Putting a dollar sign on TB in Amsterdam

One TB/HIV case = school costs for 10 kids

Ministers of health and finance from 20 of the 22 "high-burden" countries have signed a declaration in which they promise to try harder to fight TB but also warn they’ll need more help from rich countries if they’re to succeed.

As that part of the declaration reads: "While it is first and foremost the responsibility of affected countries to take the necessary actions . . . against tuberculosis, the problem is often the greatest in the very countries which can least afford to take action."

Rich countries that think TB isn’t their problem may be in for a surprise, said U.S. Secretary of Health and Human Services Donna Shalala at the March conference in Amsterdam where the ministers of health and finance met for four days. Shalala cited findings from the new World Health Organization report on global drug resistance that show resistance rates up by 50% in three developed countries. "There’s no way to build a fortress America’ or a fortress Europe’ against TB," she added.

Before heading home, the ministers also promised to expand coverage of WHO’s approved strategy known as directly observed therapy, short-course (DOTS) by ensuring 70% case detection by the year 2005. In addition, they affirmed WHO’s proposal to create the Global Fund for Tuberculosis.

Good intentions notwithstanding, new drugs are urgently needed, said Jim Orbinsky, head of Doctors Without Borders. Orbinsky leveled blasts at the drug industry for its focus on "finding another cure for impotence or baldness. Governments either need to regulate the industry more closely or "establish their own capacity to promote research," he added.

No matter what the outcome, the fact that the conference took place at all was cause for celebration. "It was extremely exciting to see so many ministers of health gathered to talk about just one disease. That’s never happened before," says Bess Miller, MD, associate director for science at the Division for TB Elimination at the Centers for Disease Control and Prevention in Atlanta.

For some ministers, the high energy continued after the conference disbanded. The South African Minister of Health, for one, e-mailed Miller excitedly about the noisy press conference she found waiting for her when her plane touched down at the airport.

When they weren’t talking about the need for better access to affordable drugs or the troubles that afflict countries that use DOTS but are bedeviled by high rates of HIV or multidrug-resistant TB, the ministers listened to speakers hammer home the conference’s stated theme of how TB hurts economic growth.

"Health expenditures to fight TB and HIV epidemics will force very hard trade-offs in public finance if we don’t act now," explained Mieko Nishimizu, the World Bank’s president of the South Asian region. Nishimizu and Gro Bruntland, MD, director general of WHO, drew examples from India to portray the enormous financial dimensions of the problem.

TB costs India $2 billion a year

Each year, Bruntland said, more than 300,000 Indian school children must abandon their studies because a parent falls ill with TB, and each year, more than 100,000 Indian women are evicted from their homes because of the social stigma of the disease. The average cost of treat-ing one TB patient co-infected with HIV exceeds that of educating 10 children in primary school, Nishimizu added. In sum, TB’s net cost to the Indian economy is $2 billion a year, Bruntland said.

Poor countries that put off dealing with TB now will pay dearly later, the two added. "Literally, this is a public health crisis where $10 worth of prevention is worth $5,000 of cure," said Bruntland. "If we are careless in providing that $10 treatment the first time, the next time treatment will cost $5,000 or more."