ACTION - The Power of Activism: TB vs. HIV

Aeras leverages US government clinical trial networks designed for HIV research to support TB vaccine development

ROCKVILLE, MD, USA, January 31, 2012 — Aeras announces today that the National Institute of Allergy and Infectious Diseases (NIAID), part of the United States National Institutes of Health (NIH), has joined as a partner for a Phase II proof-of-concept clinical trial of a tuberculosis vaccine candidate jointly developed by Aeras and Dutch biopharmaceutical company Crucell.

NIH has a long history of supporting TB vaccine development. However, this is the first time that NIH is leveraging its HIV/AIDS clinical trial networks to advance a tuberculosis vaccine candidate. Along with the recent announcement of NIAID's new partnership in a Phase III TB drug trial, this collaboration follows the NIAID plan to leverage infrastructure originally intended for HIV-related clinical trials to also advance tuberculosis vaccine and therapeutic research for both HIV uninfected and infected populations.

One-third of the world's population is infected with tuberculosis. Infants and people who are immune compromised, including those with HIV infection, are at higher risk of developing active TB. Safe and effective vaccines hold promise for protecting these at-risk populations.

"NIAID's involvement in this important clinical trial will maximize return on U.S. government investment in clinical research infrastructure while accelerating progress against the world's deadliest infectious disease after HIV/AIDS," said Mary Woolley, CEO and President of Research!America, the nation's largest not-for-profit public education and advocacy alliance committed to research.

The clinical trial, which began in October 2010, has already enrolled infants at three sites in Kenya, South Africa and Mozambique. The goal of the trial is to evaluate the safety and efficacy of vaccine candidate AERAS-402/Crucell Ad35 in HIV-uninfected infants. Significant support for the trial is also provided by the European and Developing Countries Clinical Trials Partnership (EDCTP) and European Member States.

The first NIAID-supported site to join the clinical trial is the Perinatal HIV Research Unit (PHRU) located in Soweto, South Africa at the Chris Hani Baragwanath Hospital. The research site is a member of NIAID-funded clinical trial networks including the HIV Vaccine Trials Network (HVTN), the HIV Prevention Trials Network (HPTN) and the International Maternal Pediatric Adolescent AIDS Clinical Trials Network (IMPAACT).

"Our novel collaboration with NIAID comes as multiple TB vaccine candidates are poised to enter efficacy trials requiring thousands of participants and significant investment, as well as complex infrastructure and sophisticated expertise," said Jim Connolly, President and CEO of Aeras.

"We are grateful for the partnership of one of the most well-respected biomedical research institutes in the world, and the opportunity to utilize well-established clinical sites," he added.

In 2004, Aeras and Crucell began joint development of this vaccine candidate. AERAS-402/Crucell Ad35 has been tested in 13 completed or ongoing early-stage clinical trials. These trials include healthy adults and infants as well as adults with HIV infection and adults with recently treated pulmonary tuberculosis. The vaccine candidate has been shown to be immunogenic and to have an acceptable safety profile in these studies.

Tuberculosis is the world's second deadliest infectious disease, with 8.8 million new cases diagnosed in 2010. According to the World Health Organization (WHO), an estimated 1.4 million people died from TB in 2010. An estimated one-third of the world's population has been infected with the TB bacillus. Current guidelines require a minimum of six to nine months of treatment. The current TB vaccine, Bacille Calmette-Guérin (BCG), developed 90 years ago and given to newborn infants, reduces the risk of severe forms of TB in early childhood but is not very effective in preventing pulmonary TB in adolescents and adults - the populations with the highest rates of TB disease. TB is changing and evolving, making new vaccines more crucial for controlling the pandemic. Tuberculosis is now the leading cause of death for people living with HIV/AIDS, particularly in Africa. Multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) are hampering treatment and control efforts.

Aeras (www.aeras.org) is a non-profit product development organization dedicated to the development of effective vaccines and biologics to prevent TB across all age groups in an affordable and sustainable manner. Aeras has invented or supported the development of six TB vaccine candidates, which are undergoing Phase I and Phase II clinical testing in Africa, Asia, North America and Europe. Aeras receives funding from the Bill & Melinda Gates Foundation, other private foundations, and governments. Aeras is based in Rockville, Maryland, USA where it operates a state-of-the-art manufacturing and laboratory facility, and Cape Town, South Africa.

NIAID conducts and supports research-at the US National Institutes of Health, throughout the United States, and worldwide-to study the causes of infectious and immune-mediated diseases, and to develop better means of preventing, diagnosing and treating these illnesses. For more information about NIAID visit www.niaid.nih.gov/.

Related Stories

Addressing the Evolving Needs of Haiti’s Women and Children Two Years After the Earthquake

By Andrea Brush, ACTION intern

January 12, 2010 is one of those days that I will never forget. I remember exactly where I was and the moments after the news broke of the devastating earthquake that shook the island nation of Haiti to its core. I was sitting in my office gathering my things to head home for the day and talking with my boss, who is Haitian, about the meetings we were preparing for the following day. Her phone began ringing, everything fell silent and the mood in the room instantly changed. I have never felt so helpless in my life. Fast-forward two years and I am weeks away from earning a Master's degree in Public Health; a decision that was made before January 2010, but was cemented as the correct one after that day in my office.

During my coursework, I have laid out a focus area of displaced and vulnerable populations; the humanitarian side of public health has always intrigued me. Therefore, when the opportunity to attend a talk entitled, "Addressing the Evolving Needs of Haiti's Women and Children Two Years After the Earthquake," I knew I had to attend. I am firm believer in "The Girl Effect", micro-credit loans (especially for women), and involving women in community decisions. If a woman is in charge of a family's finances, more money is put towards the health and welfare of her children, the same is true for education. As the saying goes, "If you educate a woman, you educate an entire village."

A panel of experts gave the talk on Haiti's women and children. They were from Management Sciences for Health, the Haitian Ministry of Health, USAID, PSI, and UNFPA. The panel discussed how NGO's in Haiti (pre- and post-earthquake) can, and should, align their work with the Ministry of Health in order to achieve better outcomes in maternal and child health, emergency obstetrics, and decrease the amount of gender-based violence. The points that were really driven home were the need for more trained, skilled birth attendants and a strengthening of family planning services.

A larger cadre of birth attendants, a strengthening in health services and coordination between NGOs and the Ministry of Health would lead to a more stabilized Haiti. Putting women and children first would lead to a more stabilized Haiti. Educating girls and young women would lead to a more stabilized Haiti. In my future as a public health professional, I hope to advocate that "change starts with a twelve-year-old girl" and that I can be a part of something as grand as collaborating with a ministry of health in order to provide better access to and quality health care for all. Throughout it all, however, I will never forget the silence that hit my office on January 12, 2010.

The Future of Public-Private Partnerships

Last Friday, I had the opportunity to attend an event at the Center for Strategic and International Studies titled, "PepsiCo & World Food Program: A Public-Private Partnership to Transform Nutrition across Africa." I am very interested in this topic because I studied childhood malnutrition throughout Africa, and follow the projects of the World Food Program. I was particularly interested in how the public and private sectors can best work together to combat issues such as malnutrition, but also anything ranging from vaccine campaigns to education. The future of innovation may lie in the development of partnerships between the public and private sectors. It seems logical to think that with the varied directions the world's economy is moving in, partnerships between publically and privately funded organizations will become commonplace.

In light of this thought, when I heard that the World Food Program and USAID were teaming up with PepsiCo, I was initially taken aback. I couldn't understand why a monstrous, multi-billion dollar company like PepsiCo would want to work with a program that bases itself on providing food for free. I have since learned that PepsiCo has a much greater humanitarian side than previously imagined. The partnership formed between WFP, USAID, and PepsiCo aims to increase chickpea production in Ethiopia. The program is aptly called Enterprise EthioPEA. The aim of the program is to create a locally produced, ready to eat food (RUF) to assist in warding off malnutrition in close to 40,000 children. In addition, the program will help 10,000 local farmers produce better quality, and a higher quantity, of chickpeas. PepsiCo has stated that the goal of the partnership is to provide long-term sustainability to local farmers by providing them with better quality seeds and farming techniques. While the initial goal in Ethiopia is to make a nutritional, chickpea-based RUF to stop the increase of malnutrition, both PepsiCo and the WFP would like to eventually see farmers making a profit off of the chickpea production by increasing the amount of chickpeas exported globally.

To me, the most interesting aspect of this partnership is the changing face of large-scale, private companies. It takes courage for a food production company to make nutritious food cheaper, and that PepsiCo's decision to be a part of EthioPEA may help change the direction of how the world is nourished. Rightly so, WFP's Executive Director, Josette Sheeran stated, "With the ingenuity, power and reach of the private sector, we can make great strides in ending the malnutrition and hunger that is threatening the lives of millions...Enterprise EthioPEA will change the lives of tens of thousands of children and will chart the course for future partnerships to help stamp out hunger around the globe."

Hopefully more private sector companies take note from PepsiCo and forge innovative partnerships with the public sector to combat things such as hunger, malnutrition, and other health-related issues.

I, personally, am very excited to see how the partnership between the WFP and PepsiCo pans out and hopefully watch the resounding success of EthioPEA. This program is positioned to change thousands of lives in Ethiopia and beyond. It would be wonderful to see the success of PepsiCo's eagerness to be a part of a partnership with the public sector inspire other large-scale companies to do the same. These partnerships have the potential to change the course of millions of lives, in my lifetime. If private sector corporations are willing to part with large sums of money for the global good of the world, it would stand to reason that "diseases of poverty" could be easily eradicated. EthioPEA's fight to end childhood malnutrition is a huge step in the right direction, as well-nourished children are less likely to succumb to deadly diseases later in life. For the time being, I'll simply continue to imagine a world in which, perhaps Wal-Mart Stores, Inc. teams up with an organization such as The Global Fund to Fight AIDS, Tuberculosis and Malaria to once and for all put an end to those diseases, and malnutrition while they're at it!

On TB and Building a Safer Global Neighborhood

My dad has always taught me, "Charity starts at home." And during the State of the Union address, President Obama stressed nation building at home over nation building abroad. The president made it very clear that nation building overseas is no longer a U.S. priority. So if my own father and the President of the United States think a strong home matters most, how did I end up working in global health advocacy? After all, I don't live in Africa so why should I care about what happens there? And if I didn't care, then why should the U.S.?

If you live in a beautiful home but your neighbors are living in thatched-roof shacks, a realtor will have a bit of trouble selling your house. Why? Because a good home in a bad neighborhood isn't worth much more than the houses next to it.

I think I understand what my father and Obama are saying, and yes, it's important to have a nice, strong home. But we must not forget that our home resides in a neighborhood.

So why care about global health? Well, the United States is part of a global neighborhood. We're only as strong as our neighbors - we're all interconnected.

Take, for example, TB (a contagious lung disease that spreads through the air). What would you do if your neighbors had TB and it was spreading like wildfire in their cramped quarters? Would you help your neighbors? What if your nice home couldn't protect you against this disease? What would that mean for your neighborhood? The bottom line - if one person in your neighborhood suffers, the rest suffer.

Disease doesn't know the difference between your house and your neighbors. And it doesn't know the difference between the U.S. and Zambia. People travel across borders - so does disease. In order to address global health issues such as TB, you can't focus on only one country. TB is curable - we just need new tools for detection, better drug regimens and better integration of TB-HIV services.

My colleagues at ACTION don't like to use fear as a motivator for getting people to care about TB or any of the global health issues we work on. TB is scary; it's a silent killer that we have created ourselves with our inattention -- with a lack of political will and resources to take on tuberculosis. But here's what's worse - those who are infected are your neighbors. They may not live down the street - instead across the ocean- but they are your neighbors nonetheless.

So yes - a strong nation is good. And yes - charity starts at home. But a strong nation needs strong neighbors. So if you don't consider this your moral obligation or neighborly duty, then consider this a way to increase the value of your home.

10 Years On, Funding Crisis Threatens the Global Fund’s Effort to End AIDS

By Joanne Carter, executive director of RESULTS Educational Fund, a partner and host of the ACTION Secretariat

This blog was first published in The Huffington Post on Friday, January 27, 2012

This week marks the 10th anniversary of The Global Fund to Fight AIDS, Tuberculosis, and Malaria. The last 10 years, the Global Fund has proved to be one of the most successful efforts in the history of public health. Millions of lives have been saved in some 150 countries. But projected funding shortfalls threaten this progress. And last November, the Global Fund board canceled the next funding round and essentially suspended new grant opportunities until 2014. This is a devastating and unacceptable setback to the fight against these diseases, and donors must mobilize to fill this funding gap.

We're calling for an emergency donor conference to mobilize the resources needed to reverse the situation and provide for a new funding opportunity in 2012 and 2013. We're also calling on the United States to convene donors before the International AIDS Conference, which takes place this July in Washington, D.C.

At the World Economic Forum in Davos, two key donors cast votes of confidence with their checkbooks. Bill Gates announced a $750 million promissory note to the fund and urged support for the fund. And Japan, despite an earthquake, tsunami, and a nuclear crisis, reconfirmed its $800 million pledge. These contributions are a strong endorsement of the Global Fund's impact and effectiveness and a challenge to other donors to step up.

This week marks 10 years since the Global Fund opened its doors. Its achievements over the last decade have been extraordinary. Today in middle- and low-income countries, there are 6.6 million people on life-saving antiretrovirals for AIDS; that's up from just a few hundred thousand 10 years ago. The Global Fund has prevented an estimated 4.1 million deaths from tuberculosis and is responsible for providing 82 percent of donor financing for TB.

As someone who's worked on this issue for well over a decade, I can tell you that before the Global Fund, donor financing for TB was miniscule, and TB patients and programs were dying from neglect, and that has changed.

Through the distribution of hundreds of millions of bed nets and anti-malarial medicine, deaths from malaria are down 25 percent globally in the last 10 years, and malaria deaths have been halved in some African countries.

But these gains have not been earned by doing business as usual. In fact, the Global Fund is business unusual. For 10 years, the Global Fund has been on the cutting edge of innovation and effective aid delivery. The Global Fund empowers the countries and communities that benefit to determine how the aid is best used. In the country, ownership is complemented by rigorous accountability and unmatched transparency. The U.K.'s Multilateral Aid Review found the Global Fund among the highest-rated institutions offering strong value for money.

And the next decade holds remarkable promise. In particular, new evidence demonstrates that early initiation of AIDS treatment can massively reduce the spread of the virus to uninfected partners. This finding was named the 2011 breakthrough of the year by Science magazine and has actually allowed public health experts to credibly plot the end of the epidemic.

But just as science is telling us we can end AIDS within the next generation, making funding for scale-up for treatment and other proven prevention more critical and impactful than ever, this opportunity is jeopardized by the decision to halt new Global Fund scale-up opportunities until 2014. As many as seventy countries are beginning to feel the impact of funding cancellation. In Zambia, over 130,000 people won't have access to life-saving treatment. Without scale-up of prevention of mother-to-child treatment services, 25,000 mothers in Zimbabwe risk transmitting HIV to their unborn children.

The fight against AIDS is being pushed in exactly the opposite direction of where science is leading it, and this cancellation of new funding opportunities will also be devastating to countries' capacity to take up new game-changing technologies like TB and malaria diagnostics that could greatly advance that fight. And we're not just in danger of slowing progress, but actually reversing it.

The U.S. and other donors can fix this situation. If the U.S., the U.K., and even a handful of other key donors join together for an emergency donors meeting in advance of the AIDS conference this July and commit to meeting their pledges in some cases, topping them up in others, and with even a few new or renewing donors showing up, we can find the $2 billion in resources needed to have a new Global Fund funding opportunity this year and reverse this devastating setback.

So we're calling on the U.S. to host this meeting. We strongly believe that if the U.S. hosts this emergency donor's conference, other donors will join in. If we convene it, they will come.

The Obama administration, from Secretary Clinton to the president to Ambassador Goosby, our global AIDS coordinator, has reiterated their commitments to the Global Fund and to fulfilling the U.S.'s pledge. By doing this and by exerting U.S. leadership globally through convening an emergency meeting, the U.S. can lead the way in reversing this devastating setback.

The Global Fund has a decade-long track record of impact and innovation in the fight against AIDS, TB, and malaria, but these diseases won't wait around for the world to sort out its financial challenges. Now, if we don't advance against these epidemics, we're now moving backwards, and we don't want that to happen.

On Its Tenth Anniversary, Support for The Global Fund Is Strong in Germany

Today, the leading German opposition parties - SPD and Greens/Alliance90 - issued powerful statements of support for the Global Fund to Fight AIDS, TB and Malaria to mark its tenth anniversary.

