-HIV. Winstone lost all four of his brothers to TB; that and his own experience with TB drove him to begin speaking out. He brought these issues to donor capitals and news outlets around the world, and even when he was feeling physically weak, he pushed himself and pushed policymakers and the world to pay attention. Many of us were privileged to be his partner in these efforts.
"Among Winstone's most remarkable qualities was that his challenges and losses never turned him bitter, but instead fueled his drive to make change and his ability to eloquently call the world to account and action. Winstone radiated an enormously positive energy. As we mourn his death, the most fitting tribute will be to transmute our sadness into action and redouble our efforts to end these epidemics."
-Joanne Carter, RESULTS/RESULTS Educational Fund Executive Director
"Winstone, thank you for who you were. I will never forget the tireless HIV positive activist and TB survivor and lover of McDonalds hamburgers and Jimi Hendrix, who often changed the direction of my day. You knew and taught the value of a shared struggle, of turning personal tragedy into positive action, of valuing the contributions of those who had so much more than you, and those who had nothing. And it mattered. Your life mattered so much and to so many."
-Kolleen Bouchane, ACTION Director
"Winstone was the kind of person who had a humble rightness in his soul. Despite all the setbacks life threw his way, he just kept on doing what was right. He kept speaking, and travelling, and doing, even when the easy path was to be quiet, to stay home, to rest - because that was the right thing to do. This simple dedication to doing what was right is a moving example of how a life lived well can change the world."
-Aaron Oxley, RESULTS UK Executive Director
"He lived his life as a fighter - knowing that even though it was hard, that he had to keep on speaking out and keep on removing the next barrier to justice and opportunity. He ran the good race and ran it hard - he's an improbable top finisher because of sheer will and God's guidance."
-Ken Patterson, RESULTS Global Grassroots Manager
"The first time I met Winstone was last summer in DC. He had some free time, so I brought him out to brunch with my friends. They were surprised how someone who has been through so much hardship could be so positive...and funny! I have pet turtles, and Winstone always joked about how he wanted to use them to make turtle soup. He said, "Where I come from, what you have for a pets are what we call a delicacy." Winstone's legs were paralyzed from a childhood battle with polio so he was very passionate about improving the lives of children with disabilities. This year, he opened a school for children with physical disabilities in his hometown - over 54 students are currently enrolled. Winstone was the most amazing human being I've ever met. The world has lost a true angel."
-Mandy Slutsker, ACTION Senior Project Associate
"Winstone was the first TB-HIV patient advocate I met, and I have never felt more humbled or inspired by a single person. I often look at the photo I took with him in Zambia when I'm feeling like this boulder we are pushing isn't getting any lighter or the hill any less steep - the photo reminds me that one single person really can change hearts, minds, and the world."
-Jennifer Maurer, RESULTS Senior Policy Associate
"What a light he was. I remember a fantastic junket with Winstone, cracking up over and over again as we drove around Indiana and Ohio; rejoicing with him over a U2 costume/guitar sighting and watching him delight in the Jimi Hendrix exhibit at the Rock and Roll Hall of Fame; finally finding new rubber ends for his walking sticks; witnessing him inspire the Indy Star to speak out on TB/HIV . . . I'll never forget all of that. I still have my Hall of Fame wristband on my desk. Rest in peace, Winstone."
-Lisa Marchal, RESULTS Global Grassroots Associate
"I had the extreme pleasure to travel across the country three times with Winstone doing meetings with editors and members of Congress. The first thing that comes to mind when I think about Winstone is his humor and his love of music. Sure he was a first rate advocate for TB/HIV, but boy could that guy talk your ear off about Jimi Hendrix. On one of our trips he was able to stay with us near Seattle and we were able to take him to the Jimi Hendrix museum at the Experience Music Project in Seattle. It was such a pleasure to be his guide and friend on these trips. And, he was so much more than an advocate for TB/HIV; he was a fierce advocate for all people with disabilities of any kind. He was a loving father and husband and whenever we traveled together we spent much of our time talking about our families. My children, although they only spent a short amount of time with him, still tell stories about his visits. Winstone, for those of us who were lucky enough to know him, was quite a memorable character. One of my favorite quotes from him was when he was traveling from the U.S. to Canada and then off to Japan for a media tour and I commented on how much he was doing and how hard that much traveling must be on him. He looked right at me smiling and said, 'Stacy, there will be plenty of time to sleep when we die.' Goodnight my friend, sleep well, you will be missed."
-Stacy Carkonen, former RESULTS Global Grassroots Manager
"About a month after I started at RESULTS, I began setting up a visit for Winstone to come to Ottawa. I was new to the world of TB and I had never met Winstone, but heard that not only was he brilliant but he was a hoot, full of vim and vigour and passion and that he was exactly the right person to help us have the conversation about TB-HIV co-infection with Canadian parliamentarians. And he was. When he finally arrived in Ottawa at the end of nearly a month of travels, he was not feeling very well but insisted the show go on. He must have met 15 parliamentarians and officials at CIDA and some of the prime ministers office in about 2.5 days. I watched him deliver passionate speeches to MP after MP about why Canada needs to address TB-HIV co-infection. Winstone taught me that to be a powerful advocate, you speak from the heart and while it's always good to have a few facts to back you up, the stories of people's lives and experiences are what impact people. As Winstone and I waited in between meetings, we talked a lot about our hopes for the future. I'll never forget the look in his eyes when he spoke about his wife Vivian; passion was not something Winstone reserved only for issues and campaigns. I think maybe that is why Winstone was so powerful as an advocate; his passion was so true, so obviously from the heart and so very much for others as much as for himself. My deepest sympathies to Vivian and their children at this time; know that your RESULTS family in Canada mourns your loss."
-Katy Kydd Wright, RESULTS Canada Director of Campaigns
"I remember the first time I met Winstone; that was in 1994 during the 10th International AIDS Conference in Yokohama. He was one of the only openly HIV+ activists in Africa. I remember his courageous and powerful speeches during sessions and in front of the press, despite strong stigmatization. I remember our first discussions on the deadly duo TB and HIV, even at a time where nobody was talking about it. I remember him instantly becoming a TB and HIV advocate. Twelve years later, I remember him receiving the Kochon Prize at the Union Conference in Paris, still advocating for TB with the same and so powerful energy. Winstone, our friend in the fight for access to health for all, we will miss you."
-Patrick Bertrand, Global Health Advocates Coordinator/Principal Partner
Winstone Zulu
1964-2011
Winstone Zulu, a preeminent global advocate on TB and HIV and a dear friend and colleague of RESULTS and ACTION, passed away on October 12, 2011. After being diagnosed with HIV in 1990, he became the first individual in Zambia to publicly acknowledge his HIV status. In 1997, he contracted and was later cured of TB.
As the first publicly HIV-positive person in Zambia, he faced intolerance and violence, yet spoke out powerfully as an advocate. Years later, after surviving TB, Winstone again put his advocacy first in order to mobilize resources and worldwide attention to the burden of TB, HIV, and the deadly link between the two.
Born in Lusaka, Zambia, Winstone was the sixth of thirteen children. He watched four of his brothers die from TB due to lack of access to life-saving anti-TB drugs, and was moved to turn his personal loss into ceaseless advocacy for worldwide awareness for the fight against TB and TB-HIV co-infection. In his decades of advocacy, Winstone traveled the world to meet with heads of states and grassroots activists and speak at numerous international conferences. He championed increased financial resources and improved programs and accessibility to combat TB and TB-HIV.
In Zambia, Winstone was instrumental in reforming the Global Fund's country coordinating mechanism to ensure TB representation and gender equality. And recently, Winstone had begun to explore, in powerful ways, issues of disability rights, and to use his own experience of having polio as a child to campaign for universal access to vaccines.
Nelson Mandela said of Winstone, "There have been so few TB survivors who have stepped forward to share their stories. We need more advocates like Winstone to tell the world about TB and the effect it has on so many millions of people."
He is survived by his wife, Vivian, and their four children. He leaves behind a legacy of courageous advocacy that will continue to positively impact the fight against TB and HIV and will help save the lives of countless others in Zambia and around the world.
Contribute to the Winstone Zulu Memorial Fund
Candlelight Vigil and Services for Winstone Zulu
Winstone Zulu Profile from the book 28 Stories of Aids in Africa by Stephanie Nolan
In memory of Winstone Zulu, we have compiled photos that reflect his drive and spirit and his passion for life and combating TB.
BRAC
Shanta, a resident of Badda, a vibrant slum in northern Dhaka, is a face of the new Bangladesh. Every day she finishes her morning tasks at home and heads out into the bustle to begin her work. Around her, the streets pulse with energy: vendors offer freshly cut grapefruit and guava, stores and stalls spill over with cheap household items imported from China, cell phone ring tones sound endlessly. Once a country of villages, Bangladesh has been transformed as the promise of economic opportunity draws the rural poor to Dhaka, population 15 million and rising.
Rapid urban migration has squeezed the capital. Increasingly horrendous traffic chokes the roads, and power outages, a lack of basic sanitation and a dearth of public services are the norm here. Conditions are ripe for the spread of tuberculosis (TB), an airborne bacterial infection that kills about 5,000 people every day around the world. But there is also hope and opportunity: It is here in Bangladesh that BRAC, the world's largest anti-poverty organization, has developed a successful approach for confronting the threat of TB, described in its upcoming book, Making Tuberculosis History: Community-Based Solutions for Millions.
Shanta is a living embodiment of the organization's success. She is part of BRAC's all-female army of 80,000 "community health promoters" (shasthya shebika in Bangla) - lay practitioners who form the pillars of BRAC's anti-TB strategy. Shanta and tens of thousands like her visit households in their communities every day, selling simple health products like vitamins and sanitary napkins, while inquiring about persistent coughs, fevers, and other symptoms of TB. These women identify individuals with symptoms, and with BRAC's help, facilitate testing and diagnosis.
