Memorandum by TB Alert
QUESTION 1:
HIV, Tuberculosis and Malaria have been given
high prominence within the context of the Millennium Development
Goals (MDGs). Of the 8 goals, set by the UN General Assembly in
2000, 3 relate specifically to health; known as the health MDGs.
There is wide-spread recognition, even from Margaret Chan herself
(WHO Director General), that the goals least likely to be achieved
are the health MDGs. The health goals are severely off track,
particularly in sub-Saharan Africa where some indicators are now
behind 1990 base-levels.
If the MDGs are to be achieved, considerable
additional financing must be found and deployed immediately. The
Commission on Health and Macroeconomics estimated that in order
to achieve the health MDGs an additional $27 bn would have to
be made available by 2007—this target was not achieved.
The Commission also stated that adequate investments in global
health would equate to governments providing 0.1% of GNI as Official
development Assistance (ODA) for health. The UK government currently
provide 0.04% of GNI as ODA for health. Hence, within the UK context
we would require an immediate doubling of ODA for health to meet
the global financing target.
QUESTION 2:
The World Health Organisation produces a yearly
Global Tuberculosis Control report which represents the best and
most reliable source of epidemiological data on the TB pandemic.
QUESTION 3:
Tuberculosis is a notifiable diseases and the
Health Protection Agency (HPA) is responsible for the surveillance
of Tuberculosis in England and Wales. At local level, Consultants
in Communicable Disease control (CCDCs), usually attached to Health
Protection Units, are responsible for the management of TB cases
in the public health context. Statutory notifications are sent
to CCDCs, making them aware at early stage of emerging patterns
of disease in their area. The system is however, entirely reliant
on the diagnosing clinician completing the notification and on
its website, the HPA acknowledges that ".. since 2001 there
has been a decline in notifications and in 2002 cases reported
through Enhanced Tuberculosis Surveillance exceeded NOIDs notifications
for the first time. Recent trends in tuberculosis notifications
should be interpreted with caution since the decline in notifications
is not uniform across the country and is most likely attributable
to changes in surveillance practice at local level". It is
also important to note that a notification only requires clinical
suspicion of TB, rather than confirmed diagnosis. Confirmed culture
diagnosis of TB can take up to six weeks, although liquid culture
results can be returned in ten days. Were liquid culture standard
in laboratories, improvements in accurately predicting outbreaks
could be achieved.
QUESTION 5:
Since new reports by the United Nations and
Action for Global Health highlight that European governments are
failing to fulfill their commitments on improving health in developing
countries, Gordon Brown's government can act now and show leadership
within Europe by ensuring that at least 15% of all aid to developing
countries is allocated to providing better health care for all.
Present global health inequalities mean that
28 times more children die before their fifth birthday in sub-Saharan
Africa than in Britain. The Millennium Development Goals (MDGs),
to be reached by 2015, are a one-off opportunity to change this
and build the health systems of developing countries. Europe cannot
stand by and let them fail.
The new report from Action for Global Health
highlights that Official Development Assistance (ODA) to health
from European governments is far below what is needed to achieve
the health MDGs. Gordon Brown can show leadership by committing
more money to ODA to close the gap, and by committing to allocate
0.1% of Gross National Income for global health by 2013.
QUESTION 6:
TB Alert works to increase access to good Tuberculosis
treatment since, around the world, too many people die from lack
of access to care. Too many people get inadequate treatment, raising
the danger of multi-drug resistance.
TB Alert always looks to work through local
partner organisations which themselves operate in close collaboration
with the TB programme of the government health services. This
is extremely important with an infectious disease like TB to ensure
that our effort is a part of achieving good treatment for a whole
country. To help ensure our relatively small funds have real impact
we tend to concentrate on projects which support the community,
nursing and paramedical aspect of TB programmes—adding a
human and social dimension to good tuberculosis care.
In the UK our activities concentrate on raising
awareness of TB to ensure that patients are diagnosed quickly,
as well as helping patients to complete the minimum of six months-long
treatment (non-completion can result in drug resistance). We work
closely with the Department of Health, Health Protection Agency
and NHS teams to try and ensure that materials and messages on
the disease are consistent and feel that the work we share with
these agencies has a very good degree of synergy.
QUESTION 7:
There are many factors involved in the global
resurgence of Tuberculosis; in developing countries with high-TB
incidence we often see a combination of mass urbanisation with
sub-standard housing, overcrowding and poverty, as well as disrupted,
under-resourced and overworked health systems. In the former Soviet
countries a particular issue leading to a major increase in drug-
and multi-drug resistant TB was the disruption and breakdown of
the health system.
The government needs to prioritise long-term,
sustainable investment in health systems in developing countries.
It can do this by increasing the number of countries with which
it has 10-year partnership arrangements, and use this as a model
for investment by other European governments. The government should
also structure its development policies and strategy on health
around the health MDGs.
European countries contribute more than half
of total official development assistance globally, and have a
critical role to play in meeting the millennium development goals.
Yet a report by Action For Global Health, a new partnership of
15 non-governmental organisations, shows that today only four
out of 15 European countries are on track to allocate 0.7% of
gross national income to official development assistance (Sweden,
Luxembourg, Netherlands and Denmark).
European governments can still do their part
to make the millennium goals a reality, but they need to act now
by: closing the funding gap of $27bn by 2009; allocating 0.1%
of gross national income to address global health; and ensuring
that any increases in funding prioritise the strengthening of
health systems for long-term sustainability. Gordon Brown can
take the lead by ensuring that at least 15% of all aid to developing
countries is allocated to providing better healthcare for all.
QUESTION 8:
There were around 8,500 cases of TB reported
in the UK in both 2006 and 2007, rather than the 6,500 cases stated
in the question. In England and Wales alone, TB notifications
have exceeded 6,500 each year since 2000. In 2004 70% of TB cases
were diagnosed in non-UK born people. This reflects a broader
pattern but is not in itself a simple explanation for the increase
in the UK, since 77% of these cases are diagnosed more than two
years after arrival—45% more than five years after arrival.[45]
Black and Minority Ethnic communities need to be encouraged to
access health services and to seek diagnosis; too often already
heavy stigma surrounding TB within these communities is added
to by the focus on blame attribution, as well as changes to access
to the National Health Service affecting those without legal residency
status.
In October 2005 the UK commenced pre-entry TB
screening for those applying for visas in certain high-TB incidence
countries. This is a policy not evidenced by epidemiology and,
on the whole, port of or pre-entry screening is not supported
by associated professionals[46].
It may be appropriate for the government to consider instead a
policy of "enlightened self-interest" and instead focus
investment on reducing the burden of Tuberculosis in high-TB incidence
countries which have strong migration links to the UK.
Furthermore, whilst a large proportion of cases
come from the non-UK born population, it has been evidenced that
in London, where approximately 40% of cases are diagnosed, those
who pose a greater risk regarding transmission of the disease
are more likely to be from the homeless, prison or substance misuse
sectors[47].
A pilot project (Find and Treat, Department of Health) is now
underway in London which seeks to work closely with complex, hard
to treat cases and support them through their course of treatment.
February 2008
45 Migrant Health, Infectious diseases in non-UK
born populations in England, Wales and Northern Ireland. A baseline
report, Health Protection Agency 2006. Back
46
Port Health and Medical Inspection Review Report from the Project
Team, Health Protection Agency, March 2006. Back
47
Tuberculosis in London: the importance of homelessness, problem
drug use and prison, A. Story et al for the London Tuberculosis
Nurses Network, January 2007. Back
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