The SPD Party release was co-authored by MP Karin Roth and MP Heidemarie Wieczorek-Zeul, Former Minister for Economic Development and Cooperation. MP Wieczorek-Zeul was MP Dirk Niebel's predecessor and an instrumental figure in the German government when the Global Fund was launched in 2002. They have called on the German government to double its contribution to the Global Fund to 400m Euros annually.

Their sentiments were echoed by MP Uwe Kekeritz, Chairman of the Subcommittee on Health in Developing Countries for the Greens/Alliance90 Party, who urged the German government to reinstate a separate budget line-item for contributions to the Global Fund.

In response, MP Dirk Niebel, Federal Minister for Economic Cooperation and Development, issued a strong statement of support for the Global Fund, promising to reinvigorate his government's partnership with this tremendously effective organization.

Statement by the SPD Parliamentary Group for Economic Cooperation and Development
Ten Years of the Global Fund - Successful Work In Danger

In light of the 10th anniversary of the Global Fund for Aids, Tuberculosis and Malaria on January 28th, 2012, the responsible rapporteurs for the SPD parliamentary faction, Karin Roth, and the SPD Member of Parliament, Heidemarie Wieczorek-Zeul, declare:

The SPD parliamentary faction congratulates the Global Fund on its successful work over the past 10 years and requests that the German Federal Government does not only make available - without further preconditions - the 200 million Euro for 2012, but also increases its contribution to 400 million Euro in the coming years. This is exactly what the SPD faction requested during the most recent federal budget discussions in parliament.

10 years ago, the Global Fund for Aids, tuberculosis and malaria was founded under the leadership of the then SPD-led German Federal Government. The Global Fund constitutes the most successful vehicle for the improvement of the health and healthcare situation in disadvantaged countries. It is because of the programs run by the Global Fund that almost 8 million lives have been saved and 3.3 million people have gained access to HIV treatments. Additionally, 8.6 million cases of tuberculosis were treated, and 230 million insecticide-treated mosquito nets have been distributed.

We are poised to make even more substantial progress in the fight against Aids, tuberculosis and malaria. Yet, this progress is in jeopardy because some donors refuse to pay up. The Global Fund depends on those donors, and they must honor their stated financial commitments.

Federal Minister Niebel opened Pandora's Box when, shortly after taking office, he moved to cut the previously agreed upon contributions to the Global Fund. Most recently, he slowed down those payments based on allegations of corruption in 2011. And as a result, in the 2012 Federal Budget, the Global Fund is no longer included as a separate line item.

A number of donors have followed this example, reducing their contributions and breaking their stated promises. This has led, for the first time in the Global Fund's history, to the cancelation of a new round of financing. This means that until 2014, the Global Fund will not be able to undertake new treatment or prevention programs. This is a catastrophe for the poorest of the poor, and a major setback on the path to achieving the Millennium Development Goals.

_______________________________________________________________________________________________________________

Statement by the Greens/Alliance90 Party
Ten years of global HIV / AIDS fund - Congratulations

To mark the tenth anniversary of the Global Fund to Fight HIV / AIDS, Malaria and Tuberculosis (GFATM), Uwe Kekeritz MP, Chairman of the Subcommittee on Health in Developing Countries states the following:

Ten years of global HIV / AIDS Fund has resulted in nearly eight million lives saved in 150 countries. But despite these successes, the Global Fund and its work is at risk. A lack of financial resources means that for the first time in the history of the Fund, a new round of funding had to be canceled and no new programs can be initiated. Donors have a responsibility to change this, especially Germany.

Federal Minister Niebel must be true to his commitments and not question or delay payment at each and every turn. The Global Fund must again have a separate line item in Germany's Federal Budget. This is particularly true in light of the ongoing and necessary reform process inside the Global Fund, which requires reliable partners at its side and no Niebelesque denial tactics.

It is excellent that the Bill & Melinda Gates Foundation, are supporting the life-saving work of the Fund through a donation of 750 million U.S. dollars. Yet, it is shameful that some industrial nations have tried to solve their financial problems with cuts in this area. Since the appointment of Dirk Niebel, even Germany has become a completely insecure partner in the fight against HIV / AIDS, malaria and tuberculosis.

In 2002, fewer than 300,000 people in developing and emerging countries had access to antiretroviral therapy, today this number has climbed to over 6.6 million people, thanks to the Global Fund. We wish the Global Fund all the best in addressing these challenges and congratulations on ten years of existence. At the same time, we promise to exert massive pressure on Niebel, so that Germany will again become a reliable partner in the global fight against these insidious diseases.

_______________________________________________________________________________________________________________

Statement by MP Dirk Niebel, Federal Minister for Economic Cooperation and Development, for the tenth anniversary of the Global Fund

Dirk Niebel, Federal Minister for Economic Cooperation and Development, congratulates the Global Fund to Fight AIDS, Tuberculosis and Malaria as it marks its tenth anniversary.

Dirk Niebel: "The Global Fund is making a significant contribution to achieving the Millennium Development Goals - the fight against AIDS, Tuberculosis and Malaria, helping hundreds of thousands of people every year. Yet so far, the inefficient use of resources has limited the Global Fund's effectiveness. We therefore find ourselves in close dialogue with the Global Fund about a fresh start and overcoming the last year's crisis of confidence regarding the management of the Global Fund. We have the clear expectation that the reform decisions made at the end of 2011 will be implemented rapidly, completely and on schedule. Only then will the Global Fund be in a position to contribute to the future care of the sick - and only then will the federal government be in a position to continue to cooperate with the Global Fund. With its recent decisions, I see the Global Fund on track."

Germany is the fourth largest donor to the Global Fund after the U.S., France and Japan. Last year, after substantial allegations of corruption, Federal Minister Dirk Niebel had frozen contributions to the Global Fund. The funds for 2011 were released after the Global Fund had adopted a clear timetable for reform.

_______________________________________________________________________________________________________________

Statement by Beate Figgener, Spokesperson for Die Linke Party
Long-term and secure adequate funding for the Global Fund

"Development Minister Dirk Niebel is not allowed to withhold the much-need resources for the Fund to Fight AIDS, Tuberculosis and Malaria" said MP Niema Movassat, chairman of the Subcommittee on Health indeveloping countries for the Group of the Left, on the occasion of the tenth anniversary of the Global Fund. Movassat further:

"The fund has saved countless lives. The Fund deserves for Niebel to stop holding up its work. Instead of cutting resources for the Fund because of isolated cases of corruption which have been addressed and resolved, the Minister should - given his own proven nepotism - first and foremost clean up in front of his own doorstep. Instead, he continues to discredit himself.

It is long overdue that the federal government ensures long-term, reliable and adequate funding for the Global Fund. The Left Party has for years been calling for a separate budget item for the Global Fund and increased funding from 200 million to 400 million euros a year."

_______________________________________________________________________________________________________________

Action against AIDS Germany statement on the Global Fund
10 Years Global Fund - a successful fight against HIV/Aids, Tuberculosis and Malaria with an uncertain future?

Ten years ago, only about 250,000 people in poorer countries had access to life-saving HIV / AIDS therapy. By late 2010, the figure had risen to 6.6 million people. One of the main drivers of this positive development is undoubtedly the Global Fund. Its programs have been supplying 3.3 million people with HIV drugs to treat 8.6 million TB cases, and distributed 230 million insecticide-treated mosquito nets. "The success of the Fund is unprecedented and a clear message: It needs to be extended! Instead, however, a abrupt halt is on the horizon, "says Astrid Berner-Rodoreda, spokeswoman for the campaign against AIDS.

The Fund is dependent on donor funding. Those donors - for 2011 through 2013 - have only pledged half of the required funding. "For some of those financial commitments, it is also unclear ,in some cases, if and when those will be honored," writes Joachim Rueppel, spokesman for the campaign against AIDS. The Fund was already forced to cancel already-initiated rounds of financing, without alternative possibilities for the expansion of its efforts.

This means that no earlier than 2014 will the Fund be in a position to begin additional prevention and treatment programs. "This is a catastrophe for more than 7 million people, still waiting on life-saving HIV treatment," said Gisela Schneider, member of the Speakers' Circle for Action Alliance against AIDS. "It was not until June 2011 that the United Nations have agreed on a target to ensure that by 2015 a total of 15 million people will have access to HIV treatment. This is now moving into distant future, "said Schneider. Even Germany is not living up to her responsibilities. Even the financial commitment of € 200 million per year is less than half of the appropriate contribution level. In addition, it is left in the discretion of the minister what will actually be paid out to the Fund.

Action against AIDS and Childrens Help have therefore launched the campaign "Keep the Promise!". The campaign asks the federal government to consistently support the Global Fund. "In practical terms this means to at least include the annually pledged € 200 million in its own title in the federal budget. By 2013 at the latest, these contributions would have to be increased to the appropriate level, which is at least € 400 million, "said Ruppel. Only then can Germany's meet its responsibilities for global health.

TDR-TB and XXDR-TB: Frequently Asked Questions

The term totally drug resistant tuberculosis was invented by Iranian researchers in 2009 to describe a strain of TB that didn't respond to treatment. Whereas people with MDR-TB (resistance to 2+ first line drugs) have a 30 percent chance of dying and people with XDR-TB (resistance to all first line and most second line drugs) have a 60 percent chance of dying, its believed that people with TDR-TB have a 100 percent chance of dying.

It depends on who you ask. Many researchers say we can't be sure it's totally resistant because (1) there may be problems with drug susceptibility tests, (2) there is no standard protocol for diagnosing this strain, and (3) there are drugs currently in the pipeline that could potentially be effective against the strains of TDR-TB. However, researchers in India say their patients are resistant to all known forms of TB medication and therefore qualify as being ‘totally' resistant.

WHO does not have an official definition for TDR-TB, instead saying it's probably best described as extra XDR-TB (hence XXDR-TB). The WHO plans to meet in March to discuss TB programs and potentially define TDR-TB and/or XXDR-TB.

No. People with pulmonary TB infect an estimated 10-15 people per year regardless of drug-resistance. TB has a higher chance of being spread when there is a higher concentration of people in places with poor ventilation, such as crowded houses, hospitals, or prisons.

People with TDR-TB likely originally head XDR-TB that developed into a more resistant strain, possibly when a drug regimen was misused or mismanaged. Drug resistance can develop anywhere, but is more common in places TB control programs are managed poorly: poor patient support, low-quality health care, patients prescribed wrong treatment/wrong dose/wrong amount of time on treatment, insufficient supply of drugs, and insufficient quality of drugs.

India is home to 1/5 of the world's TB cases, killing an estimated 1,000 people a day. While it's National TB Program has been successful providing first line drugs to patients, many people in India seek health care from the unregulated private sector. One study showed only 5 of 106 private physicians prescribed appropriate drugs. Even if proper drugs are prescribed, many factors lead to people defaulting on their treatment. This is particularly in an issue for rural populations.

TB programs and strengthening and scaled up. Currently, TB programs all over the world face an $800 million funding gap - just for 2012. Eighty-six percent of TB financing comes from domestic budgets. The remaining 14 percent comes from donors. The Global Fund to Fight AIDS, Tuberculosis and Malaria is the largest external financer of TB programs. This week, as the Global Fund celebrates its 10^th anniversary, its experiencing a major financing shortfall. We're calling for an emergency donor conference to mobilize the resources needed to reverse the situation and provide for a new funding opportunity in 2012 and 2013. We're also calling on the United States to convene donors before the International AIDS Conference, which takes place this July in Washington, D.C.

Development Assistance for Health as the MDG Deadline Approaches

What's it like to be a small fish in a big pond? I'll tell you - I started my internship with ACTION just under a week ago, so I would say I'm a fairly small fish in the global health advocacy pond. On my third day at the office, I attended a Global Health Council event to discuss the Institute for Health Metrics and Evaluation's (IHME) report on global health financing. While other college sophomores were sitting in class, I was sitting next to big fish in global health, and I couldn't have been more excited to get a glimpse into the complicated world of global health financing.

Global health financing is a complex issue, and there is much that has yet to be achieved in global health, but with effective strategies (along with financing), we can work towards achieving the MDG's and beyond. ACTION focuses on TB and childhood immunizations, so I was particularly interested in financing trends for those two health topics. What I found most interesting was the significreportant role the GAVI Alliance (GAVI) plays not only in vaccination, but in overall global health financing.

Firstly, GAVI plays a significant and increasingly important role in financing development assistance for health (DAH). GAVI is much newer compared to more traditional institutions such as UN agencies, and since its establishment in 2000 has experienced sustained growth. The amount of DAH flowing through GAVI became especially pronounced in 2007 and despite the recession, DAH from GAVI has continued to grow. The IHME estimates that its growth rate increased 31% between 2010 and 2011, rising from $893.84 million to $1.17 billion. In many ways, this is a result of successful advocacy by ACTION partners and others to raise the profile and political support for GAVI. These funds have helped GAVI to support the immunization of 326 million additional children, who might not otherwise have had access to vaccines, and will prevent over five million future deaths.

Secondly, the World Bank's International Bank for Reconstruction and Development accounted for the largest share of expansion ($796.77 million) in DAH between 2010 and 2011 in the form of loans. Some in the global health community contest whether these loans should be counted as DAH, as they are targeted to provide economic stimulus primarily and have to be paid back by governments.

Despite concerns over cutbacks in foreign aid, IHME surprisingly found that DAH continues to grow (but at a much slower rate). Panelists at the Global Health Council event expressed concern over donor preference for "quick wins", and stressed the negative impact that reduced funding and short-term thinking could have on long-term health systems strengthening. In moving forward, we must identify how to best target limited resources. Developing countries need new tools to better evaluate and address ongoing burdens of infectious diseases. MDG 4, 5, and 6 depend on the trajectory of DAH growth and this requires transparency, accountability, better data gathering, and more thorough impact evaluations.

As I continue my internship with ACTION, I look forward to seeing how global health advocates can help to ensure DAH continues to grow so that it stops tuberculosis and increases vaccine access and uptake for all children around the world.

The Global Fund: Then and Now

Whenever someone visited their home village in Zambia, they would be afraid to ask the whereabouts of friends and relatives. Often times the answer was, “Didn't you hear?” Nothing else needed to be said. This grim scene changed when the Global Fund started supporting programs that provided treatment for people with AIDS and TB. Now when people in Zambia return to their village or town and asks, “Where's John?” the answer is not “Didn't you hear?” The response is more likely to be, “He went to Botswana for work” or “He went to South Africa to go to school.”

Within a decade the Global Fund stopped the terror that was draining the life out of societies, cultures, and economies around the world. Below are facts and figures that highlight the Global Fund’s successes and encourage critical reflection on global efforts to eradicate diseases of poverty.

4.1 million
Over the last decade the Global Fund has prevented 4.1 million TB deaths. Source: The Global Fund 2011

4,000
Every day Global Fund programs save 4,000 lives. Source: The Global Fund 2011

6.6 million
Worldwide, 6.6 million people in low and middle-income countries are on AIDS treatment, up from 200,000 a decade ago. Source: UNAIDS Data Tables 2011

3000%
Access to AIDS treatment has increased over 3000% since the beginning of the Global Fund.

230 million
Since 2002 the Global Fund has distributed over 230 million insecticide-treated nets for the prevention of malaria. Source: The Global Fund 2011

25%
Malaria deaths have dropped 25% in the last decade. Source: Roll Back Malaria 2011

8.2 million
The Global fund has treated over 8.2 million cases of Tuberculosis since 2002. Source: The Global Fund 2011

48%
Forty-eight percent of all people on AIDS treatment depend on the Global Fund to receive their medication. Source: The Global Fund 2011

1.3 million
Between 2002 and the end of 2010, 1.3 million pregnant women with HIV received antiretroviral prophylaxis through prevention of mother-to-child transmission (PTMCT) programs supported by the Global Fund. Source: The Global Fund Results Report 2011

Now — a decade after the Fund’s creation — we have real hope about bringing an end to the world’s three most deadly infectious diseases. The tragic irony is that just as there is real hope to end disease; donors are forcing the Global Fund to stall its progress.

1 million
We can prevent 1 million TB deaths among people living with HIV by 2015 by implementing existing tools and expanding services. Source: Stop TB Partnership 2011

12.2 million
New modeling shows that an increased investment of $6 billion for AIDS drugs will prevent 12.2 million new HIV infections by 2020. Source: UNAIDS 2011

7.4 million
New modeling shows that an increased investment of $6 billion for AIDS drugs will save 7.4 million people by 2020. Source: UNAIDS 2011

Zambia-based CITAM+, a Community Initiative for TB, HIV/AIDS & Malaria, Joins ACTION Partnership

ACTION is excited to announce that Zambia-based Community Initiative for TB, HIV/AIDS & Malaria (CITAM+) has joined the ACTION partnership. With the addition of CITAM+, ACTION now consists of nine advocacy organizations based around the world that are dedicated to empowering ordinary people to become sophisticated advocates who profoundly affect their country's political process in order to improve health and save lives.

