United Press International - June 9, 2005
Kat Huang

United Press International interviewed Nunn during his visit. He was accompanied by Joanne Carter, legislative director of Results, an international grassroots anti-poverty citizen's lobby in Washington.

Q. It seems there has been recent media attention to TB, which until now most people regarded as a thing of the past.

Nunn. TB has been hugely under-addressed. Its death rates are very comparable to HIV death rates and are slightly above malaria's, yet it is definitely No. 3 on that list. The report from (British Prime Minister Tony) Blair's visit (to Washington earlier this week) mentioned malaria, global warming, AIDS -- not TB.

Q. Why not?

Nunn. Well, it's a totally unsexy disease, isn't it? Adults get it and they waste away and die. It is about time we did something about it, particularly since there is a cure, which is not the case with AIDS. Even in poor countries, there's a system, a structure in place to address this.

Q. How does HIV complicate TB?

Nunn. If you've got HIV and TB and you don't get treatment within a few weeks, you will die. I mean obviously if your immunity is quite good, you'll take longer to die, but if your immunity is low, as is the case with someone with HIV, you'll die pretty quickly.

What that says is you've got to deliver services quickly. You've got to have treatment available in every district throughout every country. Specifically, you need collaboration between TB programs and HIV programs. Those mechanisms need to do things like joint organization, like planning joint resource-mobilization together. If you've got somebody who is turning up with TB, they should really be tested for HIV, which is something that's not happening at the moment.

Q. (The Journal of the American Medical Association) reported that immigrants may be steadily bringing new cases of drug-resistant tuberculosis into the United States ...

Nunn. In California in particular.

Q. Is this something the WHO is concerned about -- the spread of TB through immigration?

Nunn. One of our key concerns is the issue of drug-resistant TB and, in particular, our recent concern is turning up the supply of drug-resistant TB. It's caused by bad treatment, so we're focusing very hard on the countries where it really occurs, which is in the former Soviet Union ... China, India and so on.

The key method is preventing TB in the first place. It's worth adding, the most cost-effective way of keeping TB low is investing in TB control in the countries from which immigrants come -- it is not screening at borders. A very tiny percentage actually have TB as they cross over, so you're only going to catch a tiny percentage, and obviously you want to try to catch them before they come into the country because otherwise there's the possibility of transmission.

Q. Do you think enough funding has been allocated by Congress?

Nunn. I think Congress has been quite generous, but I would just draw attention to the fact that the president's emergency plan for AIDS relief is ... $3 billion per year over five years for a total of $15 billion, whereas the allocation of the U.S. government to TB control ... is about $85 million a year, and the mortality difference is about 2.9 million deaths from AIDS per year and 2 million deaths from TB a year, so the death rate is about the same.

Q. Is TB now a worldwide threat?

Carter. If you have high rates of TB all over the world, and one in three people is carrying the infection, then ... as people come here, the U.S. epidemic will look more like the global epidemic, but the point is we need a strong public-health system here to make sure people get treatment, and we also need a bigger investment in the countries where immigrants are coming from, so that people can be cured back home.

Nunn. It's not just a question of public health here. It's also a question of being mindful of the political ramifications of poverty. Reducing TB reduces poverty, so that people can lead better lives. They're less likely to invite unsavory organizations like al-Qaida and they can become components of the global market.

Carter. TB is not just a consequence of poverty, but also it's a real cause of poverty, because tuberculosis mainly impacts ... working folk, parents 16-45 -- in other words, young adults in their most productive years. So the consequences of TB are that people can't work; they use up their assets and are pushed into poverty. There's a program in Bangladesh that makes loans to woman in businesses. They actually say they started working on tuberculosis, because it was the biggest reason they found for their borrowers not being able to pay back their loans.

Q. Do we need to make a long-term investment in the fight against tuberculosis?

Carter. In the United States there was a de-investment in TB programs in the late '70s, so you saw a resurgence of the disease in the late '80s and early '90s. When things start to look better, and they stop investing, you'll see a resurgence.

Nunn. We're not against de-investment once you get the job done. In many sort of shorter-term issues like yellow fever, we cut these programs once it's no longer a problem, but the thing about TB is it's a very long-lasting disease -- if your grandfather coughed on you and you are infected with TB, you can be infected for decades, and therefore we need to keep TB preventive measures in place for three or four generations in order to get rid of the problem.

It's not something you want to start up, and when you see a drop, take money away and put it somewhere else. We've seen that with the Soviet Union. In 1998 there was a big economic fallout in Russia and they couldn't afford to buy drugs, so they shared the drugs they had among the patients, which means that nobody was getting the right dose, and you can't think of a better way of creating drug-resistant strains.

Q. What kinds of difficulties do you encounter in trying to get funding?

Nunn. (laughs) Lack of interest, I think is the biggest one. Africa is far away and we don't have many friends or relatives there, so really what do they matter -- that kind of approach. People are unaware of the impact this problem has on populations, and they are particularly unaware of the fact that there is a solution.

Q: How do you respond to a lack of interest?

Nunn. I mean, that's a very interesting question, and there's no simple response. First of all, I think there is a general lack of awareness, and that lack of awareness is found from the highest levels down. So, in Africa, you need to get heads of state to understand the problem. (The WHO) had a coordinating meeting in Ethiopia. It was a very high-level meeting, and we had a half a day's session on the problem in Africa, and I think the coordinating board bought the answer and basically said yes, we will support and encourage others to support TB prevention. It's going to be a big subject of discussion in the WHO regional meeting.

Carter. Last year at the global AIDS conference, Nelson Mandela said something that hit the nail on the head. Do you remember the exact quote?

Nunn. "To fight AIDS, we must fight TB."

Kat Huang is an intern for UPI Science News. E-mail: sciencemail@upi.com

050609
UP050605

Always watch for outdated information. This article first appeared in 2005. This material is designed to support, not replace, the relationship that exists between you and your doctor.

AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.

Copyright ©1980, 2005. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content. .