For those who test positive, a lengthy course of drug treatment begins. This is where Shanta's work becomes crucial, for one of the most worrying aspects of TB treatment is the potential development of dangerous drug-resistant strains. In order to prevent that, patients must complete the full course of drug treatment. Though medication is provided for free by the government, BRAC requires most new patients to hand over a small deposit, returned only after taking the medicine regularly for six months, ensuring the bacterial infection is eliminated completely. Shanta, like other community health promoters, makes sure the patients take their medication each day as prescribed.
"Patients usually want to stick to the treatment," says Shanta. But unexpected disruptions, mobile lifestyles and stress often make it difficult. People need a support mechanism that's nearby and flexible. Patients, too, admit that without her help, they'd likely forget to take the medication sometimes. If they need to travel outside the slum - back to their home villages for a few days, for instance - Shanta gets involved, helping them plan the trip, often identifying a temporary guardian to make sure they continue with the required dosages.
For those TB patients living in the surrounding streets of Badda, Shanta is both a friendly neighbor and care provider. Patients confide in her, often sharing personal matters during visits to her home, where they come for daily treatment. (Most live within a five to 10 minute walk and like to stop by on their way to work.) If unable to come, they call her mobile phone, and she usually responds with a personal visit. For every patient of hers that successfully completes treatment, Shanta receives 150 Bangladeshi takas (US$2) from BRAC, helping her support her own three children.
Building on its success in providing health care to rural communities, BRAC has trained an urban cadre of health promoters to reach slum dwellers as villagers increasingly pack up for the cities. The organization now accounts for about 66 percent of all TB cases treated in Bangladesh.
Emerging from its earliest experiments providing TB treatment to rural villages lacking access to government health care in the 1980s, BRAC's method has brought it under fire. Numerous public health experts, government officials, donors and human rights activists pushed BRAC to change its delivery strategy, which usually involves a bond system whereby patients put down a small deposit prior to beginning treatment, returned only if they complete the full course. The organization refused, citing program data and research that supported its approach.
Simply put, BRAC's model works. With adherence an Achilles' heel for treating infectious diseases like TB, BRAC has found a way to engage patients and motivate them to continue the full course of treatment. It has tested the model in the field, defended it from critics, and scaled it up to become one of the largest such programs in the world - thanks, in large part, to women like Shanta. BRAC has brought similar methods to Afghanistan with great success, and has promising pilots underway in Uganda and Liberia.
Since 1994, Bangladesh's National Tuberculosis Program has led a consortium of non-governmental organizations in creating systems that offer free treatment to all. This partnership has expanded since the arrival of resources from the Global Fund to Fight AIDS, Tuberculosis and Malaria in 2004, reaching deeper into communities across the country. In 2010, over 45 partners participated in national anti-TB efforts, treating 150,000 patients.
BRAC launches Making Tuberculosis History, on October 27 at the 42nd Union World Conference on Lung Health in Lille, France. For more information, write to makingtbhistory@bracusa.org.
Next in the series, we'll feature the story of Shahida, one of Shanta's patients.
BRAC
Shahida usually speaks quickly, her raspy voice sharpening every word. But she smiles and softens when asked if she'd rather just take her tuberculosis medications at home. "No," she says matter-of-factly. "I'd forget to do it every day."
As it stands, Shahida has yet to miss a single dose, a testament to the effectiveness of the anti-TB program of Dhaka-based BRAC, the world's largest development nonprofit, as detailed in an upcoming book Making Tuberculosis History: Community-Based Solutions for Millions.
Halfway through her six-month treatment course, Shahida, a resident of the northern Dhaka slum of Badda, continues her treatment under the watchful eye of her neighbor Shanta, one of BRAC's "community health promoters," or shasthya shebikas - an army of 89,000 trained lay practitioners who form the centerpiece of BRAC's anti-TB strategy.
Shahida's symptoms have already disappeared. In fact, she feels completely cured. For many, this would be the signal to stop taking the medicine, but Shahida knows, from her conversations with Shanta, the importance of finishing the full course. Not only will it prevent relapse, but failure to complete the treatment would encourage the emergence of dangerous drug-resistant strains of the bacteria that causes tuberculosis. The growth of drug-resistant strains is one of the greatest fears of global health advocates as TB continues to kill 5,000 people daily worldwide.
So Shahida continues her daily visits to Shanta's house. She sees the positive side: "It's nice to see her every day," Shahida says. "It provides a short break from all my daily chores. We usually end up talking about other things going on in the community."
It all began with a persistent fever. Shahida fell ill in May with a high temperature that didn't subside even after several days of medication. She wasn't coughing, so when she approached the doctor at a nearby clinic, TB wasn't even on her mind. But X-rays clearly indicated she had the disease.
Recognizing Shahida might be unable to afford the required treatment, the doctor recommended a visit to BRAC, which provides medications at no cost thanks to its partnership with Bangladesh's National Tuberculosis Program. A sputum test at Shahida's local BRAC branch office confirmed the diagnosis. Here, Shanta entered the picture: The patient and her shasthya shebika neighbor agreed on a time for daily visits.
Shahida prefers to keep her illness private, sharing it only with family. Though she does not buy anything else from Shanta - the shasthya shebikas have a basket of health products for sale, like vitamins and sanitary napkins - she's able to visit her regularly without eliciting suspicions from others in the community. The two women have developed a comfortable rapport.
In urban areas, local pharmacists, physicians and drug sellers (often untrained) are the first place poor people go for health care. These are often conveniently located in or near the slums and are open in the evenings, when public facilities are closed. A strategy employed by BRAC and other organizations working with the National Tuberculosis Program is to engage these providers in training and orientation to teach them about TB, the importance of adherence, and the availability of free treatment options.
Within the neighborhood of Badda alone, diverse options exist. BRAC tries to reach as many of these providers as possible, from the proper pharmacy shop to the individuals selling health products in rickshaw garages. Particularly in the complex context of Dhaka's unregulated and fragmented health care system, these partnerships create important pathways for patients to access quality TB services.
Partnership and engagement with health care providers are just two of many strategies BRAC is using for urban TB control. Learn about how BRAC works with garment factories to reach another vulnerable population.
Making Tuberculosis History, the comprehensive book on BRAC's experiences with TB, comes out on October 27. For more information, write to makingtbhistory@bracusa.org.
Next in the series, we'll feature the story of Rana, a garment worker who contracted TB.
BRAC
A chronic smoker, Rana wasn't too alarmed when he first developed a persistent cough. Within a few weeks the Bangladeshi garment worker's health had worsened, however. He began vomiting and found himself unable to go to work at the factory. A local doctor suspected tuberculosis (TB), but Rana couldn't afford the recommended X-ray diagnosis.
It's a typical story in Dhaka, and one where BRAC, the world's largest antipoverty organization, plays a crucial and potentially life-saving role. The doctor recommended Rana seek a free diagnosis at the local office of BRAC, whose successful anti-TB efforts are the subject of the forthcoming Making Tuberculosis History: Community-Based Solutions for Millions. First developed in the 1980s, BRAC's anti-TB program now covers 91 million people in Bangladesh alone.
The nearest BRAC office lay several kilometers from Rana's home in Badda, a slum in northern Dhaka, but he wasn't sure exactly where. Asking for directions along the way, he made his way through the labyrinth of narrow streets - a sprawling neighborhood of informal shops and dwellings that has cropped up beside the main road and factories as Dhaka's population soars due to migration from the countryside.
At BRAC, the test results came out positive for TB. Thanks to a BRAC-administered government program, Rana would have access to daily drug treatment for six months, but it would need to be supervised. Rana worried that he'd be unable to get to the BRAC office every day for treatment, so Mofiz, the local program organizer, connected him with Sirina, one of BRAC's community health promoters (or shasthya shebikas) living near his house.
Now, on his way to work each morning, Rana stops by Sirina's to quickly swallow the pill with a glass of water. Mofiz has also visited occasionally to make sure his health is improving. With four of six months of treatment already complete, Rana no longer experiences any symptoms, yet the system ensures that Rana and other patients finish their prescriptions, thus eradicating the bacteria completely and preventing the growth of drug-resistant TB strains.
Rana also faced the matter of employment. Upon diagnosis, he duly informed the factory supervisor that he'd contracted TB. His manager suggested that he take a few days off to begin the treatment; Rana was relieved at not being isolated from either his employer or the other workers on his floor.
Stigma is often cited as a concern for avoiding diagnosis and treatment of TB. Before medication became widely available, many considered it a fatal disease. Even those who recovered often experienced continued alienation. Some thought the disease had a genetic component, so a husband might abandon a wife who survived the illness, while unmarried survivors faced challenges finding a partner. That Rana and other patients, such as Abhur, a rickshaw driver who successfully completed his treatment, openly shared their condition with others in their community marks huge progress in combating the social dimensions of the disease.
Women in Bangladesh still experience greater levels of psychological and social consequences, however, which is one reason communications and social mobilization activities remain a central part of BRAC's strategy for TB control. The organization's all-female cadre of 80,000 shasthya shebikas, who sell health products while proffering advice on diagnosis and treatment, creates a frontline option that gives women access to TB services without having to travel, get money from their husbands, or see a male provider.
Treatment of male TB patients, meanwhile, carries its own set of concerns, including an alarmingly high rate of tobacco product usage among men. The long-term health consequences of smoking or chewing tobacco are not immediately visible, so individuals are unlikely to try quitting on their own. BRAC is informally piloting tobacco cessation support as part of its TB treatment package in a few areas of Dhaka, including Badda. Both Rana and Abhur, for instance, have smoked for years but are attempting to quit after counseling from Mofiz and their shasthya shebikas. "It's not easy to quit," Rana says, "but BRAC told me if I want to live, I need to try."