Executive Director of CITAM+ Carol Nyirenda is a leading international advocate and media spokesperson who has played an important role in advancing policies and increasing funding for TB and health programming in her home country of Zambia, on the African continent, and globally.

As a survivor of TB-HIV co-infection, Carol has tremendous knowledge of the critical needs and challenges faced by low- and middle-income populations. Carol's commitment and knowledge have propelled her into leadership positions on many national and international bodies, to help drive innovative solutions to address health challenges, and to give affected communities a voice and representation in the larger health community. She has represented affected communities on the boards of UNITAID, the Global Fund to Fight AIDS, TB and Malaria, and the International Union Against Lung Disease and Tuberculosis.

At the country-level, Carol sits on the Board of the Treatment Advocacy and Literacy Campaign (TALC), and is a founding member of both the Coalition of "Zambian Women Living" and "Act Up Lusaka". She also represents TB constituency on the Global Fund Country Coordinating Mechanism (CCM). Through these positions she spearheads national and international advocacy efforts around TB-HIV, one of which resulted in the Zambian government's ultimate decision to implement WHO recommendations for collaborative TB-HIV activities.

Carol worked to establish CITAM+ in 2005, which develops sustainable TB-HIV support groups in and around Lusaka. Through this organization, Carol was instrumental in developing a comprehensive TB-HIV plan, which included community outreach and policy analysis to help ensure HIV groups incorporate TB counseling and services into their programming, and become educated about the growing co-infection epidemic in Zambia. CITAM+ currently holds a seat on the TB/HIV Joint Collaborative Body hosted by the Zambian Ministry of Health.

With the addition of CITAM+, ACTION continues to expand its global reach and improve its ability to fight TB and other global health issues.

MSF Steps Up TB Detection and Prevention

ACTION partners selected to serve on new Global Fund for AIDS, TB, and Malaria Committees

ACTION is excited to announce that two members of the ACTION partnership, Joanne Carter, Executive Director of RESULTS Educational Fund, and Allan Ragi, Executive Director of the Kenya AIDS NGO Consortium, have been appointed to serve on newly created Global Fund committees. Joanne will act as the Developed Country NGO representative on the Strategy, Investment and Impact Committee (SIIC), while Allan will be the Developing Country NGOs representative on the Finance and Operational Performance Committee (FOPC).

The SIIC and FOPC are two of the three committees created at the Global Fund's Twenty-Fifth Board meeting in Accra, Ghana, as part of a continued effort to reform their governance structure and fully implement recommendations made by the High Level Panel to streamline the committee structure. The Finance and Operational Performance Committee (FOPC) is mandated to provide oversight of the Fund's financial resources and ensure optimal performance in the operations and corporate management of the Secretariat, while the Strategy, Investment, and Impact Committee (SIIC) is chartered to provide oversight of the strategic direction of the Global Fund and ensure the optimal impact and performance of its investments in health.

These appointments, as well as the selection of Lucy Cheshire, a close ACTION ally, as the Communities representative on the SIIC, are an exciting opportunity for ACTION to contribute to the Global Fund's work of increasing efficiency, inclusion, and effectiveness.

"Our ACTION partners have been committed to the life-saving work of the Global Fund since its inception a decade ago." said ACTION Director Kolleen Bouchane. "ACTION is excited to be represented on the new committees by Joanne Carter and Allan Ragi, brilliant leaders within our partnership and on global health. In this moment of funding uncertainly for the Global Fund, just as the end of AIDS has become a real possibility, their work - the work of all those committed to seeing the Global Fund sustain and scale-up - is absolutely critical."

To date, the Global Fund has committed US$ 22.6 billion in 150 countries to support large-scale prevention, treatment and care programs against AIDS, TB, and Malaria.

More information on these new committees can be found here

The Rise of Totally Drug-Resistant TB: Implications For Africa

Andrew Speaker caused an international incident in 2007 when he boarded an international flight while infected with XDR-TB, a form of tuberculosis resistant to most available drugs. It was terrifying to imagine what could have happened if the flight had taken off. Was there anything scarier than flying next to a person with extensively resistant TB?

This week doctors in India identified twelve cases of TB that are totally drug resistant (TDR-TB). Whereas XDR-TB is sixty percent fatal, this new form of TB is one hundred percent fatal. Researchers, policymakers, and patients are scrambling to make sense of it all. Although India's TB program has been successful, it fails to include patients with multi-drug resistant TB. Ninety-nine percent of Indians lack access to proper treatment for drug-resistance, which has fueled the rise in XDR and given root to this new form of totally resistant TB.

This new strain threatens to take us back sixty years ago when TB was incurable. But things have changed in the last sixty years. Now there's HIV.

It's terrifying to imagine the impact this new form of totally drug resistant TB could have if it combines with HIV. Sub-Saharan Africa has the highest rate of TB-HIV co-infection in the world. In some places like Swaziland, over eighty percent of people diagnosed with TB are also infected with HIV. Drug-resistant TB is particularly dangerous in this population because it preys on people with weakened immune systems.

"If we had a strain [of TB] for which there is no treatment... It would be mean mass devastation" says Carol Nyirenda, Zambian TB-HIV activist and patient advocate. Zambia is currently experiencing stock outs of anti-TB drugs - shortages that develop of drug-resistance. Emergence of TDR-TB would place even more strain on the already fragile health system. Laboratory capacity is another problem. "We don't have the capability to do that kind of testing," Nyirenda explains.

The threat of drug-resistant TB and HIV has been around for the last decade, but little has been done to address the problem. Dr. Jim Kim, co-founder of Partners in Health warned in PBS's documentary Rise of the Superbugs, "When drug-resistant TB and HIV collide, as it is right now in places like South Africa...it is going to be a disaster, the likes of which I think will surprise many of us. ... There is no reason we shouldn't be able to get it under control now, with resources that are pitiful compared to what we spend on so many other silly things."

It's time global leaders take immediate action to control and prevent the spread of TB. "We need to ensure a constant supply of anti-TB drugs and more education around TB," explains Nyirenda. This new form of totally drug-resistant TB must be taken very seriously. It won't be long before the new strain surfaces elsewhere. After all, TDR-TB is only a plane ride away.

Thoughts on a visit to Aeras

As a public health graduate student, I jump at any chance I have to get involved in my future field. The other day, I was given an opportunity to visit Aeras and tour their facility. With an academic background that is strictly social science, I was initially intimidated by the hard science that would soon be thrown my way via chemical compounds, acronyms, and scientific processes used to develop Tuberculosis vaccines. But then I thought to myself, Tuberculosis vaccines! How can I pass on an opportunity to meet with people that could potentially save millions of lives (approximately 1.4 million per year, according to Aeras)? Bolstered by the fact that my classmates back in Oregon were jealous of my opportunity to visit a place that we had discussed in classes, I took my new found confidence to Rockville, Maryland.

The scientists and researchers that we met with at the Aeras facility were wonderful. It was a humbling experience to watch these brilliant minds try to contain their excitement about their work and also try to use terms that non-scientists would understand. Admittedly, there was quite a bit of information that went over my head, such as using a matched prime boost and an adenovirus as delivery vehicles. These words mean little to me. But enough of the tour made sense for me to be in awe for my entire time at the facility. The most fascinating thing that I took away - something I had no idea was even happening in the research world - is that Aeras uses equipment for lyophilization, or freeze drying. Freeze drying! An aerosol vaccine is the ultimate goal with this technology, which is an oral dosage that would be administered directly to the lungs for faster and more efficient outcomes. An aerosol vaccine would be given through an inhaler rather than a syringe which would lead to more cost-effective production, easier access of the vaccine to most of the world, and easier storage, in that a it would not need to be kept at a specific temperature. This technology, if successful, could also be used for future vaccinations against other infectious diseases as well. The benefit of having a vaccine that does not need to be refrigerated is integral for low-income nations that may not have access to refrigeration or are prone to sporadic power outages. The current BCG vaccine requires refrigeration and has shown varying degrees of protection against TB in certain areas of the world.

Something else that affected me while on the tour was the collection of photographs hanging on the walls in the hallway outside of the laboratories. The photos, taken by David Rochkind, documented several lives affected by TB in South Africa. There was one picture, of a doctor surrounded by white buckets holding up a bag. The caption said the bag contained the heart and lungs of a deceased TB patient. All the buckets contained them as well. Gold mine workers often have their hearts and lungs preserved and examined to determine if TB killed them so their families could receive compensation. Even though TB is the killer the majority of the time, very few families are compensated.

The facts and figures surrounding TB and the need for a new vaccine are astounding. There are around 2 billion people in the world infected with TB, and the current vaccine (Bacille Calmette-Guérin (BCG), created in 1921) has little impact on the pandemic. In addition, 90% of people living with HIV that contract TB will die within three months. These facts, coupled with the new findings of totally drug resistant-TB, should be enough for anyone to want to join the fight against TB, regardless of understanding the science behind the vaccine development.

Marking a “Polio Free” Year in India

ACTION partner, Dr. Bobby John of Global Health Advocates India, reflects on one year since the last wild polio case was detected in India.

"Indian investment and global support have brought things to this critical watershed moment. The next challenge is to maintain another 24 months of polio free status to truly be able to say that endemic wild polio transmission in India is a thing of the past, and to use the experience and infrastructure to raise the rates of immunization coverage among all children for the other diseases for which vaccines are available." -- Dr. Bobby john

Sitting by a makeshift immunization booth in Baramati Taluka, Maharashtra, India, in an old government owned off-road vehicle with 4 vaccine carrier boxes, I was not thinking of halting wild polio transmission in India.

On that hot dusty day in 1995, it all seemed to be a great big “tamasha¹”, especially to a newly minted medical graduate on his first field experience - running around with additional vaccine carrier boxes, checking the labels, ensuring all babies under 5 were being counted, coaxing people to come to the booth... yes, polio was preventable, with just a drop of the vaccine; indeed it needed to be, but did we have to do all of this? And in all of India at one go?

The answer slowly sank in: Yes, and much more, as the last 17 years of work has taught us. Tackling polio on a massive scale in a country that was not doing too well on its universal immunization program seemed counter-intuitive, but it has demonstrated what well thought out and funded programs can achieve at the grassroots level.

On the way, it enabled a better understanding of how communities need to be engaged in health programs, and how clear and honest communications formed the bedrock of relationships between a public health program and the beneficiary communities.

It also paved way for innovations in delivery of health services, from the use of micro-planning techniques, GPS technologies to track teams and vaccine consignments, team building and retention of talented people, and dedicated funding within the national budget. It showed what Indians and their government could do if they put their will to it. Through Rotary, thousands of middle class Indians came out onto the streets to be part of the delivery mechanism on pulse polio Sundays.

The proof is here today to see: A year has passed by since the last wild polio case was detected in India. Indian investment and global support have brought things so far, a critical watershed moment. The next challenge is to maintain another 24 months of polio free status to truly be able to say that endemic wild polio transmission in India is a thing of the past, and to use the experience and infrastructure to raise the rates of immunization coverage among all children for the other diseases for which vaccines are available.

Meeting this challenge with enthusiasm, both for maintaining wild polio free status and covering other vaccine preventable diseases will set India up on the path to reducing its infant mortality numbers.

Totally Drug Resistant TB? I can’t even imagine.

I spend most of my day reading about TB. I go over statistics, case fatality rates, and co-infection with HIV. It's easy to get lost in the numbers. But every so often I hear a story from someone with TB that shakes me to my core. The personal stories illustrate how devastating TB is for people and their families and remind me why I do what I do. No story is more heartbreaking than that of someone suffering from drug-resistant TB.

People with drug-resistant forms of TB are forced to take more toxic second-line medication with horrifying side effects. They stay on treatment for two years and are often kept in isolation, away from their friends and family. If that is what it's like to have MDR or XDR-TB, I can't even imagine what it would be like to be diagnosed with a new form of TB that is completely resistant to all medication.

This past week doctors in India reported twelve cases of TDR - totally drug resistant TB. It's 100% fatal. I spent most of today trying to imagine what would it be like to get diagnosed with an airborne disease that has no cure? What if you had already spread the disease to the rest of your family?

In an attempt to gain further understanding, I re-read RESULTS UK's report Tuberculosis: Voices in the fight against the European epidemic. One of the most compelling stories was about a Romanian man named Iulien. When first diagnosed with TB, he took his medication regularly. But like so many others, he was forced to interrupt his treatment so he could go back to work and support his family. By the time he returned home to restart treatment the disease had become resistant - but the local dispensary had run out of one of the drugs required to treat MDR-TB. Taking incomplete treatment puts him at risk for developing XDR-TB, which is even more fatal.

Iulian explains: "I have this fear in my heart that I'm never going to get better. The pills, there are a lot of them, and they are very strong. They give you headaches, stomach aches, and make you feel like throwing up." He was isolated during treatment and wasn't able to help his wife raise their two children, which he says was the worst part about being sick.

Jonathan Stillo, a TB researcher, explains the impossible choices Iulian was forced to make. "He took his treatment conscientiously but had to go back to work in order to take care of his family. He knew it placed him at risk for a relapse and that is what happened...Given the choice between his own health and his family's well-being, he will choose them every time. It is a choice he shouldn't have to make."

Reading Iulian's story again made me wonder, if this is what it's like to have MDR-TB, what would it be like to have TB that is completely drug resistant?

Kenya’s TB campaign proves a success

“Electronic nose” shows promise for sniffing out TB

What Steve Jobs Can Teach Us About AIDS

Last week I joined heads of state, leading scientists and activists in Ethiopia's mountainous capitol city of Addis Ababa for Africa's largest gathering of leaders working to end the AIDS crisis. With access to HIV treatment at record highs and climbing, new infections falling, and recent scientific breakthroughs being put into practice, the spirit in Addis should have been one of hope and optimism. Instead, attendees saw what new research on financing for global health released yesterday confirms: unless we change course, a public health catastrophe looms directly ahead.

There's no magic bullet that will destroy the AIDS virus. But, implemented together, antiretroviral therapy (proven to reduce HIV transmission by 96% when initiated early), voluntary male circumcision (which reduces risk of infection by half), and stopping the transmission of HIV from mothers to their children during the birthing process suggest that the end of AIDS is finally within reach.

Yet there's a ghastly paradox. The funding needed to put this science to work has started disappearing. After more than a decade of gains, global AIDS funding fell for the first time in 2010, by about 10 percent (or $740 million) compared to 2009. Furthering the decline, last month the Global Fund to Fight AIDS, Tuberculosis and Malaria-the world's largest international funder to prevent and treat these three diseases-suspended all new grants until 2014, citing a lack of resources as the primary reason.

Responding to the Global Fund's announcement, Andrew Jack at the famously sober Financial Times wrote, "With donors seeking ways to cut support, billions of dollars and millions of lives are at stake."

No surprise then, that the requisite fanfare, traditional dancing and musical performances during ICASA's opening ceremony seemed an incongruent backdrop to the grave speeches delivered by the high-profile speakers.

Former U.S. President George W. Bush, who in 2003 launched the President's Emergency Plan for AIDS Relief, acknowledged the budget challenges posed by the global economic recession. Yet he insisted, "The US and other donors must set priorities and there is no greater priority than saving human lives."

Michel Sidibe, the Executive Director of UNAIDS, called on governments to provide emergency financing-currently estimated at $2 billion-to jumpstart the Global Fund and restore the AIDS funding trajectory. He admitted, "I am scared by unfolding events and that global HIV funding is declining for the first time. Once patients are off ARVs for six months, they die. If we don't pay now, we will pay forever."

Professor Peter Piot, Director of the London School of Hygiene and Tropical Medicine and co-discoverer of the Ebola virus (and a Belgian Baron to boot), warned that, "All precious gains will be wiped out unless funding comes forward."

Depending on which of the half-dozen sessions on AIDS financing one attended in Addis, funding projections ranged from uncertain to dismal. Experts intoned that the coffers are drying. Budgets are strapped. The European debt crisis has ended a decade of flush global health financing.

Listening to these grim prognoses, I was reminded of a quote from Apple's Steve Jobs relayed in Walter Isaacson's enthralling new biography, which I impulsively purchased in the airport and tore through on my way from Dulles to Addis: "The best way to predict the future is to create it."

Jobs left a legacy forged by a tenacity and unwillingness to compromise that were so unyielding it bordered on the maniacal. Colleagues felt themselves sucked into Jobs's "reality distortion field," through which he utterly failed to recognize the possibility of failure despite whatever facts laid there before him.

Time and again, those around Jobs claimed to have watched him bend reality to his will and birth beautiful new technologies others swore were beyond reach. One Apple vice president explained that when caught in Jobs's reality distortion field, "You did the impossible, because you didn't realize it was impossible."

As the world plods on in this economic malaise, we're certain to hear further admonitions that we must postpone our vision of the end of AIDS and simply learn to get on with less.

