WHO: Progress in fighting TB slows

By MARIA CHENG
The fight against the global tuberculosis epidemic has slowed to a crawl, the World Health Organization said in a report Monday. The worldwide rate of TB infection has been declining for several years. But between 2005 and 2006, the rate of new cases fell by less than 1 percent, far less than the annual decrease of 5 to 7 percent sought by health officials.
At the same time, drug-resistant TB is growing faster than ever, the WHO said last month.
Independent health experts criticized the WHO's TB policy as too passive, and urged a more proactive strategy.
WHO conceded the most recent decline in the overall infection rate "is very modest, and is not as fast as we would like it to be," said Dr. Marcos Espinal, executive secretary of the organization's Stop TB Partnership.
"Without new tools, we will not be able to break the back of this epidemic," he said, citing a lack of vaccines, outdated drugs, obsolete diagnostic tests and overwhelmed health systems as contributing to the slowdown against TB.
In 2006, there were an estimated 9.2 million new tuberculosis cases and 1.5 million deaths, the WHO said in its report, which was based on government data from 202 countries and regions.
India and China have the most cases, followed by Indonesia, South Africa and Nigeria, the report said.
By region, Asia has 55 percent of all TB cases, and Africa has 31 percent.
WHO acknowledged its treatment programs "have not yet had a major impact on TB transmission and incidence," according to the report, which assessed the WHO's efforts for the past 12 years.
WHO primarily works by recommending how governments and donors can best fight TB, and it is up to individual countries to decide how to spend funds. Last year, countries and donors spent about $2.3 billion on TB control. This year, WHO estimates that $3.1 billion will be needed to identify and treat TB patients.
The report said TB infection rates were stable in Europe, and declined about 3 percent in the United States.
In Africa, however, they were still increasing as the AIDS epidemic fuels transmission. TB in Africa has increased at least fivefold since the 1990s.
The report said 30 million people — or 84.7 percent of identified TB patients — have been cured through treatment.
Espinal acknowledged that WHO may not have enough evidence to show that its treatment strategy reduces transmission. The strategy works to cure people, he said, not necessarily to reduce the disease's spread.
Other experts countered that if treatment rates were as high as WHO claimed, there would be less drug-resistant tuberculosis.
Last month, WHO said drug-resistant TB was spreading faster than ever. Globally, there are about 500,000 new cases of drug-resistant TB every year, about 5 percent of the 9 million new TB cases, WHO said.
Independent experts also criticized the WHO's reporting, saying it did not take into account those who are infected but not diagnosed, and was gathered from governments without being verified independently.
"This is a compilation of what the countries want to show," said Dr. Francis Varaine, coordinator of Medecins Sans Frontieres' tuberculosis working group. "Some of these data are too good to be true."
In developing countries, WHO's main tuberculosis treatment program depends on patients volunteering to be tested, instead of doctors seeking out patients.
WHO's Espinal estimated that only about 60 percent of infected patients are diagnosed.
"By the time a TB patient turns up, they have been coughing for weeks and have probably infected most of their family, friends, work mates and anyone else they were in contact with," said Ruth McNerney, a TB expert at London's School of Hygiene and Tropical Medicine. She said WHO's strategy was "like shutting the door after the horse has bolted."