In Bangladesh's transition to a middle-income country, chronic disease prevention and management will likely replace infectious disease control as top priorities. Supporting Rana and Adhur in quitting smoking is yet another example of BRAC's experimentation with shasthya shebikas to extend its community-based approach so that it continues to have a powerful impact even in changing times. In Making Tuberculosis History: Community-Based Solutions for Millions, the authors also explore how BRAC might apply its anti-TB methods to other pressing health issues, including HIV/AIDS and hypertension.
Making Tuberculosis History, the comprehensive book on BRAC's experiences with TB, comes out on October 27. For more information, write to makingtbhistory@bracusa.org
http://www.themoscowtimes.com
The World Health Organization has challenged Russia to compete with neighboring countries for the best national plan to fight drug-resistant tuberculosis - and offered money to boot.
Russia has the third-highest rate of tuberculosis of all countries in Europe and the former Soviet Union, after Moldova and Romania, according to the latest data compiled by the WHO.
The WHO action plan urges European and CIS countries to draft national programs to adopt quicker and more expensive methods of tuberculosis detection that can reduce the time between a medical exam and the results from two months to two hours, Zsuzsanna Jakab, the WHO's regional director for Europe, said at a conference of state health officials and nongovernmental activists from Europe and the CIS.
The action plan also calls for universal access to the prevention, diagnosis and treatment of drug-resistant tuberculosis by 2015 and tailored services for specific segments of the population, including migrants, drug users and prisoners, according to a WHO booklet distributed at the conference Monday.Implementation of the plan will cost an estimated $5 billion for the whole of Europe and the CIS, but will save about $12 billion for member states in the WHO European region, which includes Europe and the CIS, the booklet said.
Countries with the best programs will be eligible for financing from the Global Fund to Fight Aids, Tuberculosis and Malaria, the European Commission and other international agencies, the booklet said.
The plan is expected to help avert 263,000 cases of drug-resistant tuberculosis in the region and treat another 127,000 cases successfully, it said.
More than 128,000 new cases of tuberculosis and microscopy-confirmed tuberculosis relapses were registered in Russia, or 90.7 cases per 100,000 people, compared to 102.4 cases in Moldova and 101.7 in Romania in 2008, the latest year for which data are available.
A total of 63.1 new tuberculosis cases were registered in Lithuania that year, but all other European countries had less than eight new tuberculosis cases per 100,000 people that year.
by McKay Campbell, ACTION global intern
I am used to explaining the issues of tuberculosis as a global health program to my friends, as many of them view it as an issue that was resolved in the 1900s. However, I was surprised to be facing the same struggle when talking to a group of friends from the developing world, including friends from Mozambique and Afghanistan- two of the 22 high-burden TB countries. I attempted to explain the need for advocacy around global TB control, but they remained unconvinced that TB was a major public health problem. Eventually the group walked off, muttering under their breath that there's no way TB is worse than malaria.
When the 2011 World Health Organization's report on Global Tuberculosis Control was published this morning, I eagerly combed through it for proof of TB's severity that I could share with my classmates. Just a few paragraphs into the introduction, I came across the fact that, after HIV, TB is the second leading cause of death from an infectious disease worldwide, killing 1.5 million people each year and is largely considered to be a disease of poverty.
In retrospect, my excitement over finding that fact is a bit embarrassing. However, it is a good anecdotal summary of the global problem of TB control. TB is simply not perceived as an issue that merits attention or investment, potentially because it is easy to treat in the developed world or maybe just because it hasn't had an attention-grabbing ad campaign like malaria and HIV/AIDS. The most commonly used TB diagnostic tests and vaccines are over 100 years old, the prominent set of first-line drugs are over 50 years old, and conventional laboratory capacity remains inadequate.
However, this is not to say that the TB report predicted a bleak future. This year's report is the first ever to declare the absolute number of TB cases has been declining since 2006 and we are on track to cut the TB mortality rate in half by 2015 in almost every region. Xpert MTB/RIF, a new rapid molecular diagnostic test that helps diagnose TB and forms of drug resistance in under two hours, is rolling out globally which will drastically increase the accuracy and efficiency of diagnosing TB. It would be comforting to relax and become complacent in the fight against TB. But this is not the time to do so. The WHO report emphasizes the importance of scaling up investments in TB control now to maintain momentum.
TB is silently killing our world's most vulnerable populations, often under the mask of AIDS. We are at the critical point to turn the tide against the disease. With the new tools like Xpert and other diagnostics and treatments in the pipeline, it is imperative that we work NOW to raise awareness, invest, and put our full force into fighting one of our world's biggest killers.
I personally look forward to doing my part to raise awareness about TB by talking to my classmates about the severity of TB, a disease that just so happens to kill more people each year than malaria, and a disease that we can control with better investments and increased focus.
By Teresa Rugg, founder of TB Photovoice
Two weeks ago, at 14 years of age, David shyly greeted me in his Kenyan community of Nyumbani, a special home that cares for orphaned children infected and affected by HIV. It was obvious that he was in good health and was happy to have visitors as his eyes filled with loving connection with his older brother William. William and I traveled to Nyumbani outside of Nairobi to spend the afternoon with David who had survived tuberculosis after losing his parents to HIV.
David had endured months of TB treatment that left him feeling sick and wondering if the medicine he was taking actually was helping him to get better. But with constant care and encouragement from his foster family and medical community, David recovered. To see David and his brother together, arms draped over one another's shoulders, smiling and sharing looks that only brothers can give, moved me greatly as I know David is one of the lucky ones. I have met the mothers whose children did not survive from this preventable and curable disease. TB is one of the top ten killers of children worldwide. We must continue to illustrate how important comprehensive TB care is for our children around the world, and follow up with action by encouraging our communities and leaders to prioritize TB prevention and treatment. David is a testament to the loving commitment provided by his local community. Scaling up similar efforts is critical to our children.
This blog first appeared on September 21, 2011 on Teresa Rugg's blog. Please read more of her entries here: http://www.tbphotovoice-teresa.blogspot.com/
http://en.trend.az
All regional TB laboratories in Turkmenistan will from now on perform luminescent (light-emitting diodes, LED) microscopy for detection of tuberculosis (TB), using luminescent microscopes and reagents that have been procured by the United Nations Development Programme (UNDP) project on strengthening TB diagnostics and treatment in Turkmenistan implemented in partnership with the Ministry of Health and Medical Industry of Turkmenistan, UNDP in Turkmenistan said.
The project also plans to support training of laboratory staff and introduction of appropriate quality assurance, and to follow up the effect of TB case detection rates and treatment outcomes.
With the project support, the expanded use of LED microscopy in Turkmenistan will facilitate the achievement of the national targets for TB control set by 2015, as well as the achievement of Millennium Development Goal 6 and the Stop TB Partnership goal, which is to reduce dramatically the global burden of TB by 2015.
The project "Strengthening and expanding of qualified services on TB diagnostics and treatment in Turkmenistan" is funded by the Global Fund to Fight AIDS, tuberculosis and malaria. Its goal is to reduce the burden of tuberculosis in Turkmenistan by consolidation of DOTS framework, its expansion by introducing and scaling up the management of drug-resistant tuberculosis and strengthening the health system performance for effective TB control.
A few weeks ago, a teacher in Texas walked into a high school classroom with a cough. Now at least 128 students have tested positive for Tuberculosis (TB) - a disease that though curable still shockingly takes the lives of 1.7 million people a year.
In the U.S., we often feel immune from many diseases plaguing other parts of the world. The recent TB outbreak is a reminder that TB is a disease that does not respect borders. Everyone who breathes is at risk.
This outbreak has led many parents to feel angry and frustrated. People want more information. This exposes a deeper problem - the lack of awareness about TB. Especially TB in children.
ACTION has been working to fill the information gap and recently released a report exposing this hidden epidemic. The truth is that many people get exposed to TB. This doesn't necessarily mean they will get sick. Most of the students in Texas have latent forms of the disease which are not infectious. In fact, one-third of people in the world have this form of the disease. Only 10% of people with latent TB will develop active disease. To prevent this from happening people with latent TB are treated with antibiotics for nine months.
"But didn't my child get vaccinated against TB?" many parents are wondering. The answer is probably no. While there is a vaccine called BCG that can protect against the most severe forms of TB - it is older than the automobile and doesn't always work. The BCG vaccine is usually only given to children in developing countries but it only protects against the most severe forms of the disease such as TB meningitis, however it fails to protect against most other forms of TB and wares off as children get older. Scientists are working on developing a new vaccine, but further funding is needed to develop and deliver it worldwide.
While the students in Texas have access to TB testing and treatment, it's important to remember that millions of children around the world do not have these resources. A lack of political will, inadequate funding, and children's exclusion from research remain barriers to eliminating childhood TB. It's time we expose this hidden epidemic and find the resources to make the fight against childhood TB a global health priority
by Jen Pollakusky, Elizabeth Glaser Pediatric AIDS Foundation
*ACTION asked Jen Pollakusky, a Senior Public Policy and Advocacy Officer at the Elizabeth Glaser Pediatric AIDS Foundation, to write a blog about current issues in childhood TB-HIV co-infection. The Foundation has a long history of advocating for child health and is a key ally in the fight against childhood TB-HIV.
