Inter Press Service - October 23, 2001
Emad Mekay

"The world needs to fill in a gap of 900 million dollars a year so that we can carry out our plans to end the disease," Gro Harlem Brundtland, director general of the World Health Organization (WHO) told IPS.

Brundtland said international institutions involved in the fight against the disease would have to turn to wealthy countries and private donors to meet the challenge.

"Over the past two years there has been an increasing understating and commitment to dealing with links between health and poverty. Developed countries should substantially increase their aid because this is key to the plan and private donors should help too," she said.

Brundtland was in Washington for the launch of a new action plan by the ''Stop TB Partnership'', a coalition set up in 1998 whose 120-odd members include the WHO, World Bank, and international financier George Soros's Open Society Institute. The group appealed to industrial nations to increase their aid to poor countries to help reverse the epidemic.

The total estimated price tag for fighting TB over the next five years is 9.3 billion dollars. "Right now there's a total shortage of 4.5 billion dollars," Brundtland said. "It's time we talked loudly about an increase in aid. Somebody needs to raise this important issue."

Soros agreed. "I am very critical of the U.S. for only spending 0.1 percent of its GDP (gross domestic product) and I don't think the public is aware of that," he said. "Our target is 0.7 and I think it's reasonable. It's important that all the countries should meet it."

World Bank officials said the institution was seeking to raise the aid level to 0.7 percent of GDP in industrialised nations, from a current average of about 0.22 percent.

Rich countries have attributed their reluctance to increase aid to doubts about how their money is administered in developing nations. Western governments have long complained about waste and corruption in recipient countries.

WHO and the Bank, in a joint statement, said they hoped that the gravity of the situation would alter this.

TB caused the death of two million people last year alone, the agencies said. More than 5,000 people die every day from the airborne disease of the respiratory system, despite a cure having been available for 50 years.

According to the WHO, 22 low-income countries bear nearly 80 percent of the global burden of TB cases.

These countries include Afghanistan, Ethiopia, India, Myanmar, Nigeria, Pakistan, Sudan, and Uganda. At least four have shown worsening treatment success rates. A lethal combination of HIV- AIDS and TB is leading to sharp increases, particularly in Africa.

TB afflicts the poorest in these countries in what the World Bank called "a vicious cycle of disease and impoverishment."

Brundtland, however, said international institutions should not use the situation to advocate policies that saddle poor people in impoverished nations. She told IPS that imposing user fees for health services - a central plank of the Bank's policy platform with respect to many borrowing countries - is not a good idea, although she added that governments in these countries should go ahead with economic reform programmes and levy a fee from middle-class or rich citizens to help anti-TB efforts.

"As developing countries reform their systems and get taxation systems to work continuously and once those reforms are put in place, they will have more opportunities to have some functioning health system," she said.

"In many cases, we have seen that when governments introduced health user fees for the poor, it was a setback to the public health because they (the poor) have nothing so they cannot pay. On the other hand, people who are middle-class or rich can pay either through user fees or through taxation," she said.

The WHO and World Bank highlighted Afghanistan and Pakistan as having particularly high TB prevalence rates and noted that the combined burden of political uncertainty and military action further cloud their outlook.

Hundreds of thousands of refugees live in cramped and swelling camps and informal settlements along their common border and, the agencies said, ''in these circumstances there is a real risk that even more people will fall victim to the disease."

Jozef M. Ritzen, vice president of the Bank's human development network said that aid to Afghan refugees, now nearly four million people, was at a low level of only 1.5 million dollars. He added, however, this was likely to increase dramatically in coming days.

If the new drive to raise funds for the fight against the disease proves successful, the two organisations say they hope to be able to cure 22 million people and save 16 million lives by 2005. Otherwise, these goals will not be achievable before 2013.

The latest global plan includes prevention of multi-drug-resistant TB; research and development of new TB drugs; and strategies to improve treatment for people with TB who also are HIV-positive.

The plan also aims to increase access to drugs in poor countries where non-governmental organisations (NGOs) have said expensive drugs developed in and for rich markets help spread the disease.

Oxfam and other international NGOs have said the international patenting system, while essential for maintaining innovation, was a key factor in keeping prices high. The system prevents poor countries from producing cheaper and locally affordable versions of some medicines.

Diana Weil, of the World Bank's health department, countered that this argument does not apply to TB. "Most TB drugs are off- patents," she said. "Major developing countries, like India and China, are big players in producing TB drugs."

"We, however, are not encouraging developing countries to produce TB drugs because such drugs are high-quality and their production is very complicated," she added.

The WHO and World Bank said their new initiative would ensure a "regular, uninterrupted supply of all essential anti-TB drugs."

Weil added that they launched a global drug facility to help ensure poor countries' access to existing drugs. The facility has initial financing of 10 million dollars but aims for 50 million dollars per year for the next five years.
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