Health Officials Seek Fourfold Rise in Global TB Funds

JOHANNESBURG, June 22 -- Global health officials on Friday called for a quadrupling of spending to combat highly lethal, drug-resistant strains of tuberculosis spreading through Eastern Europe, Africa and parts of Asia.

The two-year, $2.15 billion plan, presented by the World Health Organization and the Stop TB Partnership, would pay for advanced drugs, dozens of new laboratories and research. If fully implemented, health officials said, it would prevent 134,000 deaths and improve their ability to diagnose and track the emerging threat.

"We either sort it out now or pay a penalty down the road," said Paul Nunn, a WHO official who monitors drug resistance for tuberculosis and AIDS.

Tuberculosis is a disease mainly of the lungs, spread when infected people cough. Six months of medication typically can cure it, but many people with the disease fail to complete the full course, allowing strains to emerge that cannot be easily treated.

Each year, more than 400,000 people contract multi-drug-resistant tuberculosis, which cannot be cured by the cheapest and most widely available medicine. Most die.

Even more lethal is extensively drug-resistant tuberculosis, known as XDR-TB, which kills almost all of the 27,000 people it infects each year.

In the most famous case of XDR-TB, Atlanta lawyer Andrew Speaker caused an international panic when the Centers for Disease Control and Prevention tried to isolate him during a trip through Europe out of fear he would infect fellow travelers. Speaker is undergoing treatment in Denver.

Extensively drug-resistant tuberculosis has been identified in 37 countries, with an especially high concentration in Eastern Europe. Much of the plan would fund treatment of tens of thousands of cases there.

Tuberculosis also has become widespread in southern Africa because of high rates of AIDS. Doctors call the two diseases "the terrible twins" because people with AIDS are more vulnerable to developing tuberculosis, and tuberculosis speeds the death of people with AIDS.

Public health officials in Cape Town, South Africa, which has a severe tuberculosis epidemic, improved their cure rates -- from 67 percent in 2004 to 79 percent in 2006 -- by hiring more nurses and improving management of programs, said Ivan Toms, executive director for city health.

Nulda Beyers, a tuberculosis expert at South Africa's Stellenbosch University, said the key to controlling drug-resistant strains of the disease is to treat ordinary cases properly, preventing the creation of more-difficult ones. She said most of the proposed funding should be devoted to hiring more medical staff.

"If one just put all the money into labs and fancy drugs, that's not going to do the thing," she said. "We need to build human capacity. We need people to do the work."

Nunn said the spending plan would provide money to improve existing programs that fight more common forms of tuberculosis. "Strengthening current TB control is vitally important to turn off the tap of drug-resistant TB," he said.