"It is unthinkable and grotesque that we make the same mistake over and over again. There should be an uproar of children shouting, ‘What about me?' But they often can't speak and so their plight goes unnoticed until an outraged parent decides to speak out." -Elizabeth Glaser, champion for children's health and AIDS research
Thirty years ago, when scientists first discovered AIDS, fighting the disease in children was an afterthought. Today, children still lag behind in the fight against HIV and other infectious diseases, including childhood tuberculosis (TB).
As the leading cause of death among people living with HIV in sub-Saharan Africa, TB affects millions around the globe every year. HIV-positive children and women are among the hardest hit, often suffering from both HIV and TB - a potentially deadly combination, exacerbated by their weakened immune systems.
Despite this, TB in children remains a largely overlooked and neglected issue.
Currently, diagnosing TB in children remains a challenge and early detection of TB is difficult. Identifying TB is particularly difficult in children with HIV, who often have other pulmonary conditions that mimic the symptoms of TB. Children with HIV are also 20 times more likely to develop active TB than HIV-negative children and have a higher risk of dying of TB.
Like pediatric HIV, few medicines exist to treat TB in children, and there are more treatment options available for adults than children. Current methods of cutting adult tablets in half for use in children fall woefully short of adequately treating pediatric TB, and often prove difficult to administer to younger patients. Additional pediatric research and drug development are also urgently needed to improve TB treatment options for children.
Another important step in fighting TB in children is identifying TB in mothers.
Pregnant women with HIV are ten times more likely to contract TB, and those who have TB have a greater likelihood of passing HIV on to their infants during pregnancy, at birth, or during breastfeeding. Sadly, if infected, TB leads to a much higher mortality rate for both mothers and babies with HIV.
But TB rates among women and children with HIV can be greatly reduced by integrating TB services withexisting programs to prevent mother-to-child transmission (PMTCT) of HIV, as well as within broader maternal and child health services. The Elizabeth Glaser Pediatric AIDS Foundation is currently working to combine services for HIV and TB into one integrated package of care to improve the health of both mothers and children.
Working in partnership with the Ministry of Health and Social Welfare in Lesotho and John Hopkins University, the Foundation is studying the most effective ways to integrate HIV and TB services into maternal and child health clinics and PMTCT settings in Lesotho. As a first step to tackling the co-epidemics, this research will help strengthen medical guidelines and ultimately improve TB and HIV services for pregnant women.
In South Africa - which has the fourth highest number of TB cases worldwide - nurses like Sister Liza are doing their part to better identify women with TB and HIV. Sister Liza works with communities to raise awareness about HIV and TB, educate families about the dual diseases, follow-up with HIV-positive women and families who have missed their appointments, and visit patients at home to help deliver and administer medicines.
In Uganda, women living with HIV such as Kakazi are proof that integrating HIV and TB services is feasible - with successful results. Soon after learning she was HIV-positive, Kakazi developed a persistent cough. Because of her status, doctors tested Kakazi for TB. Her test results came back positive and she was immediately put on treatment.
Increasing screenings of HIV-positive pregnant women for TB and expanding TB testing to child immunization programs could help address HIV and TB co-infection in mothers and children. New TB diagnostic equipment, called Xpert MTB/RIF, significantly reduces the amount of time it takes to get TB test results back and increase the accuracy of those results - while also detecting more dangerous drug-resistant TB. While initial results show this new tool may be useful in diagnosing pediatric TB, more studies are needed.
More than twenty years ago, Elizabeth Glaser spoke out on behalf of children living with HIV and inspired policymakers to take action. Today, we have an important opportunity to follow Elizabeth's example and advocate for children living with HIV and TB.
Let's not make a mistake in failing to give children a voice. We must make fighting pediatric HIV and TB a priority.
http://www.bbc.co.uk/news/health/
Smokers are about twice as likely to get the lung infection and die from it, compared with non-smokers.
Many of the new TB cases will be in Africa, the eastern Mediterranean and Southeast Asian regions, according to projections published in the BMJ.
A lung charity said global efforts to fight TB are being undermined by the tobacco industry's "aggressive promotion" of smoking in some places.
Dr John Moore-Gillon is a TB specialist and honorary medical advisor for the British Lung Foundation.
He said: "It is nearly 20 years since the World Health Organization declared tuberculosis to be a 'global health emergency'.
"Since that time rates have risen rather than fallen, and smoking increases the risk of getting - and dying from - TB.
"Concerted international efforts are now under way to try and turn the tide of TB, but this important research shows that all these efforts may be undermined by the tobacco industry's continuing aggressive promotion of smoking in many parts of the world."
Mathematical model
Nearly a fifth of people in the world are smokers; many in countries with high rates of TB where multi-national tobacco companies have expanded their markets.
Smoking is a known risk factor for TB, and may reduce the ability of the lungs to fight off infection.
Dr Sanjay Basu and colleagues from the University of California set out to predict the impact of smoking on future TB rates.
According to their mathematical model, worldwide smoking could lead to 40 million extra deaths from TB from 2010 to 2050.
If current smoking trends continue, the number of new cases of TB will rise by 18 million.
Smoking alone could undermine the worldwide goal of reducing TB mortality by half between 1990 and 2015, they say.
Writing in the BMJ, the team concludes: "Tobacco smoking could substantially increase tuberculosis cases and deaths worldwide in coming years, undermining progress towards tuberculosis mortality targets.
"Aggressive tobacco control could avert millions of deaths from tuberculosis."
Contagious
Tuberculosis is a contagious infection that mainly affects the lungs, but can spread to other parts of the body.
If not treated, it can damage the lungs to such an extent that a person cannot breathe properly.
Sometimes, people do not experience any symptoms for many months or even years after being infected.
TB can treated with antibiotics but is sometimes fatal.
Last week, the GAVI Alliance announced the approval of a new wave of funding for lifesaving vaccines for children around the world. With resources garnered from its successful pledging conference in June (in part due to advocacy from ACTION partners), the GAVI Alliance Executive Committee reviewed and approved financing applications for 37 countries to roll out new and underused vaccines.
“Thanks to our donors and partners, the GAVI Alliance is now delivering on its promise to protect more children across the developing world against rotavirus, pneumococcal disease and other life-threatening yet preventable diseases,” said GAVI CEO Seth Berkley M.D.
This wave of applications is the first to utilize funding from pledges made last June and will finance 18 additional countries for pneumococcal vaccine roll out, and 16 for the rotavirus vaccine. As a demand-driven institution, GAVI saw the largest number of eligible country applications ever and estimates that the round will cost a little over 1 billion U.S. dollars including GAVI contributions and co-financing from recipient governments.
As a result of last week’s announcement, financing from GAVI will help immunize millions of children and protect them against some of the deadliest diseases. The WHO estimates that one child dies of a vaccine-preventable cause every 20 minutes. With GAVI’s support to introduce new lifesaving vaccines, countries can reduce this number drastically.
With new applications approved, GAVI expects roll-outs to begin in early 2012 with some occurring in 2013 to allow countries enough time to educate communities, improve cold-chain and distribution systems, and train healthcare workers. GAVI is on its way to achieve the goal of immunizing 90 million children against pneumococcal disease in 40 countries by 2015.
Read GAVI’s press release here.
Communities Living with HIV, Tuberculosis and affected by Malaria Delegation of the Board of the GFTAM
The Communities Living with HIV, Tuberculosis and affected by Malaria Delegation (Communities Delegation) of the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) welcomes the report of the High-Level Independent Review Panel (HLP) and acknowledges the recommendations put forth in strengthening fiduciary controls and oversight mechanisms at all levels of the Global Fund, which are consistent with its values of transparency and accountability.
The comprehensive findings of the HLP is a result of six months of intensive work, and includes the review of 40 existing grants with a conclusion that all current weaknesses are opportunities that can be strengthened and improved. The Board of the Global Fund will meet on the 26th September 2011, in Geneva, Switzerland to review and discuss the findings and recommendations, act on the most urgent issues and agree on a process to address and action the recommendations.
The Communities Delegation is deeply concerned, however, on how some of the findings of the HLP can be misconstrued. The Global Fund has committed US$ 22.4 billion in over 150 countries to support large-scale prevention, treatment, care and support programmes against the three diseases. This in practical terms translates to putting 3.2 million people on HIV treatment, treating 8.2 million people infected with Tuberculosis (TB), and 190 million bed-nets distributed to avert malaria infections. Millions of lives have been saved, because of the work of the Global Fund and its partners, and this needs to be put into perspective.
During times of a massive financial crisis and instability in the biggest world economies, major Global Fund contributors could translate the outcomes of the report into excuses not to meet funding commitments. The Global Fund needs the current and new donors to increase their contributions and pledges expressed at the Third Voluntary Replenishment Conference from US$ 11 billion to more than US$20 billion to ensure that efforts and gains made in the last decade can be effectively sustained. The Global Fund is thus far, the only mechanism in existence that could invest these resources needed in life-saving interventions. The report states, "the failure of the Global Fund would be a global health catastrophe".
Currently, 15 million people living with HIV are in dire need to be on life-saving drugs; the case detection for TB globally is at 65%, with drug resistant TB spiralling faster; and malaria cases though contained might be at a risk of exploding if efforts are not preventive efforts are not sustained. These are all emergencies that require immediate attention and extraordinary actions so as to benefit the very communities that we stand up for.
The Communities Delegation does not support the HLP suggestions to re-evaluate the Board decision on Round 11 funding, and proposals for new eligibility criteria. The Board of the Global Fund needs to be able to discuss the impact, consequences and recommendations responsibly bearing in mind the tremendous ramifications these decision(s) will have on achieving MDGs 4, 5, and 6, and ultimately on the lives of communities.
Shared responsibility is at the core of partnerships, and the Global Fund is a unique funding mechanism and partnership with an oversight and governance structure that includes multi-stakeholder participation at both global and national level. The report provides a timely opportunity for both implementers and donors to not only make the money work, but also to demonstrate how it works.