When we do, I'll be thinking of Jobs. And I'll see a reality that he might have seen: we work hard, leaders lead, we mobilize the resources and re-establish the course.

AIDS 2012: Submit A Workshop Proposal

Impact the profile of TB-HIV at the conference

WHY SHOULD I SUBMIT A WORKSHOP?

HOW DO I SUBMIT A WORKSHOP?

These workshops will help participants develop skills and collaborative learning around the latest scientific research, emerging technologies, and breakthroughs in policy and programming. It is a great opportunity to highlight advances in research and scale-up of evidence based approaches, including TB-HIV.

These workshops should provide participants with innovative skills to assess and measure the commitments and actions of leaders. Workshops should challenge individuals and organizations to consider the ways they go about developing leadership and accountability and what outcomes they hope to achieve by doing this.

This series of workshops will showcase effective community empowerment programs that add value to public health outcomes in treatment, prevention, care, and support. Participants will broaden their knowledge and skills to be able to implement effective programs in their communities.

Remarks by Stephen Lewis, Co-Director of AIDS-Free World at ICASA

Remarks by Stephen Lewis, Co-Director of AIDS-Free World, delivered at a plenary session at the 2011 ICASA

ADDIS ABABA, 7 December 2011 (ICASA 2011) -

"With your indulgence, I'm going to deviate from the assigned topic. I shall address the Millennium Development Goals, but not in the way that was anticipated. There are two reasons. First, I want to speak in an unusually personal way, and from the heart, and in a fashion that leaves no room for ambiguity. Second, I consider the attack on the Global Fund to be the most serious assault it has endured in its ten-year history. I would feel utterly delinquent to let the issue slide.

I am seized by frustration and impatience. Let me explain.

I'm thrilled when UNICEF tells us of the possibility of the virtual elimination of pediatric AIDS by 2015. But I know-as knowledgeable people in this audience know-that it remains an unlikely prospect, but more important, that we lost several precious years during the last decade where we simply didn't apply the knowledge we possessed to prevent vertical transmission. It was a terrible failure on the part of international agencies and governments. Worse, the mother barely factored into the so-called "PMTCT" equation at all. As we come to this thrilling moment of progress, I cannot forget the millions of infants who died unnecessarily and the women who were never given treatment.

I'm thrilled at the creation of UN Women, and the possibility, once they join as a formal co-sponsor of UNAIDS, that the focus on women will be given a new lease on life. But I can't dislodge from my mind the experience of my years in the role as Envoy, and subsequently working with AIDS-Free World, when it became clear that in every aspect of the pandemic women were rendered subordinate. Gender inequality doomed their lives. Sexual violence fed and feeds the virus. The entire survival of communities and families was placed on their shoulders. Men were the social determinants of women's health, and men simply didn't care. As we come to this thrilling moment of potential progress, I can't avoid the spectral faces of stigma, discrimination, isolation, and pain, and they are the faces of women. That doesn't mean that women aren't the core of courage and strength in this pandemic; it simply means that they have to struggle valiantly to challenge the phalanx of male privilege, of male hegemony. Just a few days ago, coincident with World AIDS Day, the Harvard School of Public Health held a symposium called AIDS@30 to assess the past and plot the future. The symposium had a Global Advisory Council of nineteen eminent experts on the pandemic: 17 men and 2 women. It is ever thus. It's the rare woman indeed who doesn't ultimately report to a man in the world of HIV, or who can command, ever-so-rarely, the place and presence that legions of men command automatically.

I'm thrilled when I hear animated talk of male circumcision. But I know that we didn't need to wait for the results of the three studies in Uganda, Kenya, and South Africa. Nothing would have been lost if we'd focused immediately on making circumcision safe and available for informed parents to choose for their male babies; it's a minor procedure that has been performed for centuries. Instead, during nearly a decade as the evidence piled up that circumcision was a defense against AIDS-evidence provided by experts in the field-we waited and waited and waited, in that self-justifying paralysis of excruciating scientific precision. As we come to this thrilling moment of progress I cannot forget the numbers of lives that might have been saved had we acted sooner.

I'm thrilled with all the talk of "Treatment as Prevention" and how it has suddenly become the mantra of the international AIDS community. But back in 2006, I sat beside Dr. Julio Montaner, about to become President of the International AIDS Society, when he first expounded the proposition at a press briefing at the International AIDS Conference in Toronto. His evidence and argument were rooted in science and common sense in equal measure. But he had to endure scorn and derision, and we had to endure a five-year delay until Treatment as Prevention was definitively authenticated by the National Institutes of Health in Washington. Julio's theory suddenly became the 96% solution five years later, and it doesn't-I emphasize-it doesn't apply only to discordant couples. As we come to this thrilling moment of progress, I cannot forget the numbers of lives that might have been prolonged if we hadn't waited nearly five years to create the momentum that now propels us.

I'm thrilled with the turnaround in South Africa. The dramatic roll-out of treatment is nothing short of miraculous. But I remember all those years of denialism, and not a single voice at the most senior levels of the United Nations-Under-Secretaries-General, the Secretary-General himself. Not one of them said publicly to Thabo Mbeki, "You're killing your people". Oh, to be sure, it was said in private by everyone. They took Thabo Mbeki aside and begged him to reverse course. He didn't budge an inch. Around him, in every community in South Africa, and in communities throughout a continent heavily influenced by South Africa, were the killing fields of AIDS. As we come to this thrilling moment of progress, I can't forget the millions who died on Thabo Mbeki's watch, while those who should have confronted him before the eyes of the world stood mute.

I'm thrilled by the embrace of the slogan "Know Your Epidemic; Know Your Response" and the current concentration on high-risk groups. But I note that there were many voices, over the years, not all of them eccentric, calling attention to concurrent sexual partners and discordant couples, to MSM and sex work and sexual violence, and particularly injecting drug use, and they were contemptuously dismissed. I cannot but remember that magnificent gay activist from the Caribbean, Robert Carr, who died such an untimely death ... back at the pre-conference on MSM in advance of Vienna last year, Robert made one of those speeches that leaves you gasping. When you hear what the experts say, said the normally tactful Robert, it's bullshit - and he repeated bullshit so many times in the course of thirty minutes that the crass word became a cry of mobilizing dignity. As we come to this thrilling moment of progress, I can't forget the casual delays in responding to vulnerable groups. Experts fiddled while human rights burned.

So if you sense a certain impatience in me, you're right. We don't have another day to lose. Peter Piot did the arithmetic yesterday ... 1,350,000 put on treatment in 2010; 2,700,000 new infections, exactly double the number in treatment in the same year. It works out to 7,397 new infections every day. And it's 2011, for God's sake. It's appalling that such numbers continue to haunt us; it's heart-breaking beyond endurance to contemplate further exponential agony. We cannot delay another minute in putting the ‘prevention combination' to work.

And I think, judging from the mood in the corridors, that's what seizes this conference. But right at the moment when we know, irrefutably, that we can defeat this pandemic, we're sucker-punched at the Global Fund.

What's a sucker punch? It's when a boxer in the ring gets a punch below the belt that he doesn't see coming. No one expected a complete cancellation of Round Eleven, with new money unavailable for implementation until 2014.

It's just the latest blow in a long list of betrayals on the part of the donor countries, in this instance the Europeans in particular. I've heard from several people that the politics of the Global Fund meeting in Accra two weeks ago, when the decision was made, were not just complicated, but amounted to miserable internecine warfare. Certain governments on the Board of the Global Fund simply discredited themselves. They give a soiled name to the principle of international solidarity. The Chair of the Board, in a remarkably convoluted effort, tried to explain things in a press release. He would have done far better to remain silent.

The decision on the part of the donor countries is unforgiveable. In a speech a few days ago, I addressed the Global Fund predicament by talking of the moral implications of a decision that you know will result in death ... death on the African continent.

I asked: "Do they regard Africa as a territorial piece of geographic obsolescence? Do they regard Africans themselves as casually expendable? Is it because the women and children of Africa are not comparable in the eyes of western governments to the women and children of Europe and North America? Is it because Africans are black and unacknowledged racism is at play? Is it because a fighter jet is worth so much more than human lives? Is it because defense budgets are more worthy of protection in an economic downturn than millions of human beings?"

These are not phrased as rhetorical questions. I mean each and every one of them.

Spare me, I beg of all the speakers ... spare me the economic crisis. Everyone knows that when it comes to financing wars, or bailing out the banks, or bailing out Greece, or reinstituting corporate bonuses, or even responding to natural disasters that threaten economies, there's always enough money. We're drowning in crocodile tears. It's not a matter of the financial crisis; it's a matter of human priorities. We have a right to ask the G8: what do you sanctify as governments: profits and greed or global public health?

That's especially true in the case of the United States. I was, like everyone else, delighted by President Obama's endorsement of the proposition that PEPFAR could treat a total of six million people rather than four million people by 2013 with the same money. And I congratulate Ambassador Goosby for seeing that through. It's wonderful. No one would take issue. How could you? There's no additional money involved: it's just greater efficiency and more targeted spending.

And then the President went on to affirm his support for the money that's supposed to be destined for the Global Fund ... $4 billion over three years, 2011-2013; $1.3 billion a year.

Now let me take you back a step. In 2010, when the three-year pledge for the Global Fund was being discussed, the activists in the United States were asking for $6 billion over three years, believing that this was a fair share for the United States and an inducement to all the other donors. They feared that the President would stay at $3 billion over the next three years ... roughly the previous allocation for the Global Fund. When he endorsed $4 billion, it was considered a partial victory.

In my respectful submission, it's time for the United States to take a hard look at $6 billion. Many American speeches glow with the words that the US is the largest donor to the Fund. Well of course they're the largest donor; they're the most dominant and wealthy economy in the world. I really think that apart from calling on the European governments to reverse their decision, President Obama should tell Congress he wants a full $6 billion.

I don't expect that anyone ever listens to me. But I do point out what was emphasized at the opening of the conference: money to do battle against HIV/AIDS is the singular non-partisan issue in Congress. Even those irascible philistines who want to cut foreign aid, or global health, have shown in the past that they're prepared to shore up funding for HIV/AIDS. It seems to me that President Obama should put his moral authority on the line, and ask Congress to raise the ceiling from $4 billion to $6 billion for the Global Fund.

It's not a matter of comparison with other countries; it's a matter of doing what's right. And that means doing your fair share regardless of whether others are doing theirs. There are many commentators who agree that the salvation of George Bush's presidency was PEPFAR. President Obama doesn't need salvation. But I can't imagine a greater act of statespersonship than to say to the world: I, Barack Obama, cannot stand the thought of another unnecessary death; if the United States of America has to bail out the Global Fund, we will.

Is the extra $2 billion dollars outrageous? The economist Jeffrey Sachs has answered that question. He points out that the United States defense budget amounts to $1.9 billion a day. In other words, we're asking that HIV/AIDS receive an additional amount, over three years, that equals American military spending in one day.

It seems to me that that's an argument that African political leaders can effectively pursue amongst the many arguments they should employ in dealing with the donor community. I agree with Michel Sidibe-who's given significant and visionary leadership to this struggle-that there must be a high-level crisis meeting, and that Prime Minister Meles should convene it.

We've waited for this moment for a long time. This is an opportunity for the African political leadership to show its muscle, and to demand that the Global Fund be restored to its intended level. Remember, at the last formal replenishment in 2010, the funding came in at a dismal $11.7 billion, far short of the $20 billion that the Global Fund really needed in order to scale up to meet universal access. Now we're being told that even the $11.7 billion is out of reach. It's unconscionable, indefensible, outrageous. It's murder, that's what it is: murder. And the donor countries expect to get away with it because there's a culture of fiscal impunity.

As I wind my way to a conclusion, let me relate an anecdote that I think is relevant.

When I left my diplomatic post at the United Nations in 1988, I took on a role as the Secretary-General's Advisor on Africa. (I admit that seems odd, but there is an explanation that more or less justifies the appointment.) There was an Inter-Agency Task Force established, and there was a kind of executive committee of four. The Chair was the noted African economist, Professor Adebayo Adedeji of Nigeria and at the time Executive Secretary of the Economic Commission for Africa; the Vice-Chair was the remarkable, brilliant Richard Jolly, Deputy-Executive Director of UNICEF; the Rapporteur was the accomplished economist Sadig Rasheed, also with the ECA, and I was the fourth, a sort of honorary post. (Note that then, as now, men were tapped to lead the way.)

We met, often in Addis - where the ECA was and still is located - with many of our colleague agencies working in Africa. The World Bank was almost always in attendance, and intermittently, the International Monetary Fund.

It was the height of "structural adjustment" programs. Every meeting was a battleground, filled with heated imprecations, accusations, and malice. Our little executive cabal of four detested the international financial institutions, and they detested us.

In the midst of endless angry discussions of conditionality, we looked carefully at the financial data, and suddenly realized a staggering truth: when you took into account the interest payments and some capital payments as well, and ran the statistics carefully, it became clear that Africa was paying out far more than it was taking in ... hundreds of millions more. The continent was financing the World Bank; the World Bank wasn't financing the continent.

And it continues to this day. Again, I remind you of Peter Piot's reference yesterday. I have a close friend who writes columns for the newspaper The Globe and Mail in Canada. Commenting on the study that Peter Piot referenced, the title of his column was, "Africa: The World's Most Generous Foreign Aid Donor". It confirms the fact that a study of nine African countries, Ethiopia, Kenya, Malawi, Nigeria, South Africa, Uganda, Tanzania, and Zimbabwe showed that they had exported doctors to Canada, the United States, the UK, and Australia, costing Africa between $2 billion and $13 billion in education and training, and saving the four western countries more than $4.5 billion in education and training. The nurses' financial ratios would be even higher.

This is an AIDS conference. We talk endlessly about capacity building. Africa desperately needs its doctors and nurses. Instead, in the vital field of health professionals, Africa loses billions in exporting its human resources.

I say all this to challenge the artificial debate on dependency. From slavery to today's extractive industries of minerals and oil, Africa is financing the world. The modern world's economy was built on Africa's human and natural resources, and it depends on them to this day. The money from the Global Fund and PEPFAR amount to partial reparations. Western donors are not engaged in some kind of financial philanthropy: we owe Africa what we give to Africa. And a hell of a lot more to boot.

That's the debate that Prime Minister Meles should induce. The donor countries to the Global Fund, having ransacked the continent for six hundred years, have no right to withdraw. They must be confronted. And all of you, who make up civil society in so many countries, must press your Presidents and Prime Ministers into action.

Let me end by coming full circle to the Millennium Development Goals. Africa will never reach the MDGs if AIDS is not vanquished. AIDS adds to the desolate state of poverty. Obviously, it affects both maternal and child health. It continues to leave children parentless (though the millions of orphans whose plight seemed a priority at past AIDS gatherings, increasingly, mysteriously, disappear from view). Gender equality is a mockery in the face of AIDS. And the so-called partnership between the haves and the have-nots is rendered laughable. Even sustainable development is influenced, because climate change feasts on weakened populations.

If the MDGs are as important as everyone says, then AIDS must be subdued.

As a last parting thought, in respect of the Global Fund, I beg you to mobilize as a truly civil society and stand up to the reckless nation-states who dare to decide whether Africans will live or die."

AIDS 2012: Call for Abstracts

In July 2012 tens of thousands of HIV researchers, policy makers, and advocates will attend the 19th International AIDS Conference in Washington, D.C. We invite you to submit abstracts for symposia that will bring TB-HIV to the forefront of the conference agenda.

Why Should I Submit An Abstract?

How Do I Submit An Abstract?

What Are the Submission Categories?

This track addresses basic science around disease progression, morbidity and mortality. It is a great opportunity to highlight advances in basic research on the influence of opportunistic infections, including TB, on HIV disease course and immune control. Emphasis is being placed on new technologies and diagnostic tools.

This track focuses on the long-term goals of providing HIV care, treatment and prevention. Abstracts should focus on the latest research findings, complexities, and controversies related to the prevention, diagnosis and treatment of opportunistic infections, including TB.

This track addresses recent advances in the epidemiology of HIV/AIDS prevention. Sessions in this track will foSubmissions in this track examine the ways in which HIV programs affect both clinical and non-clinical outcomes including health indicators, economic growth, and health systems functioning. Science from this track may evaluate the impact of prevention, care and treatment program scale-up and implementation and aims to inform resource allocation among different sectors in the fight against HIV. cus on HIV prevention research at both individual and population levels. Topics of particular interest include HIV testing, treatment as prevention, pre-exposure prophylaxis, and microbicides.

Track D encompasses a wide range of social and behavioral science disciplines. Abstracts should provide qualitative and quantitative assessments of social, political, behavioral and human rights factors that influence HIV risk, vulnerability, response and impact. Submissions from community-based program implementers and advocates are encouraged.

