Washington File - March 23, 2000

A World Bank press release said the recommendation was made to delegates at an international meeting on tuberculosis control being held in Amsterdam, the Netherlands, March 22-24.

Tuberculosis (TB) is killing almost two million people a year, the release says, and about 95 percent of the 20 million people ill with the disease are in the developing world.

"A world free of poverty will remain a mere dream, unless we join hands to overcome major global threats to the poor and marginalized people around the world," said World Bank Vice-President for South Asia Meiko Nishimizu.

"Without question, tuberculosis is one such threat, and its control must be on the global development agenda."

Nishimizu is advising delegates from TB-affected nations that they must work together to prevent further development of drug resistance. She also recommends greater efficiency in health systems, and public health investments that will reach those facing the most serious TB risk.

With a $350-million commitment to TB control, the press release says the World Bank is the largest single source of financing for control of the disease. The bank's funding commitment to TB is expected to rise further, to more than $450 million within a year.

Following is a text of the World Bank press release: (begin text)

The World Bank Group March 22, 2000 Tuberculosis Poses Serious Threat To Development

The World Bank tomorrow will urge its national and international partners to emphasize TB control in their poverty reduction and development agendas. Given the spread of drug-resistant disease and TB's resurgence in many parts of the world, the World Bank warned that traditional coping strategies are no longer enough to compensate for the blow to economies and social structures that this killer of nearly 2 million people a year causes.

With about 95 percent of the 20 million people ill with TB today living in the developing world, and effective tools available to combat the worsening epidemic, investing in TB control programs makes economic and development sense, World Bank Vice President for the South Asia region, Mieko Nishimizu, will say in remarks prepared for delivery.

"A world free of poverty will remain a mere dream, unless we join hands to overcome major global threats to the poor and marginalized people around the world. Without question, tuberculosis is one such threat, and its control must be on the global development agenda. TB and poverty are closely linked. Poor living and working conditions stimulate transmission and disease, and disease exacerbates economic and social distress," Nishimizu says in her remarks at the conference entitled, "Tuberculosis and Sustainable Development."

"Worse yet, the lethal combination of TB and HIV/AIDS compounds this cycle, increasing the burden on health finance and, in turn, placing the entire public finance under enormous pressure. In India, for example, the average treatment expenditure per year on one HIV/TB case costs more than educating 10 primary school students. Health expenditure to fight such epidemics will force very hard trade-offs in public finance, if we do not act now."

From March 22-24, senior health, finance and planning representatives of governments from 20 countries that shoulder the burden of nearly 80 percent of the world's tuberculosis incidence have gathered in Amsterdam to participate in the Ministerial Conference, convened by the World Health Organization (WHO) and the World Bank, and hosted by the government of the Netherlands.

"The unity of purpose among the nations and agencies at this conference is pathbreaking," said World Bank President James D. Wolfensohn. "We know that only through partnerships can countries effectively respond to tuberculosis and other top communicable disease threats. None of us can have the impact alone that we do together."

In her address at the conference, Nishimizu will add that "The public health strategy known as DOTS (Directly-observed Treatment, Short course) provides the cornerstone for action in fighting TB. But for such a strategy to stop TB, it must be an integral part of poverty reduction strategies of developing countries strategies that are of these nations' own conviction and political will, and strategies that are owned by these countries and supported by the international community."

She further noted that in responding to the TB epidemic, governments, and those that assist them, will need to recognize that drug resistance and other threats will increase unless they work in concert; they will need to eliminate gross inefficiencies in health systems and invest in the most effective strategies that reach those most at risk; they will need to build public-private partnerships; and they will need to subscribe to "the national discipline of prudent fiscal policy and high-quality public expenditure."

The World Bank is the largest single source of financing for TB control in developing countries. The Bank has committed more than $350 million in TB control through a variety of disease control and health sector development projects over the last decade. With new projects in the pipeline, the commitments will likely rise to over $450 million within a year. A majority of these commitments has been made with top high-burden countries, including India and China that are home to over one third of the estimated TB sufferers worldwide.

The goal of the conference, "Tuberculosis and Sustainable Development," is for participants to seek to better understand the social and economic impacts of TB; assess how effective TB programs can contain the epidemic and contribute to overall development, and identify specific priority actions for the new millennium. The participating countries are: Bangladesh, Brazil, Cambodia, China, Democratic Rep. of Congo, Ethiopia, India, Indonesia, Kenya, Nigeria, Pakistan, Peru, Philippines, Russian Federation, South Africa, U. Rep. of Tanzania, Thailand, Uganda, Viet Nam, and Zimbabwe. They are accompanied by international, bilateral, and non-governmental institutions that are partners in the Stop Tuberculosis Initiative. The Initiative aims to provide the foundation for sustained partnerships to control tuberculosis, to reduce the human, economic, and social toll of the disease, and to find effective solutions to the new threats of drug-resistant TB and HIV-associated disease and new tools to speed up control efforts.

For more information about the conference and about tuberculosis, go to: www.stoptb.org/conference/index.html .

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