We are dismayed with some disparaging and opportunistic public statements related to the leadership at the Global Fund Secretariat after the release of the HLP report, and would like to point out that the recent reappointment of the Executive Director proves the trust and confidence of the Board in his work. The Communities Delegation has confidence in the leadership of the Executive Director, and would like to express our most sincere gratitude to staff at the Global Fund Secretariat for their tireless commitment and dedication to ensuring that lives are being saved across the three diseases.
The Communities Delegation reiterates its position of zero tolerance to corruption and the commitment to transparency and accountability. We bring to the Global Fund Board the voices and needs of millions of people living with and affected by the three diseases, and together with the Civil Society Constituencies on the Board of the Global Fund, we will remain vigilant to ensure that the most urgent changes in the structures, policies and processes of the Global Fund are implemented in order to continue saving lives.
We call for the responsible use of the public information released in the HLP report by media and governments and other partners, with a reminder that the challenges related to the three disease is an on-going emergency in many parts of the world. We need to ensure that the recommendations of the Board, and its responses to these recommendations constantly place the lives of people at the centre of our discussions.
On behalf of the Communities Delegation,
Shaun Mellors
Board Member,
Communities Delegation
Lucy Chesire
Interim Alternate Board Member,
Communities Delegation
Rachel Ong
Communications Focal Point,
Communities Delegation
GAVI Alliance
GAVI Alliance delivers on its promise to tackle diarrhoea and pneumonia
Geneva, 27 September 2011 - The GAVI Alliance today announced it will provide funding for 16 more developing countries to introduce rotavirus vaccines and 18 more countries to introduce pneumococcal vaccines -- a major step towards protecting children against severe diarrhoea and pneumonia -- the two leading child killers.
The roll out of rotavirus vaccines across the African continent has already begun in Sudan, and today's announcement confirms funding for 12 more African countries to follow suit.
"Thanks to our donors and partners, the GAVI Alliance is now delivering on its promise to protect more children across the developing world against rotavirus, pneumococcal disease and other life-threatening yet preventable diseases," said GAVI CEO Seth Berkley M.D..
"The death toll of rotavirus and pneumococcal infections in Africa is particularly devastating, and this is where these vaccines will make the most significant impact, not only in lives saved, but also in terms of healthy lives lived," he added. "Immunisation enables good health and healthy people are more productive and ultimately fuel economic growth."
An ever-increasing number of countries have applied for vaccine funding and yesterday (Monday) GAVI's Executive Committee approved applications from 37 countries - 16 for rotavirus vaccines, 18 for pneumococcal vaccines, five for pentavalent vaccine, and 12 for other types of vaccines (see annex for detailed list of approved countries - some countries have been approved for more than one vaccine). Out of the 37 countries, 24 are in Africa.
Rotavirus is the leading cause of severe diarrhoea in children under five years of age, killing more than half a million children each year worldwide and causing illness in several million more. Nearly 50% of all rotavirus deaths occur in Africa, where access to treatment for severe rotavirus diarrhoea is limited or unavailable.
Pneumococcal disease causes pneumonia, meningitis and sepsis and also takes the lives of more than half a million children each year worldwide, the vast majority of them in Africa and Asia. The funding of 18 more countries (including 12 in Africa) to introduce pneumococcal vaccines will take the total to 37 since the roll out of pneumococcal vaccines in GAVI-supported countries began in December 2010 in Nicaragua.
By 2015, GAVI and its partners plan to support more than 40 of the world's poorest countries to rollout rotavirus vaccines and immunise more than 50 million children. In addition to Sudan, Nicaragua, Bolivia, Guyana, and Honduras have already introduced rotavirus vaccines with GAVI's support.
"The high number of approved applications for funding for new vaccines in this latest round is yet another milestone in the fight to prevent child deaths from vaccine-preventable diseases," said Dr Margaret Chan, WHO Director-General. "As demand for new vaccines increases further, WHO will continue providing critical support to countries for decision-making on new vaccines, surveillance, and immunization programme planning, training, and evaluation."
"These new vaccines will prevent millions of children from dying of pneumonia and diarrhoea, the biggest killers of children under five," said UNICEF Executive Director Anthony Lake. "In rolling out these vaccines, we need to focus especially on reaching the children at greatest risk, for it is among the most vulnerable that these vaccines can make the biggest difference, especially if they are combined with better nutrition, sanitation and other critical interventions."
"Vaccines prevent disease and give children a healthy start to life - they represent one of the best investments in global health," said Dr. Rajeev Venkayya, Director of Vaccine Delivery at the Bill & Melinda Gates Foundation. "We must work together to ensure that all children have access to the right set of vaccines, in rich and poor countries alike."
Rotavirus vaccines have proven to be highly effective at reducing severe and fatal diarrhoea and have saved thousands of children's lives. Recent studies show the swift and significant impact of rotavirus vaccines to reduce child deaths and improve children's health.[1] For example, prior to the introduction of the vaccines in Mexico in 2006, 50% of deaths due to childhood diarrhoea were caused by rotavirus. The country has since seen a remarkable 46% reduction in the number of children under age five dying from diarrhoea.[2]
GAVI and its partners also plan to support more than 40 countries to introduce pneumococcal vaccines and immunise more than 90 million children against pneumococcal disease by 2015.
# # #
[1] http://journals.lww.com/pidj/toc/2011/01001
[2] http://www.nejm.org/doi/pdf/10.1056/NEJMc1100062
The GAVI Alliance is a public-private global health partnership committed to saving children's lives and protecting people's health by increasing access to immunisation in poor countries. The Alliance brings together developing country and donor governments, the World Health Organization, UNICEF, the World Bank, the vaccine industry in both industrialised and developing countries, research and technical agencies, civil society organizations, the Bill & Melinda Gates Foundation and other private philanthropists. Since it was launched at the World Economic Forum in 2000, GAVI has prevented more than five million future deaths and helped protect 288 million children with new and underused vaccines.
For more information, please visit: www.gavialliance.org
Sign up to receive GAVI's newsletter: Immunisation insights
Media requests:
Dan Thomas
+41 22 909 6524
+41 79 251 8581
Ariane Leroy
+41 22 909 6521 office
+41 79 340 1878 mobile
GAVI Photographs: http://www.gavialliance.org/audiences/journalists/high-res-photos/
GAVI Video B-roll: http://vimeo.com/album/1660201
BRAC.net
Like many of BRAC's programs, its community-based model for TB has garnered much praise: it's been profiled in articles in the New York Times, documented in Harvard Business School case studies, received the Stop TB Partnership Kochon Prize, and hosted dozens of distinguished visitors. Some of its methods have brought them under fire, within conservative communities, with the public sector, and international donors-it was one of the first to treat patients with lay volunteers (called shasthya shebikas), all women, in the community. And while medications have always been provided for free by the government, BRAC requires patients to hand over a small deposit prior to beginning treatment that's returned only when the patient completes the six months of treatment (this can be paid by the community or waived when necessary). Shasthya shebikas watch the patients take their medications every day (a strategy now called directly observed therapy, short-course or DOTS) at their homes, receiving a small payment upon treatment completion.When pressured to change its delivery strategy, BRAC has refused, with one argument amply supported by program data and rigorous research studies: this model works. With adherence as an Achilles' heel for treating infectious and non-communicable disease alike, BRAC found a way to engage patients and motivate them to continue the full course of treatment, defended it, and then scaled up to one of the largest programs in the world. Now a critical member in a national partnership with the Government of Bangladesh, over 40 other non-governments organizations, BRAC treats close to 100,000 patients a year with a success rate of 92%, defying the assumed trade-off between quality and scale. These achievements reflect significant contributions from many, including technical expertise from the World Health Organization and the Japanese Anti-TB Association, and resource mobilization by the Country Coordinating Mechanism, and transcend national borders.Internationally, BRAC has begun to adapt the model to new contexts. BRAC Afghanistan has worked with the government to make community-based TB treatment options part of the standard package of health services offered nationally.
Since its first write-up in a scientific newsletter in 1991, BRAC has published several academic articles on its successes in tuberculosis. It has even written chapters on the program in Tuberculosis: an interdisciplinary perspective and more recently, in From One to Many, a collection of programmatic experiences in scale up edited by BRAC. Ian Smillie dedicates a chapter of his book on BRAC, Freedom from Want, to tuberculosis control. But a thorough, reflective documentation, one capturingthe broader elements of the history, collective insights, support systems, strategic thinking, and overall, the story of what had built the program, written by its veteran leaders and staff, was absent. Finally, in Making Tuberculosis History: Community-based Solutions for Millions, we have achieved just that. The book offers a complete account of the program: how it was conceived, piloted, refined, scaled, managed, and ultimately adapted for new contexts, including Bangladesh's rapidly growing citiesand Afghanistan's remote mountainous regions. Summarizing past successes and current dilemmas, the book's ultimate aim is to advance efforts to eliminate poverty and disease globally. The public health challenges facing the world today demonstrate the critical need for large-scale thinking; lessons from BRAC's TB program can inspire others to think creatively about health delivery and advancing towards health for all.
When I first began researching children and TB, I started with a simple question: how many children get sick with TB each year?
The answer I got was shocking: "We're not completely sure."
As a researcher, I found this difficult to believe. TB has been around for thousands of years, so how it that we still don't have clear or comprehensive data? I needed to know more.
I dug a bit further and found that in 2009, the World Health Organization (WHO) estimated at least one million children became sick with TB. However, most countries only report on TB cases that are "sputum smear positive" (where TB bacteria are visible under a microscope). But only 10-15 percent of children have this kind of TB. That being said, it is likely that the majority of childhood TB cases go unreported - making it very difficult to determine the true burden of childhood TB that exists in the world.