Submissions in this track examine the ways in which HIV programs affect both clinical and non-clinical outcomes including health indicators, economic growth, and health systems functioning. Science from this track may evaluate the impact of prevention, care and treatment program scale-up and implementation and aims to inform resource allocation among different sectors in the fight against HIV.

Global Fund Forced to Cancel Funding Round, Jeopardizing Health of Millions

November 23, 2011 - As a consequence of donor governments' failure to fulfill their financial pledges to the Global Fund to Fight AIDS, Tuberculosis and Malaria, the fund's Board cancelled plans to fund new grants to fight the three pandemics until 2014. The Board also announced it does not have the cash on hand to fund some previously approved grants. This financing shortfall has created an emergency in the international fight against AIDS, tuberculosis, and malaria-the world's three leading infectious killers.

"Donors have triggered a genuine crisis in the response to the world's three biggest infectious disease pandemics," said ACTION Director Kolleen Bouchane. "Their failure to make good on their financial pledges to the Global Fund will absolutely mean lives lost. This is a devastating breach of responsibility that will greatly limit access to proven life-saving interventions. It is not clear that the scale of this potential tragedy is fully realized by political leaders."

The emergency comes immediately on the heels of an announcement from the administration of President Barack Obama, which made supporting the rise of an AIDS-free generation an official goal of U.S. policy. Secretary of State Hillary Clinton made the announcement in a high-profile speech on November 8. The U.S. Government is the biggest donor to the Global Fund, providing roughly a third of the fund's total resources.

"In the U.S., all eyes are now on President Obama to step in and respond to this emergency by rallying Congress and other donor governments to fulfill their obligations," said Bouchane. "It is outrageous that the commitments and progress made over the last decade may now be fatally undermined by this funding shortfall, just as we were all beginning to talk seriously about the end of AIDS."

The Global Fund is the world's largest international financier of programs to treat TB and malaria, and the second-largest for HIV/AIDS. January 2012 is the 10^th anniversary of the Fund's existence.

In countries fighting these diseases around the world, governments and civic organizations were well into the process of developing proposals to submit to the Global Fund for its upcoming round of grant funding. Proposals were to be reviewed and approved in 2012. The cancellation of new grant-making until 2014 will effectively halt programs that provide basic services to treat AIDS, TB, and malaria in countries most ravaged by the diseases.

In a small country facing major health challenges like Burundi, the impact could prove catastrophic. The Burundi national TB program is almost entirely funded through early grants from the Global Fund and was slated to apply for renewal funding next year. Other countries that were set to apply for new funding to continue expanding services include Botswana, Tanzania, Zambia, Malawi, Guyana, and dozens of others. All will be negatively impacted.

"With the cancellation of new grant funding, the whole fight against tuberculosis in the East African country of Burundi is in danger," said Patrick Bertrand, of ACTION partner Global Health Advocates in France, which has ties to treatment programs across Francophone Africa. "People in Burundi will die unnecessarily from a curable disease as a consequence of this new funding suddenly evaporating. The ensuing drug shortages will almost certainly give rise to drug-resistant strains of TB, which no one will be able to stop from spreading."

ACTION, founded to fight tuberculosis, is an international partnership of advocacy organizations working together to mobilize resources and influence policies to address urgent global health challenges.

Global Health Advocates India: Not a Toy Story

Journée mondiale contre la pneumonie

Voici le constat accablant qui démontre l'ampleur de la principale cause de mortalité chez les enfants de moins de cinq ans. Le 12 novembre a été désigné journée mondiale contre la pneumonie, une journée pour parler d'une maladie oubliée qui rime trop souvent avec pauvreté et vulnérabilité. L'occasion aussi d'appeler la communauté internationale à tous mettre en ouvre pour l'éradiquer.

Plus de 1,5 million d'enfants succombent chaque année à la pneumonie, soit plus que n'importe quelle autre maladie. Avec plus de 98% de décès dans les pays en développement, la pneumonie est un obstacle majeur à l'atteinte de l'OMD 4 (réduire de deux tiers la mortalité infantile d'ici 2015) et près d'un quart des enfants qui contractent et survivent à une méningite à pneumocoques souffriront de maladies chroniques invalidantes

Il existe pourtant aujourd'hui les outils comme la vaccination pour empêcher et protéger les enfants ou la prise d'antibiotiques pour traiter ceux qui souffrent de cette maladie. Malheureusement dans des pays ou les systèmes de santé sont faibles, et l'accès aux soins limités et moins de 30% d'enfants reçoivent des traitements antibiotiques contre la pneumonie. Le manque d'accès à un traitement rapide ne peut que renforcer l'importance de la prévention au moyen de la vaccination.

Les vaccins constituent en effet un élément essentiel des stratégies de santé intégrées qui peuvent sauver la vie d'enfants atteints de pneumonie. Selon une étude, l'immunisation permettrait de prévenir 80 % des infections à pneumocoques chez les enfants vaccinés.

Alors qu'il fallait habituellement entre 10 et 15 ans pour qu'un nouveau vaccin, après son introduction dans les pays industrialisés, arrive dans les pays pauvres, les vaccins contre la principale cause de pneumonie sont pratiquement administrés en même temps aux enfants des pays en développement et des pays riches. Aux Etats-Unis, les enfants ont reçu ce vaccin début 2010. Grace à l'Alliance pour la Vaccination (GAVI) et à ses partenaires moins d'un an après, les enfants de la Sierra Leone ont été protégés par le même vaccin.

Le déploiement des vaccins anti-pneumococciques dans les pays en développement, qui a débuté en décembre 2010 au Nicaragua, a été rendu possible grâce à des dons via un dispositif de financement innovant, appelé Garantie de marché (AMC), dont GAVI a été le pionnier. Avec plus 1,5 milliard US$ en provenance de l'Italie, du Royaume-Uni, du Canada, de la Russie, de la Norvège et de la Fondation Bill & Melinda Gates, et à l'engagement à hauteur de 1,3 milliard US$ de GAVI, l'AMC a permis de rendre le vaccin disponible en accélérant les capacités de production des fabricants de vaccins anti-pneumococciques recrutés jusqu'ici tout en réduisant les prix.

Selon les prévisions de l'OMS, 3,6 millions d'enfants auront été vaccinés contre l'infection pneumococcique fin 2011 dans les pays éligibles à l'aide financière de GAVI. ( un PIB de moins de 1500 $/ habitants).

Si on ne peut que se réjouir de tels résultats, des millions d'enfants n'ont toujours pas accès aux programmes de vaccination. En juin dernier lors de la conférence des donateurs de GAVI, un total de 4,3millions d'euros à été annoncé pour l'ensemble des contributions. Grâce à une partie des fonds, GAVI prévoit de vacciner 90 millions d'enfants contre les infections à pneumocoques d'ici 2015.Pour autant plusieurs conditions devront êtres remplis pour répondre aux objectifs fixés

Dans un contexte économique défavorable, un risque réel existe quant à l'absences de décaissement des fonds promis. Des pays donateurs pourraient en revenant sur leur promesse, entraîner une effet boule de neige et réduire dramatiquement les financements disponibles et donc les ambitions de GAVI, mais aussi des pays bénéficiaires ayant fait preuve d'efforts politiques et financiers considérables pour améliorer la santé de leur population . De telles décisions de la part des pays bailleurs aurait des conséquences mortelles pour des millions d'enfantsIl est donc primordial que les Etats tiennent leurs engagements trop souvent annoncés et peu souvent respectés.

Si le vaccin anti-pneumocoque est aujourd'hui disponible, les conditions pour son introduction et pour une immunisation massive dans de nombreux pays dépendra la capacité des systèmes de santé des pays à atteindre les populations les plus mal desservies, marginalisés et exclues des pratiques de soins. L'équité sera l'a pierre angulaire du succès des programmes de vaccination. Si Gavi à permis d'améliorer l'accès à la vaccination pour les pays à faible revenu, il existe aujourd'hui des disparités flagrantes aux seins d'un même pays, avec plus de 19 millions d'enfants non immunisés dans les pays GAVI-éligibles .

Sans l'implication de la société civile et plus particulièrement des organisations communautaires, l'universalité d'accès restera une utopie. Les vaccins sont là, le savoir faire existe et les fonds sont disponibles .

Continuons à agir collectivement pour rendre le doit à la santé un droit effectif et améliorer l'avenir de millions d'enfants.

Pneumonia kills babies: to protect them = vaccinate!

Winner of the 2011 US Presidential Early Career Award for Scientists and Engineers

I'm a pediatrician, an infectious disease pediatrician at that. We're supposed to know what to do when a baby has pneumonia---apparently that's not always true. I've treated hundreds of such cases --- but this time was different. When it's your own infant none of that experience matters. Jack looked at me with what seemed like panic in his eyes. Coughing, crying, breathing fast, sleeping in fits and spurts. Babies aren't supposed to breath that fast. He lay beside me in bed. It was the day before Christmas and I just kept telling myself that we'd be better soon---apparently that's not true either. We both had influenza, I'm sure of that. If you've had it you'll know what I mean---I felt like hell, exhausted, muscle aches, every time I coughed it felt like sandpaper scraping over my trachea. But since I'm an infectious disease doc, of course we were vaccinated!---well, apparently that wasn't true this year. I had every intention of getting that done weeks earlier, but life got in the way.

The middle of the night always makes things worse, or at least things seem worse. So, we became ‘that family', calling our neighbors in the middle of the night to care for our two-year old while we drove to the hospital with Jack. So many times I was that doctor we were about to meet in the emergency room, scratching my head wondering, "Why did they wait the whole day at home and decide to finally come in at 2 in the morning?" Well, now I knew. Sometimes it doesn't get better. He had pneumonia on the chest x-ray and needed antibiotics.

Every day, of every year, millions of children get pneumonia and struggle to breath; more than a million of them don't get the treatment they need and die. Every day of every year something unimaginable to the mothers we are, happens to mothers we don't know, over 90% of them living in poor countries in Africa and Asia ---their child dies in front of their eyes from pneumonia. It's senseless. It's inhuman. Vaccines against the biggest pneumonia causing bacteria, Hib and pneumococcus, along with other simple strategies can prevent these deaths. So, this year on World Pneumonia Day, look at your kids and remember to get them vaccinated, remember to get yourself vaccinated and remember that not every mother is so lucky....yet. The GAVI Alliance is helping give those mothers the same opportunity for their kids, faster than ever before for any vaccine. At a time when the world seems to be more complicated than ever, this seems like a pretty sensible thing to do.

Pneumonia - No Longer A Silent Killer of Children

Despite being a preventable and treatable disease, one child dies from pneumonia every 20 seconds, almost 99% of whom live in the developing world[1]. As a result of this immense inequity, UNICEF has called pneumonia the "forgotten killer of children".

Tomorrow is the third World Pneumonia Day where we refuse to allow pneumonia to be forgotten as the leading killer of children under 5, and promise to prevent and treat the disease worldwide.

Thanks to institutions like the GAVI Alliance, life saving vaccines to prevent pneumonia are being rolled out to developing countries almost immediately after the vaccine was rolled out in the developed world. Children in the developing world are the ones who need vaccinations the most in order to protect themselves against potentially deadly cases of pneumonia.

GAVI supports the roll out of the pneumococcal and Haemophilus influenzae B (Hib) vaccines, which can prevent 49% of pneumonia infections.[2] The pneumococcal vaccine is now being used in 15 developing countries and has already reached more than 3 million children with another 10 million expected to receive the vaccine in 2012.

Countries that increase basic immunization coverage with vaccines against measles and pertussis can also help prevent pneumonia cases.

Prevention of serious cases of pneumonia can save children who are most at risk - those that live too far from health facilities, those living with HIV or those with poor nutrition. Vaccines are powerful tools that can not only prevent children from dying of disease like pneumonia, but save years of suffering and costly hospitalization fees which can sink families deeper into poverty.

This World Pneumonia Day is a time to celebrate the enormous progress we have made through supporting institutions like GAVI, but reminds us that our work is not done. Preventative interventions like vaccines must reach every child, including the most vulnerable, as a part of a broader package of interventions which can save children's lives like improving nutrition and sanitation, and breastfeeding in the first 6 months of life.

[1] World Health Organization. World health statistics 2006. Geneva: World Health Organization; 2006. http://www.who.int/whosis/whostat2006.pdf. Accessed September 6, 2009. AND Black R, Cousens S, Johnson H, et al. Global, regional, and national causes of child mortality in 2008: a systemic analysis. Lancet. 2010; 375:1969-87.

[2] Global Action Plan for Prevention and Control of Pneumonia (GAPP). World Health Organization and United Nations Children's Fund, 2009.

Tuberculosis is thriving in Texas

After a frightful outbreak, Ennis High School students infected with tuberculosis have been allowed back to school. Thanks to the state's effective response - and cutting-edge medical technology and public health actions - the sick kids will almost certainly recover, and this crisis will soon be behind us.
The outbreak reminds us that tuberculosis is thriving in Texas and beyond our borders. Last year, there were 1,385 cases across the state, and 402 cases in the Houston area alone.

Worldwide, there will be almost 10 million tuberculosis cases causing 1.4 million deaths in 2011. An increasing number of tuberculosis germs have become resistant to the only available drugs. If we're ever going to end this disease, we must develop new tools for diagnosis and treatment - and we must do a better job of protecting children.

Tuberculosis is caused by bacteria that attack the lungs. The germs spread through the air when an infected person coughs or sneezes.

The traditional method of diagnosis in developing countries is for a sick patient to cough up phlegm, which a lab technician using a microscope visually searches through for the tiny bacteria.

This diagnostic method dates back to the turn of the century - the 20th century. More than 100 years later, it is still the foundation for controlling tuberculosis in most developing countries. It has never worked well, and it is even less effective with children, as they often have trouble producing phlegm and the germs are rarely seen.

Children also have less developed immune systems, so the bacteria tend to spread beyond their lungs, infecting the brain and other vital organs. These forms of tuberculosis are even harder to diagnose.
As a result, children receive little attention in tuberculosis control programs in countries where the most cases occur. This situation is just plain tragic. Because cases of childhood tuberculosis are massively underreported, official estimates are scarce and children are underrepresented in research and clinical trials for new diagnostic tests and drugs.

The World Health Organization published its annual global tuberculosis control report last week in Washington, D.C., and - shockingly - didn't say one word about the number of children infected or dying with tuberculosis. Estimates suggest that about 1 million children develop tuberculosis each year, and more than 250,000 die.

With foreign aid under threat, there is plenty that developing countries can do with limited resources. The experience at Ennis High School is instructive. If someone is diagnosed with tuberculosis, family members, close contacts and schoolmates should be proactively screened for the disease. Unfortunately, this rarely happens now where childhood tuberculosis occurs most frequently.

We must invest in better technologies to control - and end - tuberculosis here and abroad. We need better drugs, more accurate diagnostic tests and a better vaccine. The newest drug was developed before the first moon landing, and our only vaccine predates World War I. We must develop a rapid, accurate test to diagnose the disease in children. Tuberculosis in children will persist in Texas and worldwide if these advances do not occur.

It is heartening to see our health system mobilized so efficiently to protect the kids at Ennis High School and throughout Texas. But we can and must do more to help those affected by this disease beyond our borders. We cannot eliminate tuberculosis as a threat in Texas unless it is controlled throughout the world. Our safety depends upon it.

Starke is professor of pediatrics and director of the Children's Tuberculosis Clinic at Baylor College of Medicine in Houston

Saving For a Rainy Day

I'm sure we've all heard of the saying "saving for a rainy day." I try my best to put a little away every chance I get; you never know what opportunities or obstacles may be just around the corner. At this time in our history we have a really unique opportunity to begin to end the global AIDS epidemic, but some people don't quite see it that way. Here in the U.S. and abroad, you might be surprised at what counts for a "rainy day."

Between 2010 and 2012 it is estimated that $6 Billion dollars is expected to or has already been spent on sending a man to Mars, renovating airports, ethanol subsidies, and campaigning for the U.S. presidency. Let's spend that money on something that has a bit more impact. $6 Billion dollars is also how much it would take to begin to end the global AIDS epidemic and save millions of lives around the world. Just like in our personal lives, what our countries spend their money on reflects what their values are and where their priorities fall. Ending AIDS is something that CAN be done, if we put our money where our heads and hearts should already be.

Voices in the Fight

Candlelight Vigil and Services for Winstone Zulu

Services will take place at 12.00 pm Lusaka time on Saturday, October 15 at the Cathedral of the Holy Cross and burial on the same day at Leopards Hill Memorial Park.

In addition, there is a candlelight vigil tonight (Friday October 14th, 2011) in Zambia - starting at 6.00 pm Zambia time and going throughout the night. Imagine Winstone looking down with that smile and seeing not only all the lights in Zambia but in the US, Canada, UK, Japan, France, Australia, India, Kenya and all the places in the world where he touched someone - which would literally be everywhere. Think about lighting a candle in your own home, office, or where you might be during this time so we can stand in solidarity with our brothers and sisters in Zambia!

