WHO/CDS/STB/2001.13 Distribution: General Original: English STOP TB PARTNERS’ FORUM:STOP TB PARTNERS’ A TB-FREE FUTURE TOWARDS The Stop TB Partnership Secretariat is hosted by the World Health Organization 20, avenue Appia – CH-1211 Geneva 27 www.stoptb.org – [email protected] Fax (41) 22 791 4886 World Health Stop TB Organization Partnership WHO/CDS/STB/2001.13 Distribution: General Original: English 50 YEARS: HISTORICAL50 REVIEW 50 MONTHS:50 COUNTDOWN TO A TB-FREE FUTURE World Health Stop TB Organization Partnership “Our vision is one of a TB-free world: The first children born this millennium 50 YEARS: HISTORICAL50 REVIEW 50 MONTHS:50 COUNTDOWN TO A TB-FREE FUTURE will see TB eliminated in their lifetime.” iv TOWARDS A TB-FREE FUTURE © World Health Organization, 2001 This document is not a formal publication of the World Health Organization (WHO), and all rights are reserved by the Organization. The document may, however, be freely reviewed, abstracted, reproduced or translated, in part or in whole, but not for sale or for use with commercial purposes. The views expressed by named authors are solely the responsibility of those authors. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by WHO in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. Writing: Adrea Mach Design: Gilles Lasseigne Layout: Bruno Duret Photos: WHO & PNT Romania/Zellweger Stop TB Partnership Secretariat World Health Organization 20, avenue Appia CH-1211 Geneva 27 Switzerland Fax: (41) 22 791 4886 E-mail: [email protected] www.stoptb.org he Stop TB Partnership Secretariat wishes to acknowledge all those who Thave contributed to the preparation of this report: Jaap Broekmans, Ken Castro, Mario Raviglione, Joelle Tanguy (editorial review committee) and also: Francis Adatu, Dongil Ahn, Sandy Althomsons, Patrick Bertrand, Leopold Blanc, Dan Bleed, Daniel Chin, Pierpaolo de Colombani, Etienne Declercq, Chris Dye, Gijs Elzinga, Sarah England, Marcos Espinal, Katherine Floyd, Tom Frieden, Ulli Fruth, Ann Ginsberg, Raj Gupta, Daniel Kibuga, Jim Yong Kim, Juergen Koenig, Jacob Kumaresan, Jon Liden, Dermot Maher, Mariquita Mantala, Jai Narain, Ikushi Onozaki, Philip Onyebujoh, Rigo Peeters, Mark Perkins, Elil Renganathan, Karen Reynolds, Giorgio Roscigno, Akihiro Seita, Pedro Suarez, Axel Wiegandt and Diana Weil. ACKNOWLEDGEMENTS COUNTDOWN TO A TB-FREE FUTURE vii iv TOWARDS A TB-FREE FUTURE Acronyms ................................................................................................................................................................................viii Preface...........................................................................................................................................................................................1 Executive summary ...........................................................................................................................................................3 Facts & Figures: TB or no TB ..................................................................................................................................6 1. 50 YEARS: HISTORICAL REVIEW OF TB CONTROL 1.1 Assessing the problem: the big picture ................................................................................................9 1.2 Discovering the tools ..........................................................................................................................................10 1.3 Developing the TB control strategy ......................................................................................................12 1.3.1 India research: setting the stage ................................................................................................................12 1.3.2 Five TB pioneers .......................................................................................................................................................13 1.4 Overcoming complacency .............................................................................................................................14 1.5 Building momentum .............................................................................................................................................16 2. GLOBAL PROGRESS SINCE AMSTERDAM 2.1 Promises to keep .....................................................................................................................................................19 2.2 Global partnerships and plans ....................................................................................................................20 2.2.1 Stop TB Initiative ......................................................................................................................................................20 TABLE OF CONTENTS TABLE 2.2.2 Global Plan to Stop TB .......................................................................................................................................22 2.2.3 Global DOTS Expansion Plan ......................................................................................................................23 2.2.4 Global Drug Facility (TB) ....................................................................................................................................24 2.2.5 Tackling TB and HIV/AIDS in tandem ...................................................................................................25 2.2.6 DOTS-Plus against MDR-TB .........................................................................................................................26 2.3 Global Initiatives ......................................................................................................................................................28 2.3.1 Global Alliance for TB Drug Development .......................................................................................28 2.3.2 TB Diagnostics Initiative.....................................................................................................................................29 2.3.3 TB Vaccine Initiative...............................................................................................................................................30 2.4 TB and global funding .........................................................................................................................................31 2.4.1 Scaling up the financial response to diseases of poverty ..................................................31 2.4.2 Summary of global external TB funding 1990–2000................................................................32 8 3. NATIONAL PROGRESS SINCE AMSTERDAM 3.1 Success stories .........................................................................................................................................................35 3.2 Progress towards targets ...............................................................................................................................36 3.2.1 TB’s 22 high-burden countries at the turn of the millennium ...........................................36 3.2.2 DOTS Expansion in action (India and Viet Nam)..........................................................................38 3.2.3 GDEP in action (China)........................................................................................................................................41 3.3 Progress in implementing the Amsterdam Declaration .....................................................43 3.3.1 Pakistan: developing national partnerships .....................................................................................43 3.3.2 The Philippines: augmenting national resources .........................................................................43 3.3.3 Cambodia: mobilizing international resources...............................................................................44 8 4. 50 MONTHS: COUNTDOWN AND CALL TO ACTION 4.1 TB in the year 2000 ...............................................................................................................................................47 4.2 DOTS Expansion is too slow .......................................................................................................................48 4.3 Expanding DOTS coverage is not enough ......................................................................................50 4.3.1 Coverage does not equal use .....................................................................................................................50 4.3.2 Increasing the impact of DOTS ..................................................................................................................50 4.3.3 Bangladesh: high coverage, low detection.......................................................................................51 4.4 Increasing case detection and cure .....................................................................................................52 4.4.1 Peru’s success story: patient support, incentives, education ........................................52 4.4.2 Uganda: community-based care................................................................................................................53 4.4.3 Kenya: involving the private sector ..........................................................................................................54