Memorandum by Target Tuberculosis
INTRODUCTION
Target TB is a specialist agency which targets
the causes and effects of TB. It was set up in 2003 in response
to the growing crisis posed by TB but grew out of an older organisation,
the Ryder-Cheshire Foundation, which had been running or supporting
TB projects since 1966. At present the organisation works with
11 partner organisations spread across India, Pakistan, Bangladesh,
Zambia, Malawi and East Timor. These are all countries with a
high burden of TB. Our partners are all working within the National
Tuberculosis Control Programmes of their countries. We provide
partners with access to financial support and also help them to
build their capacity to operate effectively. Through our partner
network we aim to build up a stock of knowledge which can be used
as examples of best practice in the planning and implementation
of other TB control programmes. The principles which we share
with our partners are that we are working to raise awareness of
TB, helping people to find a diagnosis, supporting them through
treatment and trying to break down the stigma associated with
the disease. We recognize the close relationship between TB and
HIV and encourage our partners to integrate services to address
the impact of these dual epidemics. We are also working to address
the poverty so closely associated with TB, for example by helping
to train affected people in income-generating activities to improve
their overall welfare.
THE ISSUES
The questions which the AHCIO has posed will
be answered from the perspective of Target TB, and referring only
to Tuberculosis, in the order in which they appear and with the
same numbering:
1. It is certainly true that the earlier
optimism that communicable diseases would be eradicated has been
unfounded as we see more TB cases globally now than at any other
time and, in some areas of the world, the rates of TB infection
are increasing. It is true to say that the global situation is
deteriorating and certainly not an exaggeration to say that there
is a crisis. The crisis is exacerbated by the increasing incidence
of drug resistance in TB which is reflective of poorly managed
TB control programmes.
2. Data on TB infection are based on projections
and estimates as it is the general belief of most people involved
in TB control that we are not reaching many patients, hence there
are no accurate figures for the extent of infection. As TB particularly
affects countries with poorly developed, or declining, public
health services the quality of data gathered is poor.
Numbers infected with TB are thought to be increasing
and while the WHO believes that rates of infection have stabilized
in most parts of the world the trend in sub-Saharan Africa is
of rising rates. There is a particularly close association of
TB with HIV so increasing rates of the latter directly affect
the incidence of the former. This is compounded by reporting issues
around dual diagnosis where reported AIDS deaths may also be reported
as TB deaths. TB is also closely associated with poverty and it
has been suggested that the most effective method of controlling
TB would be to eradicate poverty. Even in countries with high
rates of TB it is the poor who tend to become infected rather
than the rich. Poor people are much more likely to be malnourished,
living in crowded conditions and under stress caused by merely
trying to survive all of which are likely to compromise immunity.
3. I can't comment on this in any detail
4. TB has confounded expectations and while
there has been an expectation since the mid-20th Century that
TB would be eradicated it has continued to grow in extent. Future
spread of the disease is likely to be affected by the growing
problem of drug resistance and the success or otherwise of public
health developments throughout the world. Until TB is conquered
wherever it is found it will remain a threat to all—see
the theme for World TB Day 2007 "TB Anywhere is TB Everywhere".
The close association of TB and HIV has already been mentioned.
We believe that while rates of HIV infection continue to rise,
so will cases of TB related to HIV.
5. Poverty and the parlous state of the
health services in many countries are major blockages. With greater
prosperity we might see the development of more effective health
services. I do not feel that health developments should be seen
in isolation but need to be integrated into more general development
programmes aiming at increasing prosperity throughout the world.
6. Target TB works, of course, to combat
Tuberculosis but because of its close association with HIV and
poverty it also work to address these associated issues. The principal
work of the organisation is to educate people about TB, to encourage
people to recognize TB symptoms, to help people obtain a proper
diagnosis through recognized government health services and to
support them through the long period of anti-biotic treatment.
Target TB currently supports 11 projects in India, Bangladesh,
Pakistan, East Timor, Zambia and Malawi and all are implemented
through local partner organisations. An underlying principle of
our work is that it should be integrated into and be complementary
to the national TB control programmes of these countries.
We believe a holistic approach to combating
TB is the correct approach. A medical approach to TB eradication
is not enough, factors such as poverty which make people vulnerable
to infection must also be considered. Social issues such as stigma
and discrimination must also be tackled.
Target TB is a growing charity which relies
on fundraised income. We have found that TB is a forgotten disease
and many donors, including the general public, are unaware of
the severity of the worldwide TB epidemic. This can make fundraising
difficult, and core costs to support the organisation are always
challenging. Nevertheless Target TB is very fortunate to have
recently received significant grants from Big Lottery Fund, Comic
Relief, and the states of Jersey, Guernsey and the Isle of Man
which support our work.
