Tag Archives: WHO

So you think TB doesn’t affect people in Europe?

Jessica Kuehne, Health Advocacy Officer at RESULTS, presents some key facts about the scale of the TB epidemic in Europe and what RESULTS and partners are doing to help get rates down.

We talk a lot about how many people think TB is a disease of the past when in fact it still kills 1.3 million people every year. Yes, more than 90 percent of all the people who get sick with TB live in developing countries. But – Europe is not immune from the one disease that has killed more people than any other in history.

Here are a  facts about TB in Europe that might surprise you. They are:

  • TB is the top infectious disease killer in Europe. Of all deaths caused by communicable diseases (diseases caused by viruses, bacteria, parasites etc.), more than 40 percent are still due to TB.
  • Europe is a hot bed for drug-resistant TB. Although the European region only accounts for 13 percent of the world’s population, it makes up nearly a quarter of all drug-resistant TB cases.
  • The European Union has some of the worst treatment outcomes for drug-resistant TB. Of all people who are diagnosed with multidrug-resistant TB worldwide, only about half are able to successfully complete their treatment. In the EU this number is even lower – only one third of patients with multidrug-resistant TB successfully complete their treatment.

So the answer is yes, TB does still matter. And with drug resistance on the rise, TB in Europe REALLY matters.

Treatment for drug-resistant TB is tough – patients have to have daily injections at the start of treatment followed by two years of swallowing fists full of pills. On top of this come the side effects – vomiting, diarrhoea, headaches, depression, suicidal thoughts and even deafness.

Credit: Tom Maguire/RESULTS UK

Credit: Tom Maguire/RESULTS UK

Want to know what it’s like to have to go through that treatment? Read Marina’s account of going through TB diagnosis and treatment in three different EU countries.

Marina said that during those two years, one of the things that kept her going was a quote by Martin Luther King who said:

“If you can’t fly then run, if you can’t run then walk, if you can’t walk then crawl, but whatever you do you have to keep moving forward.”

Marina said she tried to focus on whatever she could to take her forward.

TB is often forgotten in Europe. Even amongst the TB community, little attention is paid to a region where people think TB isn’t actually a problem or, when it comes to Eastern Europe and Central Asia, people don’t know very much about.

But it’s not all bleak news. Last week, the TB Europe Coalition brought together 24 TB advocates from 13 countries across Eastern Europe and Central Asia to build a network of individuals raising the issue of TB and to work out ways of getting Governments to allocate more funding for TB in the region. RESULTS is supporting the coalition to build stronger ties in the region and find ways advocates can support each other and work together to respond to TB in Europe.

It was also encouraging to see that Public Health England, when welcoming the World Health Organisation’s new report on antimicrobial resistance, specifically identified TB as an area of antibiotic resistance we need to be paying attention to.

TB still kills an estimated 40,000 people in the European region every year, and the rise in drug resistance is nothing to be scoffed at. This is a disease we should be responding to with a global approach. And when I say global, that includes Europe, too.

Photo story: Finding TB cases in Cambodia’s Slums

The World Health Organisation estimates that of the nearly nine million people who become ill with tuberculosis every year, nearly one third are ‘missed’ by national health systems. This means that roughly one out of every three individuals with TB is never officially diagnosed or treated and continues to spread, suffer, and die from the disease.

In Steung Meanchey, Cambodia, a new programme, supported by TB REACH, has been introduced to help find people in slums who have symptoms of TB, but have never received a formal diagnosis. TB REACH is a an initiative of the Stop TB Partnership that seeks to use innovative and forward thinking techniques for finding and diagnosing cases of TB in hard to reach populations.

Steung Meanchey is a poor community on the outskirts on Phnom Penh that sits directly above a sewage lake and has high rates of TB due to overcrowded living conditions and poor nutrition. Many families in the community do not have access to health services or are unaware that symptoms such as a cough or weight loss could actually be the early stages of TB.  To address this problem, the programme sends health workers to visit families to see if any individuals have symptoms of TB. If they have symptoms, health workers collect a sputum sample from the individual, place it in a cool box and then transport it back to the lab for testing. If the person turns out to have TB, they are provided treatment free of charge, in their home, until they recover.