President Sata (new President of Zambia) released an official statement today and there are several other statements coming out of Zambia.Llocal NGOs are hoping to film the funeral services and link to YouTube so you can keep an eye out for that on our videos page.

Nigeria: TB Cases Drop, but Progress Face Poor Funding

The number of people falling ill with tuberculosis or dying from the disease is declining around the world for the first time in 10 years, according to the World Health Organisation.

Data reported from 198 countries in the WHO 2011 Global Tuberculosis Control Report published yesterday, showed the number of people who fell ill with TB dropped to 8.8 million last year--down from a peak of 9 million in 2005.Deaths from TB fell from 1.8 million in 2003 to 1.4 million last year, a reduction of nearly 400,000. Between 1990 and last year, death rates from TB dropped 40%.

WHO concluded all regions, except Africa, were on track to reduce mortality by half by the year 2015.

It also warns that funding problems and drug resistance could hamper current progress.

In 2009, 87% of patients treated were cured, with 46 million people successfully treated and seven million lives saved since 1995, according to the report.

United Nations secretary-general Ban Ki-Moon said the reduction in numbers of TB deaths and illness was a major progress, but insisted it was "no cause for complacency."

"Too many millions still develop TB each year, and too many die. I urge serious and sustained support for TB prevention and care, especially for the world's poorest and most vulnerable people," said Ban.

Serious decline was in large countries, including Kenya and Tanzania, where TB burden is estimated to have been falling for most of the last 10 years after a peak linked to HIV epidemic.Similar declines have also been reported in Brazil and China where TB deaths fell almost 80% in two decades--from 216,000 to 55,000.

WHO's director-general Margaret Chan said strong leadership and domestic financing, with robust support from donors, had started to make a "real difference" in combating TB.

She added, "The challenge now is to build on that commitment, to increase the global effort - and to pay particular attention to the growing threat of multidrug-resistant TB."

Domestic funding allocated to TB is expected to increase by 80% next year, though many low income countries still rely on external funding.

Nigeria is among countries concluded to have a high burden of tuberculosis, along with HIV and cases of TB resistant to drugs--so-called multidrug-resistant TB (caused by resistance to the most effective anti-TB drugs isoniazid and rifampicin).

Mortality rate from TB alone stood at 21 per 100,000 population, nearly 33,000. But prevalence of TB combined with HIV averaged 320,000 last year.

Some 40% of all cases on average was detected in 2010. In all, there were 81,454 new cases, more than 1000 in children under age 15.

At least 2,667 cases of retreatment were reported--8% of them came from treatment after failure, another 18% from treatment after default.

Some 22% of the new cases reported were showed multi-drug resistance. Among patients under retreatment, multidrug-resistant TB accounted for 94%.

WHO blames funding shortages for stalled progress in TB intervention. It said funding available for the programme in Nigeria--some $28 million--fell below $39 million budgeted.

Some $43 million is budgeted for TB next year, but only $26 million may be available for funding.

WHO suggests that the cost of treatment a patient under the DOTS programme will drop to nearly $200 next year in budgeting.DOTS is Directly Observed Treatment Short course, the recommended strategy for TB control.

Cost of treating multidrug-resistant will also drop, but remain far higher than regular TB. Each patient with resistant TB will require slightly less than $35,000.

Government funding of TB treatment for 2012 is expected to increase slightly over 2011, while funding from sources as Global Fund will shrink. But the highest proportion of funding is still expected to come from Global Fund and other grants.

WHO, however, spoke of developments in drugs, diagnostics and vaccines to combat TB. Results from three Phase III drugs are expected between 2012 and 2013 and could reduce time spent on treatment courses. Results of two other trials on multidrug-resistant TB are expected next year.

Contribute to the Winstone Zulu Memorial Fund

A memorial fund has been established at RESULTS, Inc. to provide financial support to Winstone's family. Winstone is survived by his wife, Vivian, and their four children, Michael, age 14; Waza, 11; Mwenda, 7; and Dan, 5. 100 percent of your generous contribution will go directly to Winstone's family in their time of need.

To contribute, please visit RESULTS, Inc. and choose your payment method. In order to alert RESULTS that your contribution is for the Winstone Zulu Memorial Fund, you must copy and paste "Winstone Zulu Memorial Fund" into the field that asks, "Who invited you to give to us?"

If you have any questions, please feel free to contact .(JavaScript must be enabled to view this email address)

RESULTS is a 501(c)(4) organization. Any contributions will not be tax-deductible.

ACTION Remembers Winstone

ACTION remembers Winstone as a friend, colleague, and tireless advocate. Here, staff and partners reflect on Winstone's life and work through personal stories and memories.

"Winstone was among the most courageous, life-affirming advocates I have ever known. As the first person to go public with his HIV status in Zambia, Winstone encountered much prejudice and some outright violence in taking that stance. But he persisted and was in the forefront of efforts to change attitudes and mobilize a national and global response.

"Many of us at RESULTS know Winstone best for his passionate global advocacy to address the massive neglect of the dual epidemic of TB-HIV. Winstone lost all four of his brothers to TB; that and his own experience with TB drove him to begin speaking out. He brought these issues to donor capitals and news outlets around the world, and even when he was feeling physically weak, he pushed himself and pushed policymakers and the world to pay attention. Many of us were privileged to be his partner in these efforts.

"Among Winstone's most remarkable qualities was that his challenges and losses never turned him bitter, but instead fueled his drive to make change and his ability to eloquently call the world to account and action. Winstone radiated an enormously positive energy. As we mourn his death, the most fitting tribute will be to transmute our sadness into action and redouble our efforts to end these epidemics."

"Winstone, thank you for who you were. I will never forget the tireless HIV positive activist and TB survivor and lover of McDonalds hamburgers and Jimi Hendrix, who often changed the direction of my day. You knew and taught the value of a shared struggle, of turning personal tragedy into positive action, of valuing the contributions of those who had so much more than you, and those who had nothing. And it mattered. Your life mattered so much and to so many."

"Winstone was the kind of person who had a humble rightness in his soul. Despite all the setbacks life threw his way, he just kept on doing what was right. He kept speaking, and travelling, and doing, even when the easy path was to be quiet, to stay home, to rest - because that was the right thing to do. This simple dedication to doing what was right is a moving example of how a life lived well can change the world."

"He lived his life as a fighter - knowing that even though it was hard, that he had to keep on speaking out and keep on removing the next barrier to justice and opportunity. He ran the good race and ran it hard - he's an improbable top finisher because of sheer will and God's guidance."

"The first time I met Winstone was last summer in DC. He had some free time, so I brought him out to brunch with my friends. They were surprised how someone who has been through so much hardship could be so positive...and funny! I have pet turtles, and Winstone always joked about how he wanted to use them to make turtle soup. He said, "Where I come from, what you have for a pets are what we call a delicacy." Winstone's legs were paralyzed from a childhood battle with polio so he was very passionate about improving the lives of children with disabilities. This year, he opened a school for children with physical disabilities in his hometown - over 54 students are currently enrolled. Winstone was the most amazing human being I've ever met. The world has lost a true angel."

"Winstone was the first TB-HIV patient advocate I met, and I have never felt more humbled or inspired by a single person. I often look at the photo I took with him in Zambia when I'm feeling like this boulder we are pushing isn't getting any lighter or the hill any less steep - the photo reminds me that one single person really can change hearts, minds, and the world."

"What a light he was. I remember a fantastic junket with Winstone, cracking up over and over again as we drove around Indiana and Ohio; rejoicing with him over a U2 costume/guitar sighting and watching him delight in the Jimi Hendrix exhibit at the Rock and Roll Hall of Fame; finally finding new rubber ends for his walking sticks; witnessing him inspire the Indy Star to speak out on TB/HIV . . . I'll never forget all of that. I still have my Hall of Fame wristband on my desk. Rest in peace, Winstone."

"I had the extreme pleasure to travel across the country three times with Winstone doing meetings with editors and members of Congress. The first thing that comes to mind when I think about Winstone is his humor and his love of music. Sure he was a first rate advocate for TB/HIV, but boy could that guy talk your ear off about Jimi Hendrix. On one of our trips he was able to stay with us near Seattle and we were able to take him to the Jimi Hendrix museum at the Experience Music Project in Seattle. It was such a pleasure to be his guide and friend on these trips. And, he was so much more than an advocate for TB/HIV; he was a fierce advocate for all people with disabilities of any kind. He was a loving father and husband and whenever we traveled together we spent much of our time talking about our families. My children, although they only spent a short amount of time with him, still tell stories about his visits. Winstone, for those of us who were lucky enough to know him, was quite a memorable character. One of my favorite quotes from him was when he was traveling from the U.S. to Canada and then off to Japan for a media tour and I commented on how much he was doing and how hard that much traveling must be on him. He looked right at me smiling and said, 'Stacy, there will be plenty of time to sleep when we die.' Goodnight my friend, sleep well, you will be missed."

"About a month after I started at RESULTS, I began setting up a visit for Winstone to come to Ottawa. I was new to the world of TB and I had never met Winstone, but heard that not only was he brilliant but he was a hoot, full of vim and vigour and passion and that he was exactly the right person to help us have the conversation about TB-HIV co-infection with Canadian parliamentarians. And he was. When he finally arrived in Ottawa at the end of nearly a month of travels, he was not feeling very well but insisted the show go on. He must have met 15 parliamentarians and officials at CIDA and some of the prime ministers office in about 2.5 days. I watched him deliver passionate speeches to MP after MP about why Canada needs to address TB-HIV co-infection. Winstone taught me that to be a powerful advocate, you speak from the heart and while it's always good to have a few facts to back you up, the stories of people's lives and experiences are what impact people. As Winstone and I waited in between meetings, we talked a lot about our hopes for the future. I'll never forget the look in his eyes when he spoke about his wife Vivian; passion was not something Winstone reserved only for issues and campaigns. I think maybe that is why Winstone was so powerful as an advocate; his passion was so true, so obviously from the heart and so very much for others as much as for himself. My deepest sympathies to Vivian and their children at this time; know that your RESULTS family in Canada mourns your loss."

"I remember the first time I met Winstone; that was in 1994 during the 10th International AIDS Conference in Yokohama. He was one of the only openly HIV+ activists in Africa. I remember his courageous and powerful speeches during sessions and in front of the press, despite strong stigmatization. I remember our first discussions on the deadly duo TB and HIV, even at a time where nobody was talking about it. I remember him instantly becoming a TB and HIV advocate. Twelve years later, I remember him receiving the Kochon Prize at the Union Conference in Paris, still advocating for TB with the same and so powerful energy. Winstone, our friend in the fight for access to health for all, we will miss you."

Tribute to Winstone

"There have been so few TB survivors who have stepped forward to share their stories. We need more advocates like Winstone to tell the world about TB and the effect it has on so many millions of people." -Nelson Mandela

Winstone Zulu, a preeminent global advocate on TB and HIV and a dear friend and colleague of RESULTS and ACTION, passed away on October 12, 2011. After being diagnosed with HIV in 1990, he became the first individual in Zambia to publicly acknowledge his HIV status. In 1997, he contracted and was later cured of TB.

As the first publicly HIV-positive person in Zambia, he faced intolerance and violence, yet spoke out powerfully as an advocate. Years later, after surviving TB, Winstone again put his advocacy first in order to mobilize resources and worldwide attention to the burden of TB, HIV, and the deadly link between the two.

Born in Lusaka, Zambia, Winstone was the sixth of thirteen children. He watched four of his brothers die from TB due to lack of access to life-saving anti-TB drugs, and was moved to turn his personal loss into ceaseless advocacy for worldwide awareness for the fight against TB and TB-HIV co-infection. In his decades of advocacy, Winstone traveled the world to meet with heads of states and grassroots activists and speak at numerous international conferences. He championed increased financial resources and improved programs and accessibility to combat TB and TB-HIV.

In Zambia, Winstone was instrumental in reforming the Global Fund's country coordinating mechanism to ensure TB representation and gender equality. And recently, Winstone had begun to explore, in powerful ways, issues of disability rights, and to use his own experience of having polio as a child to campaign for universal access to vaccines.

Nelson Mandela said of Winstone, "There have been so few TB survivors who have stepped forward to share their stories. We need more advocates like Winstone to tell the world about TB and the effect it has on so many millions of people."

He is survived by his wife, Vivian, and their four children. He leaves behind a legacy of courageous advocacy that will continue to positively impact the fight against TB and HIV and will help save the lives of countless others in Zambia and around the world.

Share Your Tribute to Winstone

Memorial Slideshow

In memory of Winstone Zulu, we have compiled photos that reflect his drive and spirit and his passion for life and combating TB.

The story of Shanta, neighbor and care provider: How BRAC is making tuberculosis history

Shanta, a resident of Badda, a vibrant slum in northern Dhaka, is a face of the new Bangladesh. Every day she finishes her morning tasks at home and heads out into the bustle to begin her work. Around her, the streets pulse with energy: vendors offer freshly cut grapefruit and guava, stores and stalls spill over with cheap household items imported from China, cell phone ring tones sound endlessly. Once a country of villages, Bangladesh has been transformed as the promise of economic opportunity draws the rural poor to Dhaka, population 15 million and rising.

Rapid urban migration has squeezed the capital. Increasingly horrendous traffic chokes the roads, and power outages, a lack of basic sanitation and a dearth of public services are the norm here. Conditions are ripe for the spread of tuberculosis (TB), an airborne bacterial infection that kills about 5,000 people every day around the world. But there is also hope and opportunity: It is here in Bangladesh that BRAC, the world's largest anti-poverty organization, has developed a successful approach for confronting the threat of TB, described in its upcoming book, Making Tuberculosis History: Community-Based Solutions for Millions.

Shanta is a living embodiment of the organization's success. She is part of BRAC's all-female army of 80,000 "community health promoters" (shasthya shebika in Bangla) - lay practitioners who form the pillars of BRAC's anti-TB strategy. Shanta and tens of thousands like her visit households in their communities every day, selling simple health products like vitamins and sanitary napkins, while inquiring about persistent coughs, fevers, and other symptoms of TB. These women identify individuals with symptoms, and with BRAC's help, facilitate testing and diagnosis.

For those who test positive, a lengthy course of drug treatment begins. This is where Shanta's work becomes crucial, for one of the most worrying aspects of TB treatment is the potential development of dangerous drug-resistant strains. In order to prevent that, patients must complete the full course of drug treatment. Though medication is provided for free by the government, BRAC requires most new patients to hand over a small deposit, returned only after taking the medicine regularly for six months, ensuring the bacterial infection is eliminated completely. Shanta, like other community health promoters, makes sure the patients take their medication each day as prescribed.

"Patients usually want to stick to the treatment," says Shanta. But unexpected disruptions, mobile lifestyles and stress often make it difficult. People need a support mechanism that's nearby and flexible. Patients, too, admit that without her help, they'd likely forget to take the medication sometimes. If they need to travel outside the slum - back to their home villages for a few days, for instance - Shanta gets involved, helping them plan the trip, often identifying a temporary guardian to make sure they continue with the required dosages.

For those TB patients living in the surrounding streets of Badda, Shanta is both a friendly neighbor and care provider. Patients confide in her, often sharing personal matters during visits to her home, where they come for daily treatment. (Most live within a five to 10 minute walk and like to stop by on their way to work.) If unable to come, they call her mobile phone, and she usually responds with a personal visit. For every patient of hers that successfully completes treatment, Shanta receives 150 Bangladeshi takas (US$2) from BRAC, helping her support her own three children.

Building on its success in providing health care to rural communities, BRAC has trained an urban cadre of health promoters to reach slum dwellers as villagers increasingly pack up for the cities. The organization now accounts for about 66 percent of all TB cases treated in Bangladesh.

Emerging from its earliest experiments providing TB treatment to rural villages lacking access to government health care in the 1980s, BRAC's method has brought it under fire. Numerous public health experts, government officials, donors and human rights activists pushed BRAC to change its delivery strategy, which usually involves a bond system whereby patients put down a small deposit prior to beginning treatment, returned only if they complete the full course. The organization refused, citing program data and research that supported its approach.

Simply put, BRAC's model works. With adherence an Achilles' heel for treating infectious diseases like TB, BRAC has found a way to engage patients and motivate them to continue the full course of treatment. It has tested the model in the field, defended it from critics, and scaled it up to become one of the largest such programs in the world - thanks, in large part, to women like Shanta. BRAC has brought similar methods to Afghanistan with great success, and has promising pilots underway in Uganda and Liberia.

Since 1994, Bangladesh's National Tuberculosis Program has led a consortium of non-governmental organizations in creating systems that offer free treatment to all. This partnership has expanded since the arrival of resources from the Global Fund to Fight AIDS, Tuberculosis and Malaria in 2004, reaching deeper into communities across the country. In 2010, over 45 partners participated in national anti-TB efforts, treating 150,000 patients.

