MARCH 6: Why does tuberculosis continue to kill millions when there is a cure for it? The World Health Organsation declared it a global emergency in 1993 but the world is nowhere near getting rid of the disease.A network of voluntary organisations, doctors and researchers devoted to TB control round the world have been looking for answers for the last four years. This year in their meeting in Kathmandu, they pored over issues like poverty and globalisation. But the conclusion most of them arrived at was that TB was there because there was lack of commitment to its removal.Delegates felt that TB and poverty formed a vicious circle. TB caused poverty and poverty led to TB as bad living conditions meant bad and less food and poor immunity, crowded habitats.Ian Smith, representing the WHO, pointed out that the medical remedy was found nearly a century ago. And for nearly a decade, the world has been following a system of ensuring that the patient took the medicine too. The strategy of Direct Observed Treatment Short Course or DOTS ensured that the patients visited the DOTS centres thrice a week and took the drugs under the observation of the health worker for the whole course of six months.But so far only 21 per cent of patients worldwide had been treated under this scheme. Only two of the high disease-burden countries, Peru and Vietnam, had met their target coverage, Smith said.Smith pointed out that the global TB expense so far has been $ 4 billion but only 4 per cent of the money went to areas which bore 60 per cent of the disease burden.The same inequity was pointed out by delegates who blamed globalisation for the continuance of TB in the world despite the enormous wealth of the nations.Dr Jim Yang Kim of the Harvard Medical School said that the fact that the wealth of the world was now concentrated in a few corporations or business houses made it worse for the world's sick and the poor. He said that the three richest executives of Microsoft earn $ 140 billion each which is more than the GNP of 43 countries having 600 million people. Similarly while global earnings have increased from $ 3 trillion to $ 30 trillion, 49 of the 100 largest economies of the world are business corporations. The governments were hostages to business houses, he said.While globalisation was blamed for the most part, the TB Net conference concluded that it was lack of commitment that was the cause for TB wherever it existed.In fact, Dr Holger Sawert, WHO officer in Thailand, said that no study has been done yet to hold poverty responsible for TB. A study completed last month in England found links between poverty and TB in European patients but found no such links between Asian patients of TB.Meanwhile, the conclusions of the three-day long deliberations are also the objectives of WHO's latest drive against TB the Stop TB Initiative.And the conclusions are, says Binod Mahanty, the spokesperson for the Initiative: Take TB from global level to the local level, find local leaders, find implementers among cured patients who are an ever expanding force and forge new partnerships with NGOs, private sector, corporate houses, local bodies, actors, celebrities.Money is not the main issue as far as TB is concerned. It is commitment. And commitment comes from those affected and from the local level. TB programmes must go down to that level, Mahanty said.Dr David Stevens, the main facilitator of the TB Net conference, also felt that lack of commitment has been the bane of the world's struggle against tuberculosis.It was low on the priority list of nations and there was no enthusiasm to monitor implementation of TB programmes either among governmental or non-governmental groups or in the media. He said that TB programmes continue to be TB control programmes rather than TB eradication programmes despite drugs to cure it.