To me, the lack of data highlights how neglected TB is as a children's health issue. Little has been done to prioritize childhood TB in national health programs and to eliminate the disease as a major killer of children. With this report, I hope to help change that.
Making the fight against childhood TB a global health priority is overdue. Please join me in taking action against childhood TB!
Read ACTION's latest report Children and Tuberculosis: Exposing a Hidden Epidemic
By Ann Hendrix-Jenkins, CORE Group
When I first got involved in the global TB world about eight years ago, one of my first questions was "Why don't TB programs treat children with TB?" I was told basically, from a public health perspective, it was because children aren't infectious. Well, as a mother of three, that rationale would not work for me if one of my children had TB. In fact, of course children with TB are treated in the U.S. It's a different story for children in low-income countries that are always at the back of the line for everything, TB care being no exception.
Since that time, the world of global TB has been evolving rapidly-becoming a more diverse, innovative field, and much more dynamic. Thanks to a few visionaries, we now believe it is both possible and worthwhile to protect children from this preventable, curable disease, and to successfully care for those children who have TB. This simple vision was not even seriously considered a mere eight years ago. How ironic considering this is a disease as old as humanity.
The bad news is that most children with TB in low-resource settings STILL DO NOT have access to protection, diagnosis, and treatment of TB. They suffer and die. The urgency is especially notable in high HIV settings.
What can we do to make up for lost time? We need to get proper systems into place to collect data on the prevalence of childhood TB and then use that data to hold everyone-including ourselves-accountable for doing something about it.
While that happens, we can begin now to work together to build pediatric TB prevention and care into all levels of global health, from global alliances to national health systems to community-level programs. This should include policies, protocols and resources for screening and referrals, contact tracing, services including diagnosis, treatment and preventative therapy, and community mobilization. Integrated program efforts are called for that link TB efforts with maternal health, child health (including nutrition), HIV, and all health programs. This will entail building strategic, logical and practical connections between people and programs that currently have few or no linkages whatsoever. And it all needs to be done from the perspective of the child and his or her family. How best to reach them, and provide care and treatment?
My grandmother, a physician, spent several years of her life in a TB sanitarium in the 1940s. When I was growing up, that seemed like ancient history to me. But, right now, as you read this, a child is coughing. TB is a real and present danger, trying, probably successfully, to steal her future. That child-and millions of others-need our help. Why aren't they getting it?
-------------------------------------------------------------------------------------------------------------
CORE Group's 60+ member and associate organizations reach 720 million people a year in 180 countries. (That's a tenth of the world's population) Historically, non-governmental organizations (and even Ministries of Health in some cases) were barred from getting involved with TB. Thus, our group has relatively little collective expertise in TB programming.
But we do have a LONG history of successfully working with communities and governments on pressing health and development problems in low-resource settings. CORE Group's multi-organizational TB Working Group seeks to accelerate the ease and pace with which our members can effectively integrated TB-including pediatric TB-care and control into their work. We have found, time and again, that if we all work together on these issues, progress comes quicker, and on a larger scale.
ACTION Releases Eye-Opening Report on Children & TB
Children and Tuberculosis: Exposing a Hidden Epidemic 
ACTION's enlightening analysis of the link between the burden of tuberculosis (TB) and the world's most vulnerable children — those who are malnourished, orphans, or living with HIV sheds light on a neglected epidemic. The report, Children and Tuberculosis: Exposing a Hidden Epidemic, is a reminder that TB is not a disease of the past and remains a leading killer, especially of children whose underdeveloped immune systems leave them particularly susceptible.
According to the World Health Organization, approximately 9 million people become sick with TB each year.1 At least 10-15 percent of these cases are in children under 15 — but the percentage is probably much higher, because childhood TB is under-reported.2 Despite these statistics and how long TB has been a known threat, we have yet to develop truly effective diagnostic tools, vaccines, or drugs specifically with kids in mind.
Dr. Jeffrey Starke, a leading TB specialist at Texas Children's Hospital, stated that childhood TB "is a fundamentally different disease than adult tuberculosis. Its proper diagnosis, treatment, and prevention require specific planning and resources. We must consider the unique nature of childhood TB if we're to successfully eliminate TB anywhere in the world."
It is through this eye-opening report that ACTION and our partners hope to call attention to the immediate need to stop neglecting TB and increase funding and research for this deadly but preventable disease to save children's lives.
1WHO (2010). Global Tuberculosis Control 2010. Geneva, World Health Organization.
2Swaminathan, S. and Rekha, B. (2010). "Pediatric tuberculosis: global overview and challenges." Clinical Infectious Diseases Suppl 3:S184-94.
Read Report
Fact Sheet
Tweet your support
We invite you to join us by sharing your stories related to children & TB — what you, family, or friends have experience or what you've witnessed in your advocacy — in the comment section below. Your story will appear here as well as on our ACTION Facebook page. Just like in our offline advocacy, we hope these stories will inspire action in our communities to help fight TB.
For those of you on twitter, we will be tweeting the United States Senate (@SenateDems and @Senate_GOPs) asking them to fight childhood TB and not cut funding for TB programs.
Below are some sample tweets to help you get the word out about our new report! Feel free to write your own tweets if you'd like, just be sure to use the hashtag #kidsTB!
Childhood TB has been swept under the rug for too long. Together we can put a stop to it. Please join us in calling for action on childhood TB.
Written By: Jessica Kuehne (RESULTS UK)
This week the ACTION Project is pleased to announce two important advocacy tools in the fight against TB in Europe. These advocacy tools - ‘Tuberculosis - Voices in the fight against the European epidemic' and MDR-TB Action Plan represent important steps in combating TB and in raising TB awareness, marking a shared commitment in tackling the disease. Medical Anthropologist Jonathan Stillo pointed out, "TB takes people out of the workforce and puts them into a state of poverty. They are not just faceless statistics, they are mothers and daughters, fathers and sons, and they are suffering." We urge European governments and institutions to fully back, both politically and financially, the WHO's Action Plan and to listen to the voices of those most affected by TB.
The ACTION Project is giving TB a ‘human face' in its report ‘Tuberculosis - Voices in the fight against the European Epidemic' by looking behind the statistics to focus on the every-day challenges faced by TB patients and their careers in Europe. Within the report, patients, doctors, advocates and healthcare workers from seven European countries - Georgia, Latvia, Moldova, Romania, Russia, UK and Ukraine - tell of their experiences. For more stories from those fighting TB in Europe, click here.
Yesterday morning, at a press conference in London, WHO Europe released its Action Plan to prevent and combat multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant TB (XDR-TB) in the WHO European Region. As a result of a variety of factors, including lack of resources and political will, drug-resistant TB strains have spread at an alarming rate in the Region.
WHO Europe's Action Plan was prepared in region-wide consultation with experts, patients and communities suffering from the disease. The Action Plan seeks to contain the spread of drug-resistant TB by achieving universal access to prevention, diagnosis and treatment in all Member States in the Region by 2015. WHO Europe predicts that full implementation of the Plan will prevent 263,000 cases of M/XDR-T and will save 120,000 lives and US$ 12 billion for Member States. For further information on TB in Europe, visit the TB Europe Coalition's website here or RESULTS UK's blog by clicking here.
CBS News: Drug resistance in TB cases alarms health officials
Reuters: Dangerous TB spreading at alarming rate in Europe
BBC News: TB: Plan to tackle rise in drug-resistant cases
Press Association: Warning on multidrug-resistant
Testing urine samples for specific chemicals could serve as a quick and painless way to detect tuberculosis (TB), according to Indian researchers.
The urine test offers a less invasive diagnostic method for an infectious disease that causes three million deaths and 10 million new cases worldwide each year. Developing countries account for 95 per cent of new infections and 98 per cent of deaths.
The Delhi-based International Centre for Genetic Engineering and Biotechnology (ICGEB) and the Lala Ram Sarup Institute of Tuberculosis and Respiratory Diseases, collaborated with the National University of Singapore to develop the test.
The test measures five specific chemicals present in urine, the researchers reported last month (July) in Analytical Chemistry, published by the American Chemical Society.
TB diagnosis relies mainly on a test to detect Mycobacterium tuberculosis in blood or sputum samples taken from the lung and examined under a microscope.
Diagnostic tests based on 'serum' - the clear liquid separated from clotted blood - are not sensitive, especially in people vaccinated against TB.
Drug-resistant cases need an expensive, sophisticated test that takes two weeks of culturing blood samples to detect the bacterium.
Developing countries prefer a simple test requiring minimum resources and trained personnel, and one that gives quick and easily interpreted results, the Delhi scientists observed.
Their technique measures five 'volatile organic compounds' (VOCs) in urine that have a low boiling point and vaporise at room temperature.
The team tested the method in 117 fresh cases of TB and found significantly different levels of these chemicals in TB patients, compared with healthy people.
It found a distinct pattern - three VOCs showed higher levels and two lower levels - in TB patients, not seen in healthy persons or in patients with lung ailments such as lung cancer or asthma.
The levels could also indicate the effect of treatment, the team said.
"A major advantage of the proposed method is the non-invasive nature of urine collection. Urine is a comparatively safer matrix as compared to sputum and painless in collection as compared to blood," it added.
ICGEB scientist Ranjan Nanda, one of the authors of the paper, explained toSciDev.Net that this was the first stage.
Nanda's team plans to validate the findings from multiple sites across India and involve a larger number of patients using improved data acquisition methods.
The team also plans to profile other VOCs in urine samples "to identify the maximum number of molecules," Nanda said.