While the approach of actively finding people in Cambodia who have TB may not sound ground-breaking, it is this sort of alternative approach that has helped the country make inroads against one of the world’s most deadly infectious diseases. Bringing health services to those who might otherwise have difficulty accessing them is helping to ensure people are diagnosed sooner and put on treatment faster, thus stopping the disease from being spread further in the community.

New UN mercury treaty protects access to life saving vaccine preservative

The United Nations Environment Programme has been drafting a global treaty to rid the world of the threats posed by mercury. As part of these discussions, proposals were made to restrict vaccines that contain the preservative thiomersal, a mercury-based preservative that has been used in some vaccine manufacturing since the 1930s to prevent contamination of multidose vials of vaccine. After a concerted effort by development partners, the final text, which will be ratified in October this year, now ensures that thiomersal can continue to be used in vaccines.

The World Health Organisation has said that “thiomersal-containing vaccines [are] safe, essential, and irreplaceable components of immunization programs, especially in developing countries, and…removal of these products would disproportionately jeopardize the health and lives of the most disadvantaged children worldwide.”

As Seth Berkley, CEO of the GAVI Alliance, pointed out in the New York Times last week, “the decision should in theory be a no-brainer: The scientific and medical consensus is that thiomersal poses no human health risk, and that rather than saving lives, a ban would put millions of the world’s poorest children at risk of deadly diseases by disrupting vaccination programs.” The science surrounding this issue has become unnecessarily clouded in recent decades. This is in part due to the efforts of anti-vaccination groups, as is pointed out by Dr Berkley.

Using this preservative is especially important in developing countries. Single dose vaccine vials are more expensive, and are less practical when health workers want to immunise large numbers of children. They also take up more space in refrigerators, subsequently limiting ‘cold chain’ capacity further (to read more about this issue, read our blog from July).

In 2010 alone it is estimated that more than 1.4 million child deaths were prevented through the use of thiomersal-containing vaccines. Today vaccines are saving millions of lives every year, with coverage rising steadily over recent decades. This restriction would have jeopardized much of that progress. A job well done by those who saw off this threat.

‘The end of the global AIDS epidemic is within our reach’ – MPs debate HIV in developing countries

Just before the Christmas break, Pauline Latham MP (Mid Derbyshire, Conservative) secured a Westminster Hall Debate on HIV in developing countries. During a busy and well-attended debate, Ms Latham pointed out that ‘the end of the global AIDS epidemic is within our reach’ and echoed the slogan used by the Stop AIDS Campaign for World AIDS Day: ‘why stop now?’

Why stop now indeed, especially when we have the tools, the science and the knowledge to turn the tide on this epidemic. Pamela Nash MP, Chair of the All-Party Parliamentary Group (APPG) on HIV/AIDS, reiterated this point and stated “We just need to sustain the political will”.

Undoubtedly political will is vital, but there is another important element to sustain, and dare we say scale up, in response to HIV/AIDS – Tuberculosis (TB) co-infection.

TB is the leading cause of death among people living with HIV/AIDS in developing countries, accounting for one in four deaths, with 1.1 million people acquiring TB in 2011. 79% of patients live in sub-Saharan Africa, yet TB does not get the attention or focus warranted by the suffering and death it causes. Why is this the case?

As Nick Herbert MP, the Conservative member for Arundel and the South Downs and a founding member of the APPG on Global Tuberculosis explained whilst speaking in the debate:

“It is striking that the diagnostic ability and treatment for HIV are much further ahead than they are for TB, yet TB is a more easily and cheaply treatable disease. Why is that? It is straightforwardly because HIV is a disease that affected the west, and TB was a disease that the west believed had gone. Its attention was therefore not on it. The resources and money that were invested in necessarily trying to deal with the terrible and growing problem of HIV were not directed in the same way at TB. Therefore, the diagnosis of TB is not as quick as it should be, and the treatments go on for an extended period, with old-fashioned drugs that must be taken on a continuous basis; if they are not taken in that way, the problem of drug-resistant TB arises—and that is a killer and particularly difficult to deal with.”

Mr Herbert also highlighted that of the estimated 9 million people who get ill with TB every year, 3 million go without proper diagnosis or treatment. Put simply, we fail to reach far too many people—often in the poorest, most vulnerable communities—with quality TB care.

