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Interview: Tackling Tuberculosis Will Be 'A Marathon'


http://gdb.rferl.org/AE546A19-53CA-4D4D-9AA3-339172926E86_w203.jpg --> http://gdb.rferl.org/AE546A19-53CA-4D4D-9AA3-339172926E86_mw800_mh600.jpg Dr. Mukund Uplekar (Courtesy Photo) The World Health Organization on March 17 launched a new strategy to fight tuberculosis. The new Stop TB strategy underpins an ambitious global plan to tackle the disease that was unveiled earlier this year. It hopes to halve the number of people who die of TB over the next 10 years and save 14 million lives. RFE/RL correspondent Kathleen Moore spoke to Dr. Mukund Uplekar, a medical officer in the agency's Stop TB Department, about the new strategy.


RFE/RL: The "Global Plan To Stop TB" was launched in January. What is the WHO unveiling this week?


Dr. Mukund Uplekar : The global plan is based on the Stop TB strategy, that is what we are unveiling now. This new strategy is new in the sense that it builds on what is already in operation, what we call DOTS [Directly Observed Treatment, Short Course], which has been going on for the last 10 years, and which has helped us make tremendous progress. For instance, over 20 million patients have been cured of TB in the last 10 years. The need for the new Stop TB strategy is that, DOTS is good, DOTS is required, but it is not sufficient if we want to achieve the Millennium Development Goals [of cutting TB cases in half] by 2015 or if you want eventually to make the world free of tuberculosis. Because there are new problems, or there are problems which are not adequately addressed by the DOTS strategy.


RFE/RL: What are those problems?


Uplekar: One is the problem of TB associated with AIDS or HIV, this is a problem in many countries, but especially in Africa. The second problem is of drug-resistant TB, again it's present in most countries but especially in Eastern Europe and former Soviet Union countries. So for these problems we need to strengthen the DOTS strategy. Treatment of drug-resistant tuberculosis needs different drugs, which are more expensive and which need to be given for longer durations. There are other things also. We cannot hope to have a good TB program if the general health systems are weak. So we have to see that the TB control contributes to and benefits from strengthening general health services. Then we have all kinds of care providers. All these years TB programs have focused on the public health sector, but we also have private-sector providers where patients go and take treatment. We have corporate-sector providers who cater to huge populations. All these providers need to be linked and we have to make them all work together for TB control.


RFE/RL: What are the new strategy's other objectives?


Uplekar: TB control is not a one-shot [thing] -- this is a marathon, it's a long race so we have to involve people, engage communities and we have to make efforts to see that people contribute to TB control. And finally, what we have achieved so far is with tools that are very old. What we have today for diagnosis is a 100-year-old method. The drugs we have today have to be given for six months at least, which is a long period, you expect the patient to take all those pills without any interruption for six months. So we need new drugs, we need good tests for diagnosis and ideally we should have a vaccine, because only a vaccine will help us prevent tuberculosis and get rid of the problem.


RFE/RL: What are your targets?


Bill and Melinda Gates in Mozambique in 2003 (epa)

Uplekar: Our first target is 2015, achieving the Millennium Development Goal of reducing the prevalence of tuberculosis by half and the deaths due to TB by half. We are very hopeful that we will be able to achieve it. And the two major regions where we need to focus attention is Africa -- because that's where the epidemic is worsening, the number of cases is rising -- and Eastern Europe, where drug-resistant tuberculosis is a huge problem.


RFE/RL: And what is the target for eliminating TB?


Uplekar: That's 2050, and we hope that with the increased investment and research into new tools -- a tool for quick diagnosis, drugs which can be given for a much shorter period, a vaccine -- if we have these new tools, which we hope to have, we should be able to eliminate the problem of TB by 2050. And when we say 'elimination' the definition is there will be less than one case per million population.


RFE/RL: The global plan calls for $56 billion in funding over the next 10 years. How hopeful are you that it will be fully funded and implemented?


Uplekar: We are hoping for the best, because this is a huge problem and with 2 million unnecessary deaths every year. As you know [U.S. tycoon] Bill Gates announced a grant of $600 million, so that's a good kick-start and we hope more resources are made available. The most important is that the countries themselves have to commit more resources and of course the international organizations, development agencies, philanthropic organizations. It's only a question of whether we collectively, the people and the world community, have the will to get rid of this ancient scourge of humanity.

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