Link to abstract in Analytical Chemistry
http://pharmtech.findpharma.com
Bayer Healthcare has pledged its support to a Tuberculosis (TB) partnership by providing 620,000 tablets of the antibiotic moxifloxacin to the World Health Organization (WHO), which will make the tablets available to China's national TB program. In particular, the medicine will be used to fight multidrug-resistant TB.
"We have decided to make moxifloxacin available to provide quick support to those patients in need," Jörg Reinhardt, chairman of the board of management of Bayer HealthCare, said in a statement. "We were happy to follow the request from WHO because we believe that this is the right step to address an increasing medical need in patients affected with this serious disease and for whom there are only very limited oral treatment options available."
According to Bayer, multidrug-resistant TB does not respond to standard TB drugs and can take two years or longer to cure. "Some countries, especially the former Soviet Union, China and India, have a high incidence of multidrug-resistant TB," explained Bayer. "According to WHO, an estimated 440,000 multidrug-resistant TB cases and 150,000 deaths occurred in 2008. Multidrug-resistant TB occurs almost everywhere in the world, the main focus being in Asia. Nearly half of multidrug-resistant TB cases are estimated to occur in China and India."
The medicine provided by Bayer, moxifloxacin, is a broad-spectrum antibiotic, but is not approved for the treatment of TB or multidrug-resistant TB. However, WHO has included the medicine in treatment group III of its guidelines as part of a second-line TB regimen in patients with confirmed multidrug-resistant TB. Moxifloxacin will be administered in China in a highly controlled manner, with close monitoring.
"Together with the Global Alliance for TB Drug Development, Bayer's pharmaceutical division is working on the development of moxifloxacin as a treatment for drug-susceptible pulmonary TB. It is the aim of ongoing studies to show that use of moxifloxacin could reduce the length of treatment for drug-susceptible TB from six to four months. Bayer HealthCare intends to apply for the approval of moxifloxacin for the treatment of pulmonary TB as soon as clinical trials have been completed," said Bayer.
The TB partnership, Stop TB, was formed by WHO in 2001, and comprises a network of international organizations, countries, donors from the public and private sectors, and governmental and nongovernmental organizations.
This is the second boost that China has had in recent weeks with regards to TB treatments. Last month, the Stop TB Partnership also announced that Aeras, a US-based product development organization and a member of the program's Working Group on New TB Vaccines, had signed a memorandum of understanding with the China National Biotech Group, with the aim of pursuing opportunities to jointly develop TB vaccines in China. Potential activities will cover the full spectrum of product development, including preclinical development, process development and manufacturing, and clinical development in TB.
According to Aeras, TB is a major public health priority in China where there are more than one million new TB cases every year. Globally, TB is reported to be responsible for 1.7 million deaths every year.
http://www.plusnews.org
While countries are rolling out new tests that will enable them to diagnose more patients with drug-resistant tuberculosis (DR-TB), a worldwide shortage of the drugs to treat these patients is likely, Médecins Sans Frontières (MSF) warns.
DR-TB can occur when TB patients do not complete their initial course of TB treatment. The only way to test for DR-TB is through cultures or via molecular testing - neither of which has been widely available in many high incident countries - until the advent of the GeneXpert, a two-hour molecular TB test released in 2010.
South Africa, which has the world's fifth-largest burden of multi-drug resistant (MDR) TB cases, will replace all microscope-based TB diagnoses with faster, more sensitive GeneXpert testing within two years, making it the world's largest user of the machine, according to Norbert Ndjeka, director of DR-TB, TB and HIV at the South African National Department of Health.
The GeneXpert machine - about the size of a milk crate - provides a fully automated nucleic acid amplification test (NAAT) that is effective in the early diagnosis of TB, MDR-TB, and TB patients co-infected with HIV, which is more difficult to diagnose.
Speaking at a recent meeting co-hosted by South African AIDS lobby group, the Treatment Action Campaign, human rights organization SECTION27 and MSF, Ndjeka said that national use of the GeneXpert machine could double the number of MDR-TB cases diagnosed.
But while more patients may get diagnosed, their access to treatment remains precarious as a limited number of approved drug producers keep many DR-TB prices high and supply uncertain, according to Dr Eric Goemaere, MSF's senior regional adviser.
Higher prices
The country cures about 42 percent of MDR-TB patients nationally, according to Ndjeka, but the national success rate masks provincial cure rates as low as 10 percent.
Treating MDR-TB patients takes up about half South Africa's TB budget and this proportion is expected to rise as the country diagnoses more cases with technology like the GeneXpert.
While DR-TB drugs remain expensive worldwide, South African activists have long complained that the country paid more than other countries that were able to access prices negotiated by the international procurement body, the Global Drug Facility. South Africa recently negotiated a US$33.8 million savings in TB drugs through its new TB drug tender, which also included DR-TB drugs such as capreomycin and moxifloxacin.
MSF has estimated that without lower DR-TB costs, South Africa will be spending as much as $630 million on treatment by 2015. At present, para-aminosalicylic (PAS), one of the world's oldest TB drugs - which has been reintroduced to MDR-TB treatment due to a lack of alternatives - can account for as much as half of MDR-TB treatment costs generally.
Ndjeka admitted that South Africa continues to pay higher-than-average prices for PAS as the drug has not been registered for use by South Africa's regulatory Medicines Control Council (MCC), which has been labouring for years under a backlog in drug registrations, including those of some fixed-dose antiretrovirals. The country now pays a private company to import the drug through a special application to the MCC.
Behind the shortages
The answer to why the prices of DR-TB drugs - even for an antiquated and highly toxic drug such as PAS - remain high is wrapped up in a range of market and regulatory dynamics that will likely mean a shortage, says Goemaere.
A drug starts with the active pharmaceutical ingredient (API), but the number of API producers for DR-TB is extremely low, and for some drugs there is only one, says Goemaere.
Many countries struggle to accurately forecast DR-TB drug needs, leaving API producers unable to forecast not only possible increases in demand but also the market: without an accurate idea of potential financial returns, would-be API producers have little reason to enter the DR-TB drug market.
In addition, difficulties in obtaining regulatory approval are another disincentive. "Because of this, our experience in MSF with stock supply is that we go from stock failure to stock failure," Goemaere remarked.
DR-TB drug capreomycin for example, has more than doubled in price in the past 10 years, according to a recent MSF report,DR-TB Drugs Under the Microscope.
MSF has called for countries to avert the looming crisis by improving drug forecasting, negotiating better prices and accelerating national medicines registrations.
Ann Danaiya Usher's report in the August 6 Lancet (pp 471 to 472) on the state of pledges to the Global Fund to fight AIDS, TB, and Malaria has an incomplete understanding of the current state of donor country attitudes towards the Global Fund.
Usher rightly highlights that the Global Fund is likely to face a critical funding shortfall as it looks to sign off on the latest set of agreements for AIDS, TB, and malaria treatment and prevention programs for the next 5 years. Usher also correctly links this shortfall to the reaction of a handful of key donors to media pieces that ran in early 2011, ones that inflated the Global Fund's own reporting of $34 million lost to fraud, misappropriation, and miss-management in four Global Fund grant recipient countries. However, Usher's portrayal is only part of the story on attitudes donor towards the Global Fund, as she fails to mention important developments that point to sustained and renewed trust.
The Global Fund came out "strong" in the United Kingdom's Multilateral Aid Review, placing it in the top tier of multilaterals reviewed, and where it was noted that that it exhibited a "likely capacity for positive change." It performed similarly in Australia's very recent aid review. Its track record against the three diseases is seen by the Australians as a strong case for increased investment. Usher mentioned neither in her article.
The article focused largely on knee-jerk initial reactions reaction from a handful of donors to the media attention on fraud uncovered by the Global Fund itself, but left out recent statements and reactions from key donors. These include the recent pledge and endorsement from the Netherlands, which took place despite significant pressure on their overall aid budget. It was accompanied by a strong supporting statement by the Dutch Minister of International Cooperation, Ben Knapen, who was, "satisfied about the measures taken by the Fund ... and therefore sees no reason to reduce the Dutch contribution." Moreover, Stephen Harper, prime minister of Canada, while juggling a busy schedule at the Davos Economic Forum, insisted that Canada stands behind its investment in the Global Fund.
Usher also mentions that Italy, Spain, and Ireland have yet to make new pledges to the Global Fund, but leaves out that that is most likely due to significant budgetary constraints brought on by debt crises in those countries.
All donors eagerly await the final findings of the independent international panel assessing the risks in Global Fund grants, due out in September. I would hope for a more balanced piece from the Lancet after the completion of the panel's review, detailing donor reactions not only to panel findings, but to the implementation of the Global Fund's own reform agenda.
The story line is reliable, says Dr. Kevin Patterson.
"Granny starts coughing" and "losing weight" and then the "night sweats" start.
It sounds like a bad case of the flu and at first that's what it feels like. "It's not something that falls on you like a ton of bricks, like other infections might, it's usually a slow moving process," he says.
Granny doesn't like going to the doctor so she puts up with "the flu" for two months, until she's "lost 30 pounds."
When she starts coughing up blood, she finally gives in. By that time, the grandkids are coughing too.
"I don't know the death rate, but it certainly is regularly lethal," says Patterson. He's speaking of tuberculosis, a disease that most Canadians never encounter except perhaps in a storybook set long ago. Hasn't TB long been banished from developed countries like Canada?
No it hasn't. Canada's TB incidence rate was 4.8 cases for every 100,000 people in 2009, a bit better than Australia (6.4 per 100,000) and a bit worse than the U.S. (4.1 per 100,000).