BRAC launches Making Tuberculosis History, on October 27 at the 42^nd Union World Conference on Lung Health in Lille, France. For more information, write to makingtbhistory@bracusa.org.

Next in the series, we'll feature the story of Shahida, one of Shanta's patients.

Not missing a dose: Shahida, a patient, recounts her experience with BRAC

Shahida usually speaks quickly, her raspy voice sharpening every word. But she smiles and softens when asked if she'd rather just take her tuberculosis medications at home. "No," she says matter-of-factly. "I'd forget to do it every day."

As it stands, Shahida has yet to miss a single dose, a testament to the effectiveness of the anti-TB program of Dhaka-based BRAC, the world's largest development nonprofit, as detailed in an upcoming book Making Tuberculosis History: Community-Based Solutions for Millions.

Halfway through her six-month treatment course, Shahida, a resident of the northern Dhaka slum of Badda, continues her treatment under the watchful eye of her neighbor Shanta, one of BRAC's "community health promoters," or shasthya shebikas - an army of 89,000 trained lay practitioners who form the centerpiece of BRAC's anti-TB strategy.

Shahida's symptoms have already disappeared. In fact, she feels completely cured. For many, this would be the signal to stop taking the medicine, but Shahida knows, from her conversations with Shanta, the importance of finishing the full course. Not only will it prevent relapse, but failure to complete the treatment would encourage the emergence of dangerous drug-resistant strains of the bacteria that causes tuberculosis. The growth of drug-resistant strains is one of the greatest fears of global health advocates as TB continues to kill 5,000 people daily worldwide.

So Shahida continues her daily visits to Shanta's house. She sees the positive side: "It's nice to see her every day," Shahida says. "It provides a short break from all my daily chores. We usually end up talking about other things going on in the community."

It all began with a persistent fever. Shahida fell ill in May with a high temperature that didn't subside even after several days of medication. She wasn't coughing, so when she approached the doctor at a nearby clinic, TB wasn't even on her mind. But X-rays clearly indicated she had the disease.

Recognizing Shahida might be unable to afford the required treatment, the doctor recommended a visit to BRAC, which provides medications at no cost thanks to its partnership with Bangladesh's National Tuberculosis Program. A sputum test at Shahida's local BRAC branch office confirmed the diagnosis. Here, Shanta entered the picture: The patient and her shasthya shebika neighbor agreed on a time for daily visits.

Shahida prefers to keep her illness private, sharing it only with family. Though she does not buy anything else from Shanta - the shasthya shebikas have a basket of health products for sale, like vitamins and sanitary napkins - she's able to visit her regularly without eliciting suspicions from others in the community. The two women have developed a comfortable rapport.

In urban areas, local pharmacists, physicians and drug sellers (often untrained) are the first place poor people go for health care. These are often conveniently located in or near the slums and are open in the evenings, when public facilities are closed. A strategy employed by BRAC and other organizations working with the National Tuberculosis Program is to engage these providers in training and orientation to teach them about TB, the importance of adherence, and the availability of free treatment options.

Within the neighborhood of Badda alone, diverse options exist. BRAC tries to reach as many of these providers as possible, from the proper pharmacy shop to the individuals selling health products in rickshaw garages. Particularly in the complex context of Dhaka's unregulated and fragmented health care system, these partnerships create important pathways for patients to access quality TB services.

Partnership and engagement with health care providers are just two of many strategies BRAC is using for urban TB control. Learn about how BRAC works with garment factories to reach another vulnerable population.

Next in the series, we'll feature the story of Rana, a garment worker who contracted TB.

Rana, the garment worker: No longer stigmatized, TB patients open up about their experiences

A chronic smoker, Rana wasn't too alarmed when he first developed a persistent cough. Within a few weeks the Bangladeshi garment worker's health had worsened, however. He began vomiting and found himself unable to go to work at the factory. A local doctor suspected tuberculosis (TB), but Rana couldn't afford the recommended X-ray diagnosis.

It's a typical story in Dhaka, and one where BRAC, the world's largest antipoverty organization, plays a crucial and potentially life-saving role. The doctor recommended Rana seek a free diagnosis at the local office of BRAC, whose successful anti-TB efforts are the subject of the forthcoming Making Tuberculosis History: Community-Based Solutions for Millions. First developed in the 1980s, BRAC's anti-TB program now covers 91 million people in Bangladesh alone.

The nearest BRAC office lay several kilometers from Rana's home in Badda, a slum in northern Dhaka, but he wasn't sure exactly where. Asking for directions along the way, he made his way through the labyrinth of narrow streets - a sprawling neighborhood of informal shops and dwellings that has cropped up beside the main road and factories as Dhaka's population soars due to migration from the countryside.

At BRAC, the test results came out positive for TB. Thanks to a BRAC-administered government program, Rana would have access to daily drug treatment for six months, but it would need to be supervised. Rana worried that he'd be unable to get to the BRAC office every day for treatment, so Mofiz, the local program organizer, connected him with Sirina, one of BRAC's community health promoters (or shasthya shebikas) living near his house.

Now, on his way to work each morning, Rana stops by Sirina's to quickly swallow the pill with a glass of water. Mofiz has also visited occasionally to make sure his health is improving. With four of six months of treatment already complete, Rana no longer experiences any symptoms, yet the system ensures that Rana and other patients finish their prescriptions, thus eradicating the bacteria completely and preventing the growth of drug-resistant TB strains.

Rana also faced the matter of employment. Upon diagnosis, he duly informed the factory supervisor that he'd contracted TB. His manager suggested that he take a few days off to begin the treatment; Rana was relieved at not being isolated from either his employer or the other workers on his floor.

Stigma is often cited as a concern for avoiding diagnosis and treatment of TB. Before medication became widely available, many considered it a fatal disease. Even those who recovered often experienced continued alienation. Some thought the disease had a genetic component, so a husband might abandon a wife who survived the illness, while unmarried survivors faced challenges finding a partner. That Rana and other patients, such as Abhur, a rickshaw driver who successfully completed his treatment, openly shared their condition with others in their community marks huge progress in combating the social dimensions of the disease.

Women in Bangladesh still experience greater levels of psychological and social consequences, however, which is one reason communications and social mobilization activities remain a central part of BRAC's strategy for TB control. The organization's all-female cadre of 80,000 shasthya shebikas, who sell health products while proffering advice on diagnosis and treatment, creates a frontline option that gives women access to TB services without having to travel, get money from their husbands, or see a male provider.

Treatment of male TB patients, meanwhile, carries its own set of concerns, including an alarmingly high rate of tobacco product usage among men. The long-term health consequences of smoking or chewing tobacco are not immediately visible, so individuals are unlikely to try quitting on their own. BRAC is informally piloting tobacco cessation support as part of its TB treatment package in a few areas of Dhaka, including Badda. Both Rana and Abhur, for instance, have smoked for years but are attempting to quit after counseling from Mofiz and their shasthya shebikas. "It's not easy to quit," Rana says, "but BRAC told me if I want to live, I need to try."

In Bangladesh's transition to a middle-income country, chronic disease prevention and management will likely replace infectious disease control as top priorities. Supporting Rana and Adhur in quitting smoking is yet another example of BRAC's experimentation with shasthya shebikas to extend its community-based approach so that it continues to have a powerful impact even in changing times. In Making Tuberculosis History: Community-Based Solutions for Millions, the authors also explore how BRAC might apply its anti-TB methods to other pressing health issues, including HIV/AIDS and hypertension.

WHO Urges Russia to Step Up TB Fight

The World Health Organization has challenged Russia to compete with neighboring countries for the best national plan to fight drug-resistant tuberculosis - and offered money to boot.

Russia has the third-highest rate of tuberculosis of all countries in Europe and the former Soviet Union, after Moldova and Romania, according to the latest data compiled by the WHO.

The WHO action plan urges European and CIS countries to draft national programs to adopt quicker and more expensive methods of tuberculosis detection that can reduce the time between a medical exam and the results from two months to two hours, Zsuzsanna Jakab, the WHO's regional director for Europe, said at a conference of state health officials and nongovernmental activists from Europe and the CIS.

The action plan also calls for universal access to the prevention, diagnosis and treatment of drug-resistant tuberculosis by 2015 and tailored services for specific segments of the population, including migrants, drug users and prisoners, according to a WHO booklet distributed at the conference Monday.Implementation of the plan will cost an estimated $5 billion for the whole of Europe and the CIS, but will save about $12 billion for member states in the WHO European region, which includes Europe and the CIS, the booklet said.

Countries with the best programs will be eligible for financing from the Global Fund to Fight Aids, Tuberculosis and Malaria, the European Commission and other international agencies, the booklet said.

The plan is expected to help avert 263,000 cases of drug-resistant tuberculosis in the region and treat another 127,000 cases successfully, it said.

More than 128,000 new cases of tuberculosis and microscopy-confirmed tuberculosis relapses were registered in Russia, or 90.7 cases per 100,000 people, compared to 102.4 cases in Moldova and 101.7 in Romania in 2008, the latest year for which data are available.

A total of 63.1 new tuberculosis cases were registered in Lithuania that year, but all other European countries had less than eight new tuberculosis cases per 100,000 people that year.

New Global TB Report: the Time to Act is Now

I am used to explaining the issues of tuberculosis as a global health program to my friends, as many of them view it as an issue that was resolved in the 1900s. However, I was surprised to be facing the same struggle when talking to a group of friends from the developing world, including friends from Mozambique and Afghanistan- two of the 22 high-burden TB countries. I attempted to explain the need for advocacy around global TB control, but they remained unconvinced that TB was a major public health problem. Eventually the group walked off, muttering under their breath that there's no way TB is worse than malaria.

When the 2011 World Health Organization's report on Global Tuberculosis Control was published this morning, I eagerly combed through it for proof of TB's severity that I could share with my classmates. Just a few paragraphs into the introduction, I came across the fact that, after HIV, TB is the second leading cause of death from an infectious disease worldwide, killing 1.5 million people each year and is largely considered to be a disease of poverty.

In retrospect, my excitement over finding that fact is a bit embarrassing. However, it is a good anecdotal summary of the global problem of TB control. TB is simply not perceived as an issue that merits attention or investment, potentially because it is easy to treat in the developed world or maybe just because it hasn't had an attention-grabbing ad campaign like malaria and HIV/AIDS. The most commonly used TB diagnostic tests and vaccines are over 100 years old, the prominent set of first-line drugs are over 50 years old, and conventional laboratory capacity remains inadequate.

However, this is not to say that the TB report predicted a bleak future. This year's report is the first ever to declare the absolute number of TB cases has been declining since 2006 and we are on track to cut the TB mortality rate in half by 2015 in almost every region. Xpert MTB/RIF, a new rapid molecular diagnostic test that helps diagnose TB and forms of drug resistance in under two hours, is rolling out globally which will drastically increase the accuracy and efficiency of diagnosing TB. It would be comforting to relax and become complacent in the fight against TB. But this is not the time to do so. The WHO report emphasizes the importance of scaling up investments in TB control now to maintain momentum.

TB is silently killing our world's most vulnerable populations, often under the mask of AIDS. We are at the critical point to turn the tide against the disease. With the new tools like Xpert and other diagnostics and treatments in the pipeline, it is imperative that we work NOW to raise awareness, invest, and put our full force into fighting one of our world's biggest killers.

I personally look forward to doing my part to raise awareness about TB by talking to my classmates about the severity of TB, a disease that just so happens to kill more people each year than malaria, and a disease that we can control with better investments and increased focus.

Reflecting on Children and TB in Kenya

Two weeks ago, at 14 years of age, David shyly greeted me in his Kenyan community of Nyumbani, a special home that cares for orphaned children infected and affected by HIV. It was obvious that he was in good health and was happy to have visitors as his eyes filled with loving connection with his older brother William. William and I traveled to Nyumbani outside of Nairobi to spend the afternoon with David who had survived tuberculosis after losing his parents to HIV.

David had endured months of TB treatment that left him feeling sick and wondering if the medicine he was taking actually was helping him to get better. But with constant care and encouragement from his foster family and medical community, David recovered. To see David and his brother together, arms draped over one another's shoulders, smiling and sharing looks that only brothers can give, moved me greatly as I know David is one of the lucky ones. I have met the mothers whose children did not survive from this preventable and curable disease. TB is one of the top ten killers of children worldwide. We must continue to illustrate how important comprehensive TB care is for our children around the world, and follow up with action by encouraging our communities and leaders to prioritize TB prevention and treatment. David is a testament to the loving commitment provided by his local community. Scaling up similar efforts is critical to our children.

This blog first appeared on September 21, 2011 on Teresa Rugg's blog. Please read more of her entries here: http://www.tbphotovoice-teresa.blogspot.com/

Turkmenistan’s TB lab services use new luminescent microscopy

All regional TB laboratories in Turkmenistan will from now on perform luminescent (light-emitting diodes, LED) microscopy for detection of tuberculosis (TB), using luminescent microscopes and reagents that have been procured by the United Nations Development Programme (UNDP) project on strengthening TB diagnostics and treatment in Turkmenistan implemented in partnership with the Ministry of Health and Medical Industry of Turkmenistan, UNDP in Turkmenistan said.

The project also plans to support training of laboratory staff and introduction of appropriate quality assurance, and to follow up the effect of TB case detection rates and treatment outcomes.

With the project support, the expanded use of LED microscopy in Turkmenistan will facilitate the achievement of the national targets for TB control set by 2015, as well as the achievement of Millennium Development Goal 6 and the Stop TB Partnership goal, which is to reduce dramatically the global burden of TB by 2015.

The project "Strengthening and expanding of qualified services on TB diagnostics and treatment in Turkmenistan" is funded by the Global Fund to Fight AIDS, tuberculosis and malaria. Its goal is to reduce the burden of tuberculosis in Turkmenistan by consolidation of DOTS framework, its expansion by introducing and scaling up the management of drug-resistant tuberculosis and strengthening the health system performance for effective TB control.

Africa: Rota-virus vaccine to be rolled out

Texas School Outbreak Reminds Us of a Forgotten Disease

A few weeks ago, a teacher in Texas walked into a high school classroom with a cough. Now at least 128 students have tested positive for Tuberculosis (TB) - a disease that though curable still shockingly takes the lives of 1.7 million people a year.

In the U.S., we often feel immune from many diseases plaguing other parts of the world. The recent TB outbreak is a reminder that TB is a disease that does not respect borders. Everyone who breathes is at risk.

This outbreak has led many parents to feel angry and frustrated. People want more information. This exposes a deeper problem - the lack of awareness about TB. Especially TB in children.

ACTION has been working to fill the information gap and recently released a report exposing this hidden epidemic. The truth is that many people get exposed to TB. This doesn't necessarily mean they will get sick. Most of the students in Texas have latent forms of the disease which are not infectious. In fact, one-third of people in the world have this form of the disease. Only 10% of people with latent TB will develop active disease. To prevent this from happening people with latent TB are treated with antibiotics for nine months.

"But didn't my child get vaccinated against TB?" many parents are wondering. The answer is probably no. While there is a vaccine called BCG that can protect against the most severe forms of TB - it is older than the automobile and doesn't always work. The BCG vaccine is usually only given to children in developing countries but it only protects against the most severe forms of the disease such as TB meningitis, however it fails to protect against most other forms of TB and wares off as children get older. Scientists are working on developing a new vaccine, but further funding is needed to develop and deliver it worldwide.

While the students in Texas have access to TB testing and treatment, it's important to remember that millions of children around the world do not have these resources. A lack of political will, inadequate funding, and children's exclusion from research remain barriers to eliminating childhood TB. It's time we expose this hidden epidemic and find the resources to make the fight against childhood TB a global health priority

TB and HIV: A Deadly Combination for Children

*ACTION asked Jen Pollakusky, a Senior Public Policy and Advocacy Officer at the Elizabeth Glaser Pediatric AIDS Foundation, to write a blog about current issues in childhood TB-HIV co-infection. The Foundation has a long history of advocating for child health and is a key ally in the fight against childhood TB-HIV.

"It is unthinkable and grotesque that we make the same mistake over and over again. There should be an uproar of children shouting, ‘What about me?' But they often can't speak and so their plight goes unnoticed until an outraged parent decides to speak out." -Elizabeth Glaser, champion for children's health and AIDS research

Thirty years ago, when scientists first discovered AIDS, fighting the disease in children was an afterthought. Today, children still lag behind in the fight against HIV and other infectious diseases, including childhood tuberculosis (TB).

As the leading cause of death among people living with HIV in sub-Saharan Africa, TB affects millions around the globe every year. HIV-positive children and women are among the hardest hit, often suffering from both HIV and TB - a potentially deadly combination, exacerbated by their weakened immune systems.