We need to accelerate our efforts to tackle TB, and it is clear that we need to think outside the box.  One way of doing this is through TB REACH, a WHO initiative that gives small grants of up to 1 million dollars to find and treat those who don’t have any access to TB diagnosis or treatment, Mr Herbert added.

He also stated that a longer term solution to tackling TB would be the creation of a new vaccine that could tackle both normal and drug-resistant strains of the disease. This would have implications not only for developing countries, but also for us here in the UK, where rates of TB infection continue to rise.

The importance and contribution of the Global Fund to Fight AIDS, Tuberculosis and Malaria to tackling both HIV and TB was widely recognised by members, as were the wider developmental benefits accrued from continued investment in fighting the three diseases.

Responding to the points raised, the Parliamentary Under-Secretary of State for International Development Lynne Featherstone MP acknowledged the two points raised by Mr Herbert in relation to the TB REACH programme and on vaccination, both of which she said she would consider further. The Minister also highlighted that DFID’s support for TB research includes £205 million to the Global Alliance for TB Drug Development, and £14 million to the Tropical Disease Research Programme.

Ms Featherstone concluded the session by stating: “It is heartening to see so many Members who genuinely hold HIV as a priority and will pursue the wonderful goal of zero infections”.

Children and Tuberculosis: From Neglect to Action


Doctor assessing young child for TB

Credit: Gary Hampton

This week at the 43rd Union World Conference on Lung Health,  the ACTION Global Health Advocacy Partnership launched the report, ‘Children and Tuberculosis: From Neglect to Action’, outlining the urgent need for international action and cooperation on childhood TB.

Today the World Health Organisation (WHO) estimates 840,000 children get sick with TB each year, and up to  64,000 die as a result – with many experts agreeing that these figures are much higher. These figures are all the more striking when considering that TB is both preventable and treatable. As Kolleen Bouchane, the ACTION Director, says:

The global TB epidemic is a disgrace. We must transform increased attention to this deadly disease into action and ensure no one, especially the most vulnerable, is left behind in the fight against tuberculosis

The report, following another by the ACTION partnership on childhood TB a year ago, highlights the issues facing children in the fight against TB. Not only do children have weaker immune systems making them prime targets, but there is also a lack of awareness in many National TB Programmes that results in problems of diagnosis or of childhood TB simply being overlooked as an issue. Continue reading

Wall Street Journal article highlights woman’s struggle to survive drug-resistant TB


Image courtesy of World Lung Foundation

A compelling article published in the Wall Street Journal last weekend tells the story of TB patient Rahima Sheikh, detailing a six-year journey that has resulted in Sheikh having one of India’s first documented cases of TB that is resistant to virtually all medicines available.

Sheikh, who was diagnosed with TB in 2006, spent the past six-years journeying throughout India in search of a cure for her illness. It has been a journey that has forced her to mortgage her family’s rice fields, spend her father and brother’s life savings, as well as causing her considerable physical and mental anguish. Despite these sacrifices, Sheikh still has no guarantee that she will survive her illness.

Treating TB ordinarily requires a six to nine month course of treatment, and, therefore, it may seem strange that Sheikh has been on this six-year journey. However, if TB cases are mismanaged, if doses aren’t correctly prescribed or  if treatment is taken incorrectly or inconsistently, the TB bacteria can re-emerge and become resistant to medication.

In the case of Sheikh, it is suggested drug-resistant strains of TB were able to emerge because she was prescribed the wrong treatment on the basis of a misdiagnosis when she first sought treatment. Continue reading

Civil Society: A key partner in ensuring access to vaccines for all

As seen in this YouTube video from the GAVI Alliance, a number of vaccine experts and politicians travelled to Bangladesh last year to see the progress underway in delivering GAVI vaccines, and discussed the powerful role that civil society has to play.

The GAVI Alliance is exactly that, an alliance. This includes governments in the global north and south, large agencies such as UNCEF, WHO and the World Bank, the private sector, and civil society. This latter category can include non-governmental or community based organisations, professional, academic or technical bodies.

In this video, some powerful vaccine advocates can be seen talking about the role Civil Society Organisations (CSOs) can, and must, play. This includes Dr Sabrina Bakeera Kitaka, who joined RESULTS in the UK earlier this year during World Immunisation Week.

