InterPress News Service (IPS); Thursday, 10 April 1997.
Johanna Son

AIDS is still incurable, but is preventible. Tuberculosis, on the other hand can be cured by antibiotics. Or, so doctors thought until virulent strains immune to drugs began showing up all over the world in the 1990s.

TB now claims 2-3 million deaths a year. From the mid-eighties to the mid-nineties, reported TB cases across in Asia per 100,000 have risen by some 18 percent even as the illness waned in other parts of the world.

Transmitted by airborne bacteria from an infected person, TB also spreads more easily than the HIV virus which causes AIDS. WHO says nearly six million people have died of AIDS since the start of the epidemic.

But the fight against TB may well be hobbled by the attention more popularly given to AIDS.

"TB and malaria for that matter kill more people than AIDS, but you see, TB has a cure," said Dr S T Han, director of the World Health Organisation's (WHO) Western Pacific office based in Manila. "That's the difference: AIDS has no cure, so that's the dividing line with which many people sympathise."

"That is why AIDS gets more prominent coverage by media and among politicians," Han added. Health experts agree, they say there is an urgent need to 'sell' more aggressive anti-TB campaigns to governments in the region.

A leading infectious killer of adults, TB is projected to kill 30 million people over the next decade if trends continue. One- third, or nearly two billion people all over the world are infected with the TB bacilli.

Reported cases in the Asia-Pacific from 1990 to 1994 account for more than 2 million of the total TB cases of 3.35 million during that time, or some 60 percent of the total.

China, India, the Philippines, Indonesia, Bangladesh account for the bulk of TB cases reported in recent years. It is also in these places where careless or intermittent treatment of TB has allowed the disease to thrive and spread, or give rise to bacilli resistant to once-potent drugs.

Unsanitary conditions, infrastructure that has not kept up with urbanisation, global travel and migration are factors that have encouraged the reemergence and spread of communicable diseases like TB, cholera, diptheria. Complacency about TB has also led to years of neglect in many countries.

TB is also increasingly the cause of death among HIV-positive people, especially in parts of Asia with more serious AIDS epidemics such as India and Thailand.

Up to two million TB cases occur in India each year and 10 percent of patients with TB in Mumbai are HIV-positive, says a paper by the Joint United Nations Programme for HIV/AIDS. TB is also the "presenting symptom" of AIDS in more than 60 percent of AIDS cases, it added.

More than a century after Germany's Robert Koch discovered the bacilli that causes it, WHO last month launched a global programme for better treatment of the disease.

It announced that a relatively simple process--called Directly Observed Treatment Short-course or DOTS--if carefully carried out can save 10 million lives in the next decade.

DOTS includes the use of four powerful, low-cost TB drugs taken in conjunction for six months. The drugs are not new, but WHO says having health workers ensure that patients take the required daily doses throughout the six months can spell success or failure.

Too many patients stop taking medication after a few weeks, since they feel a lot better. Indeed, Han said: "DOTS is not a new regimen, but it is a new ways of managing the disease so patients can be rendered non-infective."

So far, WHO says DOTS has worked wonders in places like China, where its use in a project a few years ago cured 95 percent of 114,000 people with TB. The cure rate for TB, with DOTS, is about 90 percent, compared to 60 percent in countries that do not use it.

DOTS coverage has risen sharply in China, Camvodia and Vietnam in the last three years, but remains low in places like the Philippines and Papua New Guinea.

WHO calls DOTS "the biggest health breakthrough of this decade", and hopes it will jumpstart flagging anti-TB efforts in the region.

"There is a need for a success story so we can sell this to the politicians," Dr Dongil Ahn, medical officer for WHO's TB program in the region, told IPS.

In the past, anti-TB programmes faltered in many countries because they focused on the wrong aspects of disease management and thus did little to push health workers to do more to bring it under control.

The Philippines, which has more than 180,000 TB cases or one- fourth of cases in WHO's Western Pacific region, only launched an aggressive anti-TB drive two years ago. Ahn said TB had been at high levels for two decades, and without a good programme "there was less motivation" to fight it frontally.

Last year, the Philippines began focusing on TB case management, setting targets for percentages of the population to be reached in coming years. For the region, WHO seeks to increase DOTS coverage to 80 percent by the end of 2000.

Gradually rising rates of cured cases should be proof that an anti-TB campaign works--and get the anti-TB battle the political support it badly needs. (END/IPS/AP-HE/JS/KD/97)

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