Target TB collaborates closely with other organisations,
this includes other UK and International NGOs, academic institutions,
and governments in the countries in which we work. We encourage
our partners to take the same approach within the TB control projects
we support in order to avoid duplication of effort.
7. I have already mentioned the close association
of poverty and TB. While the world's population continues to grow
there will be a growth in the actual numbers of TB cases unless
rates of TB can be reduced. As global warming seems destined to
exacerbate poverty then I see it as a potential contributory factor
to high levels of TB in future. Where global warming, for example
in Bangladesh, appears to be contributing to flooding and the
displacement of people who will be crowded together then I see
that this will encourage the spread of TB. The displacement of
people by natural or man-made disasters often precipitates outbreaks
of TB, as we have found from work in a post-conflict environment
in East Timor which has extremely high TB incidence rates.
Increasing international travel provides a means
of spreading TB. In recent months, for example, there has been
a high profile case in the United States of an individual with
Extensively Drug Resistant (XDR) TB travelling on a number of
international flights against the advice of his doctors. A case
such as this does help to raise the profile of TB but can have
negative effects such as causing panic amongst air passengers
and demonisation of the patient. Relatively cheap international
travel also allows immigrants in the UK to maintain close links
with their countries of origin, where TB may be endemic, and this
may account for relatively high levels of TB amongst certain groups.
This is, again, a very sensitive issue and, in the wrong hands,
an association between TB and immigration is unhelpful and possibly
harmful to TB control efforts.
Intergovernmental action to address poverty
should be undertaken as a priority. It is in TB, perhaps more
than with any other disease, that improvements in the socio-economic
conditions affecting people will have a greater impact than any
other factor. This has already been proven when you looking at
the decline in TB in the UK—the disease was already in decline
due to improved socio-economic conditions, prior to the development
of antibiotics to treat it.
8. Greater international travel may be a
contributory factor in that people travel more than ever to areas
of the world where TB is endemic. Immigration of people from high
TB burden countries also raises issues around the increasing TB
rates in the UK. TB in the UK is not an area in which Target TB
has detailed knowledge and responses from organisations working
in the UK such as TB Alert are able to address this issue more
comprehensively.
9. Much of the work of Target TB is in ensuring
the TB patients receive the medicines that they need and that
they complete the full course of antibiotic therapy, through recognized
health services. There are problems in some countries with intermittent
supplies of drugs however these have largely been removed due
to the Global Drug Facility.
The greatest problem with the current TB treatment
is that it requires a combination of up to 5 drugs taken over
a period of between 6 and 8 months. For some people the drugs
cause major side-effects such as nausea and some patients are
so weak that getting to clinics to collect their medicine is very
difficult. Ensuring that people complete the full course is one
of Target TB's main aims and much of our work focuses on training
community volunteers who can support patients during this time.
The situation would certainly be improved by the development of
new drugs which can cure TB over a much quicker time.
Access to health services is also a major issue.
Whilst some countries have excellent TB services, the ability
of people to access these is often limited due to a large number
of factors including geographic isolation, economic isolation
and socio-cultural barriers.
The health services of many of the countries
in which we work operate at minimal capacity, with staff and equipment
shortages being major problems. Without trained medical staff
with the necessary equipment to diagnose TB, access to the anti-TB
treatment is again limited.
Again this suggests that a more holistic approach
to tackling TB is needed, and any interventions to improve TB
treatment must be coupled with efforts to reduce the barriers
to accessing health services which can be very complex.
10. N/A
11. N/A
12. Increased drug resistance is a major
problem. We believe this issue is also under-reported due to insufficient
resources, such as testing equipment and trained personnel, to
accurately assess levels. Resources to address drug resistant
TB are even more limited than those for non-resistant TB, making
any efforts to address this issue extremely difficult. Some intergovernmental
action is being undertaken namely the funding of the Global Alliance
for TB Drug Development. It is notable that pharmaceutical companies
are having to be paid to undertake research into TB drugs rather
than investing in this to any great degree with their own funds.
13. N/A
14. I believe that all TB treatments are
now so old that they are not covered by patents.
15. Intergovernmental action which leads
to a co-ordinated approach to all aspects of TB control would
we welcomed.
16. I cannot comment in any detail.
17. I cannot comment in any detail.
18. I cannot comment in any detail.
19. I cannot comment in any detail.
20. No thank you
February 2008
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