Sabrina speaking with MPs and Peers during a Parliamentary roundtable

CSOs are a key player in immunisation efforts around the world and in the activities of the GAVI Alliance. They deliver a high proportion of rural health care, including vaccines, in countries with the greatest challenges.

Such organisations are often able to reach communities the health system otherwise could not. They can also increase knowledge of the benefits of vaccines and encourage communities to demand access to them.

Continue reading

Disability issues moving up the agenda: will the post-2015 framework be more inclusive?

Speakers at a training session on the UN Convention on the Rights of Persons with Disabilities in Odek County, Uganda. Photo by Bryan Lupton AP Fellow in Gulu, Uganda July 2009 Partner: Survivor Corps Uganda

Speakers at a training session on the UN Convention on the Rights of Persons with Disabilities in Odek County, Uganda. Photo by Bryan Lupton AP Fellow in Gulu, Uganda July 2009 Partner: Survivor Corps Uganda

15% of the world’s population – over a billion people – live with a disability, and disabled people are also disproportionately more likely to be among the extremely poor. The World Bank estimate that 20% of people living below $1.25 a day are disabled. The link between disability and poverty works both ways: disabled people are more likely to become poor, and poverty is also a major cause of disability. Disabled people are frequently excluded from accessing basic services, including education (approximately one third of out of school children of primary age have a disability) and health (disabled people are more likely than non-disabled people to report being denied access to healthcare, not being able to access appropriate healthcare, and being badly treated by healthcare professionals).

But despite this, there has historically been very little attention to the rights and needs of disabled people in development work. There is no mention at all of disability in the Millennium Development Goals (MDGs). This is a serious problem – discrimination against disabled people frequently leads to being trapped in a cycle of extreme poverty for life, and there is far too little done to address the specific problems faced by such a big section of the population that the MDGs are supposed to target.

But is this changing? We have seen encouraging signs in recent months that disability is moving up the list of priorities in the development sector. RESULTS has been working with BOND’s Disability and Development Group and with an informal group of NGOs who are campaigning together on the need to improve disabled children’s access to quality education in the developing world, and we are seeing more receptivity to our messages. Continue reading

WHO warns tuberculosis could become an incurable disease if we fail to act

Image courtesy of World Lung Foundation

An article published by the Independent over the weekend reports a dire warning made by the WHO: unless we act now, we run the risk that TB will become an incurable disease in the future. The article gives a great overview of the current situation of TB control and invalidates any belief that TB is a disease of the past.

A variety of factors have contributed to allowing TB to remain a serious public health threat. The article identifies three main factors that have undermined efforts to control the disease and have led to the emergence of drug resistant strains, namely inadequate funding for health programmes, sales of unreliable blood tests and mismanagement of drugs. Just recently the media reported cases of drug resistant TB that are not responding to any TB drugs.

Although TB continues to be the second biggest infectious disease killer in the world and the biggest killer of people living with HIV/AIDS, funding and political commitment to control the disease have faltered. This has been particularly evident when the Global Fund to Fight AIDS, TB and Malaria, which provides more than two thirds of all international financing of TB programmes, announced in December 2011 that it was forced to cancel its latest funding round and would suspend new grants until 2014 due to donors failure to live up to their funding commitments.

Continue reading

Highest rates of drug resistant TB ever reported on the EU’s doorstep

Image courtesy of World Lung Foundation

As reported by the Guardian, a recently published WHO Bulletin has documented the highest rates of multi-drug resistant TB (MDR-TB) ever to have been reported. Authors of the study found of the 80 countries that reported tuberculosis surveillance data, the highest rates of MDR-TB were identified in Russia (28.9%) and Moldova (65.1%). The study states:

“Available data confirm that Eastern Europe and Central Asia continue to have the world’s highest proportion of MDR-TB among TB cases. In 2007–2010 the highest proportions ever reported globally were documented in areas of the former Soviet Union.”

Multi-drug resistant TB occurs when the TB bacteria develops resistance to isoniazid and rifampicin, two first-line drugs used to treat people with TB. Resistance often develops in areas with poor TB control programmes where TB treatment is poorly managed, when patients do not complete their full course of treatment, when incorrect dosages are prescribed or when there is a break in drug supply. Continue reading