But TB in some of Canada's First Nations communities is far more prevalent. The rate among Aboriginals living on reserves, in fact, is 31 times higher than among non-Aboriginal Canadians, while among the Inuit the rate is 185 times higher, according to evidence presented for a 2010 report by the House of Commons Standing Committee on Health.
And Patterson is all too correct that tuberculosis kills. One out of 25 First Nations TB cases ended in death in Canada between 1990 and 2000, according to Health Canada. Older Aboriginal people are particularly vulnerable; one in five with TB over the age of 75 died.
"Tuberculosis is fundamentally a flag for poverty" says Patterson, who knows first hand. Every year since 1995, he has spent a few weeks working in northern Inuit communities. Tuberculosis, he says, is "a barometer of social privilege and the fact that no TB exists in the south among Caucasians, for all intents and purposes, and that it's highly prevalent among the reservations and among the Inuit is just the most graphic evidence of the extent of the disparity."
Patterson says this as his sail boat, The Sea Mouse, heads out of the harbour on Salt Spring Island, beginning the first leg of a sailing trip to Desolation Sound. Patterson, who allowed a reporter to sail along with him for a day, lives on Salt Spring and works at the hospital in Nanaimo. He is a well-known author who has written a memoir of sailing from Vancouver Island to Tahiti. He also has written a novel, Consumption, about how life in northern Canada changed drastically in the latter half of the 20th century and the role played by tuberculosis, formerly called consumption, in advancing these changes.
If Patterson seems consumed with the persistent toll taken by TB, he explains why as his boat slowly makes headway. "It's a manifestation of poverty and crowding." Housing in many indigenous communities is "desperate," he says. "The fact of endemic tuberculosis really reflects that."
A new strategy
Many working in TB prevention and control are hopeful a favourable shift in the wind is about to occur.
The First Nations and Inuit Health Branch of Health Canada is releasing an updated version of its 1992 TB Elimination Strategy later this year. The new strategy, called the First Nations and Inuit Health Branch National Strategy Against TB, 2011 will "reflect current knowledge, best practices and lessons learned since the 1992 release," according to an email from a Health Canada spokesperson.
The strategy is meant to include national targets that will assist in evaluating TB programs. It is unclear whether the new strategy will also adequately address the social conditions that allow TB to run rampant in Aboriginal communities, an aspect that Patterson and others say is key to effective prevention and control.
In response to questions regarding the inclusion of social targets in the new strategy a Health Canada spokesperson replied, by email, that the strategy "encourages collaboration within Health Canada and among key partners" to address the poor social conditions. Key partners mentioned specifically included: the Assembly of First Nations, Inuit Tapiriit Kanatami, First Nation and Inuit communities, provincial governments and health authorities, Aboriginal Affairs and Northern Development Canada and the Public Health Agency of Canada."
The response also says that the government has made significant investments to address these social conditions but that "improved collaboration among partners is essential to further reducing the incidence and burden of diseases."
"TB is a medical diagnosis, but it's a social disease," says Gail Turner, chair of the Committee on Health for Inuit Tapariit Kanatami, a national Inuit advocacy organization. TB rates have increased among the Inuit over the past 10 years and her organization is creating its own TB strategy designed specifically for Inuit communities.
TB is caused by Mycobacterium tuberculosis, bacteria that usually affect the lungs. It is spread when someone with active TB coughs or sneezes, releasing the bacteria into the air. If a healthy person is exposed to active TB, the infection could remain latent, reactivating at a later time if that person's immune system is weakened.
Crowded housing has long been considered a key risk factor for the spread of TB and just like the disease itself, northern Canada suffers a disproportionate percentage of housing needs in Canada.
The Conference Board of Canada's Centre for the North reported last year that up to 25 per cent of homes in northern Canada are crowded, compared with up to nine per cent of homes in southern Canada.
According to Health Canada, "First Nations communities with higher average housing densities have higher TB rates."
Patterson prescribes more and better housing.
"I think you prepare a grid of the First Nations communities with the highest TB prevalence and incidence rates and you just go in and the first step of the response is medical, screening and contacts the next step is that summer you build 50 houses and keep doing it until the TB rate goes down. And it will. Every time there's a TB outbreak, that's just an argument for building 100 houses," he says.Turner cites another key factor in the fight to reduce TB: ready access to healthy food. Patterson agrees, based on what he's observed first hand.
"It's often people who are vulnerable for other medical reasons who develop tuberculosis which makes it doubly dangerous," he says. Consider, he says, the nutrition-sensitive illness of diabetes.
"Diabetes can be thought of as being to the indigenous people of North America what HIV is to Africa," he says. It "causes impaired immune function in anyone that has it, especially if blood sugars are poorly controlled."
According to Health Canada, "before, older people used to get diabetes, but now, Aboriginal people are getting it a lot younger because their traditional lifestyle has changed so fast." Eating healthy foods is the government's number one suggestion for avoiding diabetes, something that might be difficult for a community suffering from widespread food insecurity to do.
The exact interplay of TB and diabetes isn't clear yet, but Patterson says "anything that makes you sicker... increases your risk of TB."
Very clear is the link between TB and HIV.
According to the WHO, "the risk of developing tuberculosis (TB) is estimated to be between 20-37 times greater in people living with HIV than among those without HIV infection."
Patterson says HIV has not "gotten loose" among Aboriginal people in northern Canada to the same extent as on the West Coast, "but if that ever happens, TB will become a much more serious problem."
That much more serious problem may not be too far away.
"It appears that HIV rates have been steadily increasing in First Nations and Inuit populations. They are at increased risk for HIV infections for several reasons. Social, economic, and behavioural factors such as poverty, substance use, including injection drug use, sexually transmitted diseases, and limited access to health services, have increased their vulnerability," according to Health Canada.
The medical response
When tuberculosis takes hold in a place, says Dr. Pamela Orr, a professor of medicine at the University of Manitoba, the burden increases sharply on local health workers who already may be struggling with few resources in remote places.
Where "there's a very high rate of TB, they need a lot of local workers to deliver care and provide education to the community," says Orr. "They need more nurses."
Even a single TB diagnoses in a community can mean a lot of extra work for a community health nurse or worker, says Dr. Victoria Cook, the director of Tuberculosis Services for Aboriginal Communities, a department of the B.C. Centre for Disease Control.
Diagnosing someone with TB means starting him on treatment and making sure the treatment is going smoothly, says Cook, but "there's also the follow-up."
"TB is spread through the airborne route so it's something that can be spread from person to person," she says, and "there's a lot that goes into what we call contact tracing."
Contact tracing involves identifying people that may have been exposed to TB through contact with a patient, testing those contacts for TB and starting them on treatment if necessary. Potential contacts include family members, friends and health care workers. Effective contact tracing takes a lot of time says Cook. "It can be quite onerous."
According to Orr, technological resources are also in short supply in some areas.
For instance, "on the Labrador coast many of the communities don't have x-ray machines, so people have to be flown out if they have a cough," she says, "and their system of trying to get a sputum [sample] from a patient to a lab is difficult." Sputum is mucus that is coughed up from the lungs and is used to test for TB.
A spokesperson from Health Canada said in an email to The Tyee that "in 2011-2012, Health Canada is investing more than $9 million to support TB prevention, treatment and outbreak control for First Nations on-reserve across Canada and Inuit in Nunatsiavut."
Health Canada had not responded to a follow-up question asking how the $9 million would be allocated by posting time.
Targets and accountability
When the new First Nations and Inuit Health Branch National Strategy Against TB is released in the coming weeks, many on the front lines will be looking for benchmarks that can be used to hold authorities accountable for achieving progress.
Targets are crucial, says Orr, for understanding what's working and what's not in terms of TB programming. Right now, she says "there are no national performance targets that apply across the country for the general population or for sub-groups like the Aboriginals."
Cook, from the BC Center of Disease Control, says the new strategy should have ways of tracking how quickly and thoroughly First Nations are treated for TB. The plan could look at "what percentage of active cases of tuberculosis get started on treatment within the first 24 hours, what percentage of active cases of TB are treated with Directly Observed Therapy, what percentage of active cases of TB complete their treatment... how many people screened for tuberculosis actually get put on treatment for latent infection" and "looking at how many contacts are screened."
These "are absolutely reasonable targets to look at," Cook says "and are things that are useful to compare, not only internationally but actually from province to province."
"Part of the challenge has been... looking at accountability and outcome measurement," says Turner, of the Inuit Tapariit Kanatami's Inuit Committee on Health.
Turner says the best chance to eliminate TB in Inuit communities is with "an Inuit specific" strategy that is "designed by Inuit, delivered by Inuit." The ITK TB strategy is going through approval stages within ITK now.
In the meantime, those on the front lines against TB wait to find out how ambitious will be the new national strategy. Given that rates are highest among Aboriginals, The Tyee asked both the Public Health Agency of Canada and Health Canada to provide what, if any, specific targets related to Aboriginal communities will be included in the new strategy. PHAC's spokesperson sent an email with a target number for the general population instead, saying, "the strategy outlines a course of action to help reach the TB target incidence rate of 3.6 cases per 100,000 people by 2015 in Canada, in the spirit of the Global Plan to Stop TB." The Global Plan to Stop TB is a comprehensive plan for eliminating TB as a global public health issue.
Kevin Patterson is eager to see what new map the government is preparing to deal seriously with tuberculosis among the Aboriginal people he's come to know over the 16 years he has visited their communities and tended their sick.
"You can't have 15 people in a three bedroom house for about 100 different reasons, one of which is TB," he says. "And if the other 99 aren't good enough reasons, then we can use TB as a reason to improve the housing issues on reservations."
Patterson's boat chops through the waves as he considers Canada's response so far to TB and its social causes. He scans the horizon, and finds a word. "Shameful."
© 2008 www.action.org