Currently, diagnosing TB in children remains a challenge and early detection of TB is difficult. Identifying TB is particularly difficult in children with HIV, who often have other pulmonary conditions that mimic the symptoms of TB. Children with HIV are also 20 times more likely to develop active TB than HIV-negative children and have a higher risk of dying of TB.

Like pediatric HIV, few medicines exist to treat TB in children, and there are more treatment options available for adults than children. Current methods of cutting adult tablets in half for use in children fall woefully short of adequately treating pediatric TB, and often prove difficult to administer to younger patients. Additional pediatric research and drug development are also urgently needed to improve TB treatment options for children.

Pregnant women with HIV are ten times more likely to contract TB, and those who have TB have a greater likelihood of passing HIV on to their infants during pregnancy, at birth, or during breastfeeding. Sadly, if infected, TB leads to a much higher mortality rate for both mothers and babies with HIV.

But TB rates among women and children with HIV can be greatly reduced by integrating TB services withexisting programs to prevent mother-to-child transmission (PMTCT) of HIV, as well as within broader maternal and child health services. The Elizabeth Glaser Pediatric AIDS Foundation is currently working to combine services for HIV and TB into one integrated package of care to improve the health of both mothers and children.

Working in partnership with the Ministry of Health and Social Welfare in Lesotho and John Hopkins University, the Foundation is studying the most effective ways to integrate HIV and TB services into maternal and child health clinics and PMTCT settings in Lesotho. As a first step to tackling the co-epidemics, this research will help strengthen medical guidelines and ultimately improve TB and HIV services for pregnant women.

In South Africa - which has the fourth highest number of TB cases worldwide - nurses like Sister Liza are doing their part to better identify women with TB and HIV. Sister Liza works with communities to raise awareness about HIV and TB, educate families about the dual diseases, follow-up with HIV-positive women and families who have missed their appointments, and visit patients at home to help deliver and administer medicines.

In Uganda, women living with HIV such as Kakazi are proof that integrating HIV and TB services is feasible - with successful results. Soon after learning she was HIV-positive, Kakazi developed a persistent cough. Because of her status, doctors tested Kakazi for TB. Her test results came back positive and she was immediately put on treatment.

Increasing screenings of HIV-positive pregnant women for TB and expanding TB testing to child immunization programs could help address HIV and TB co-infection in mothers and children. New TB diagnostic equipment, called Xpert MTB/RIF, significantly reduces the amount of time it takes to get TB test results back and increase the accuracy of those results - while also detecting more dangerous drug-resistant TB. While initial results show this new tool may be useful in diagnosing pediatric TB, more studies are needed.

More than twenty years ago, Elizabeth Glaser spoke out on behalf of children living with HIV and inspired policymakers to take action. Today, we have an important opportunity to follow Elizabeth's example and advocate for children living with HIV and TB.

Let's not make a mistake in failing to give children a voice. We must make fighting pediatric HIV and TB a priority.

TB smoking toll’could reach 40 million by 2050

Smokers are about twice as likely to get the lung infection and die from it, compared with non-smokers.

Many of the new TB cases will be in Africa, the eastern Mediterranean and Southeast Asian regions, according to projections published in the BMJ.

A lung charity said global efforts to fight TB are being undermined by the tobacco industry's "aggressive promotion" of smoking in some places.

Dr John Moore-Gillon is a TB specialist and honorary medical advisor for the British Lung Foundation.

He said: "It is nearly 20 years since the World Health Organization declared tuberculosis to be a 'global health emergency'.

"Since that time rates have risen rather than fallen, and smoking increases the risk of getting - and dying from - TB.

"Concerted international efforts are now under way to try and turn the tide of TB, but this important research shows that all these efforts may be undermined by the tobacco industry's continuing aggressive promotion of smoking in many parts of the world."

Nearly a fifth of people in the world are smokers; many in countries with high rates of TB where multi-national tobacco companies have expanded their markets.

Smoking is a known risk factor for TB, and may reduce the ability of the lungs to fight off infection.

Dr Sanjay Basu and colleagues from the University of California set out to predict the impact of smoking on future TB rates.

According to their mathematical model, worldwide smoking could lead to 40 million extra deaths from TB from 2010 to 2050.

If current smoking trends continue, the number of new cases of TB will rise by 18 million.

Smoking alone could undermine the worldwide goal of reducing TB mortality by half between 1990 and 2015, they say.

Writing in the BMJ, the team concludes: "Tobacco smoking could substantially increase tuberculosis cases and deaths worldwide in coming years, undermining progress towards tuberculosis mortality targets.

Tuberculosis is a contagious infection that mainly affects the lungs, but can spread to other parts of the body.

If not treated, it can damage the lungs to such an extent that a person cannot breathe properly.

Sometimes, people do not experience any symptoms for many months or even years after being infected.

Putting Pledges In Action! GAVI Approves 37 Countries for Vaccine Financing

Last week, the GAVI Alliance announced the approval of a new wave of funding for lifesaving vaccines for children around the world. With resources garnered from its successful pledging conference in June (in part due to advocacy from ACTION partners), the GAVI Alliance Executive Committee reviewed and approved financing applications for 37 countries to roll out new and underused vaccines.

“Thanks to our donors and partners, the GAVI Alliance is now delivering on its promise to protect more children across the developing world against rotavirus, pneumococcal disease and other life-threatening yet preventable diseases,” said GAVI CEO Seth Berkley M.D.

This wave of applications is the first to utilize funding from pledges made last June and will finance 18 additional countries for pneumococcal vaccine roll out, and 16 for the rotavirus vaccine. As a demand-driven institution, GAVI saw the largest number of eligible country applications ever and estimates that the round will cost a little over 1 billion U.S. dollars including GAVI contributions and co-financing from recipient governments.

As a result of last week’s announcement, financing from GAVI will help immunize millions of children and protect them against some of the deadliest diseases. The WHO estimates that one child dies of a vaccine-preventable cause every 20 minutes. With GAVI’s support to introduce new lifesaving vaccines, countries can reduce this number drastically.

With new applications approved, GAVI expects roll-outs to begin in early 2012 with some occurring in 2013 to allow countries enough time to educate communities, improve cold-chain and distribution systems, and train healthcare workers. GAVI is on its way to achieve the goal of immunizing 90 million children against pneumococcal disease in 40 countries by 2015.

Children And TB: Exposing a Hidden Epidemic (Webinar)

HIV/AIDS, Tuberculosis And Malaria Are Still Emergencies

Communities Living with HIV, Tuberculosis and affected by Malaria Delegation of the Board of the GFTAM

The Communities Living with HIV, Tuberculosis and affected by Malaria Delegation (Communities Delegation) of the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) welcomes the report of the High-Level Independent Review Panel (HLP) and acknowledges the recommendations put forth in strengthening fiduciary controls and oversight mechanisms at all levels of the Global Fund, which are consistent with its values of transparency and accountability.

The comprehensive findings of the HLP is a result of six months of intensive work, and includes the review of 40 existing grants with a conclusion that all current weaknesses are opportunities that can be strengthened and improved. The Board of the Global Fund will meet on the 26^th September 2011, in Geneva, Switzerland to review and discuss the findings and recommendations, act on the most urgent issues and agree on a process to address and action the recommendations.

The Communities Delegation is deeply concerned, however, on how some of the findings of the HLP can be misconstrued. The Global Fund has committed US$ 22.4 billion in over 150 countries to support large-scale prevention, treatment, care and support programmes against the three diseases. This in practical terms translates to putting 3.2 million people on HIV treatment, treating 8.2 million people infected with Tuberculosis (TB), and 190 million bed-nets distributed to avert malaria infections. Millions of lives have been saved, because of the work of the Global Fund and its partners, and this needs to be put into perspective.

During times of a massive financial crisis and instability in the biggest world economies, major Global Fund contributors could translate the outcomes of the report into excuses not to meet funding commitments. The Global Fund needs the current and new donors to increase their contributions and pledges expressed at the Third Voluntary Replenishment Conference from US$ 11 billion to more than US$20 billion to ensure that efforts and gains made in the last decade can be effectively sustained. The Global Fund is thus far, the only mechanism in existence that could invest these resources needed in life-saving interventions. The report states, "the failure of the Global Fund would be a global health catastrophe".

Currently, 15 million people living with HIV are in dire need to be on life-saving drugs; the case detection for TB globally is at 65%, with drug resistant TB spiralling faster; and malaria cases though contained might be at a risk of exploding if efforts are not preventive efforts are not sustained. These are all emergencies that require immediate attention and extraordinary actions so as to benefit the very communities that we stand up for.

The Communities Delegation does not support the HLP suggestions to re-evaluate the Board decision on Round 11 funding, and proposals for new eligibility criteria. The Board of the Global Fund needs to be able to discuss the impact, consequences and recommendations responsibly bearing in mind the tremendous ramifications these decision(s) will have on achieving MDGs 4, 5, and 6, and ultimately on the lives of communities.

Shared responsibility is at the core of partnerships, and the Global Fund is a unique funding mechanism and partnership with an oversight and governance structure that includes multi-stakeholder participation at both global and national level. The report provides a timely opportunity for both implementers and donors to not only make the money work, but also to demonstrate how it works.

We are dismayed with some disparaging and opportunistic public statements related to the leadership at the Global Fund Secretariat after the release of the HLP report, and would like to point out that the recent reappointment of the Executive Director proves the trust and confidence of the Board in his work. The Communities Delegation has confidence in the leadership of the Executive Director, and would like to express our most sincere gratitude to staff at the Global Fund Secretariat for their tireless commitment and dedication to ensuring that lives are being saved across the three diseases.

The Communities Delegation reiterates its position of zero tolerance to corruption and the commitment to transparency and accountability. We bring to the Global Fund Board the voices and needs of millions of people living with and affected by the three diseases, and together with the Civil Society Constituencies on the Board of the Global Fund, we will remain vigilant to ensure that the most urgent changes in the structures, policies and processes of the Global Fund are implemented in order to continue saving lives.

We call for the responsible use of the public information released in the HLP report by media and governments and other partners, with a reminder that the challenges related to the three disease is an on-going emergency in many parts of the world. We need to ensure that the recommendations of the Board, and its responses to these recommendations constantly place the lives of people at the centre of our discussions.

Vaccines Against Major Childhood Diseases to Reach 37 More Countries

Geneva, 27 September 2011 - The GAVI Alliance today announced it will provide funding for 16 more developing countries to introduce rotavirus vaccines and 18 more countries to introduce pneumococcal vaccines -- a major step towards protecting children against severe diarrhoea and pneumonia -- the two leading child killers.

The roll out of rotavirus vaccines across the African continent has already begun in Sudan, and today's announcement confirms funding for 12 more African countries to follow suit.

"Thanks to our donors and partners, the GAVI Alliance is now delivering on its promise to protect more children across the developing world against rotavirus, pneumococcal disease and other life-threatening yet preventable diseases," said GAVI CEO Seth Berkley M.D..

"The death toll of rotavirus and pneumococcal infections in Africa is particularly devastating, and this is where these vaccines will make the most significant impact, not only in lives saved, but also in terms of healthy lives lived," he added. "Immunisation enables good health and healthy people are more productive and ultimately fuel economic growth."

An ever-increasing number of countries have applied for vaccine funding and yesterday (Monday) GAVI's Executive Committee approved applications from 37 countries - 16 for rotavirus vaccines, 18 for pneumococcal vaccines, five for pentavalent vaccine, and 12 for other types of vaccines (see annex for detailed list of approved countries - some countries have been approved for more than one vaccine). Out of the 37 countries, 24 are in Africa.

Rotavirus is the leading cause of severe diarrhoea in children under five years of age, killing more than half a million children each year worldwide and causing illness in several million more. Nearly 50% of all rotavirus deaths occur in Africa, where access to treatment for severe rotavirus diarrhoea is limited or unavailable.

Pneumococcal disease causes pneumonia, meningitis and sepsis and also takes the lives of more than half a million children each year worldwide, the vast majority of them in Africa and Asia. The funding of 18 more countries (including 12 in Africa) to introduce pneumococcal vaccines will take the total to 37 since the roll out of pneumococcal vaccines in GAVI-supported countries began in December 2010 in Nicaragua.

By 2015, GAVI and its partners plan to support more than 40 of the world's poorest countries to rollout rotavirus vaccines and immunise more than 50 million children. In addition to Sudan, Nicaragua, Bolivia, Guyana, and Honduras have already introduced rotavirus vaccines with GAVI's support.

"The high number of approved applications for funding for new vaccines in this latest round is yet another milestone in the fight to prevent child deaths from vaccine-preventable diseases," said Dr Margaret Chan, WHO Director-General. "As demand for new vaccines increases further, WHO will continue providing critical support to countries for decision-making on new vaccines, surveillance, and immunization programme planning, training, and evaluation."

"These new vaccines will prevent millions of children from dying of pneumonia and diarrhoea, the biggest killers of children under five," said UNICEF Executive Director Anthony Lake. "In rolling out these vaccines, we need to focus especially on reaching the children at greatest risk, for it is among the most vulnerable that these vaccines can make the biggest difference, especially if they are combined with better nutrition, sanitation and other critical interventions."

"Vaccines prevent disease and give children a healthy start to life - they represent one of the best investments in global health," said Dr. Rajeev Venkayya, Director of Vaccine Delivery at the Bill & Melinda Gates Foundation. "We must work together to ensure that all children have access to the right set of vaccines, in rich and poor countries alike."

Rotavirus vaccines have proven to be highly effective at reducing severe and fatal diarrhoea and have saved thousands of children's lives. Recent studies show the swift and significant impact of rotavirus vaccines to reduce child deaths and improve children's health.[1] For example, prior to the introduction of the vaccines in Mexico in 2006, 50% of deaths due to childhood diarrhoea were caused by rotavirus. The country has since seen a remarkable 46% reduction in the number of children under age five dying from diarrhoea.[2]

GAVI and its partners also plan to support more than 40 countries to introduce pneumococcal vaccines and immunise more than 90 million children against pneumococcal disease by 2015.

The GAVI Alliance is a public-private global health partnership committed to saving children's lives and protecting people's health by increasing access to immunisation in poor countries. The Alliance brings together developing country and donor governments, the World Health Organization, UNICEF, the World Bank, the vaccine industry in both industrialised and developing countries, research and technical agencies, civil society organizations, the Bill & Melinda Gates Foundation and other private philanthropists. Since it was launched at the World Economic Forum in 2000, GAVI has prevented more than five million future deaths and helped protect 288 million children with new and underused vaccines.

Making Tuberculosis History: BRAC Releases New Book On Their TB Program

Like many of BRAC's programs, its community-based model for TB has garnered much praise: it's been profiled in articles in the New York Times, documented in Harvard Business School case studies, received the Stop TB Partnership Kochon Prize, and hosted dozens of distinguished visitors. Some of its methods have brought them under fire, within conservative communities, with the public sector, and international donors-it was one of the first to treat patients with lay volunteers (called shasthya shebikas), all women, in the community. And while medications have always been provided for free by the government, BRAC requires patients to hand over a small deposit prior to beginning treatment that's returned only when the patient completes the six months of treatment (this can be paid by the community or waived when necessary). Shasthya shebikas watch the patients take their medications every day (a strategy now called directly observed therapy, short-course or DOTS) at their homes, receiving a small payment upon treatment completion.When pressured to change its delivery strategy, BRAC has refused, with one argument amply supported by program data and rigorous research studies: this model works. With adherence as an Achilles' heel for treating infectious and non-communicable disease alike, BRAC found a way to engage patients and motivate them to continue the full course of treatment, defended it, and then scaled up to one of the largest programs in the world. Now a critical member in a national partnership with the Government of Bangladesh, over 40 other non-governments organizations, BRAC treats close to 100,000 patients a year with a success rate of 92%, defying the assumed trade-off between quality and scale. These achievements reflect significant contributions from many, including technical expertise from the World Health Organization and the Japanese Anti-TB Association, and resource mobilization by the Country Coordinating Mechanism, and transcend national borders.Internationally, BRAC has begun to adapt the model to new contexts. BRAC Afghanistan has worked with the government to make community-based TB treatment options part of the standard package of health services offered nationally.

Since its first write-up in a scientific newsletter in 1991, BRAC has published several academic articles on its successes in tuberculosis. It has even written chapters on the program in Tuberculosis: an interdisciplinary perspective and more recently, in From One to Many, a collection of programmatic experiences in scale up edited by BRAC. Ian Smillie dedicates a chapter of his book on BRAC, Freedom from Want, to tuberculosis control. But a thorough, reflective documentation, one capturingthe broader elements of the history, collective insights, support systems, strategic thinking, and overall, the story of what had built the program, written by its veteran leaders and staff, was absent. Finally, in Making Tuberculosis History: Community-based Solutions for Millions, we have achieved just that. The book offers a complete account of the program: how it was conceived, piloted, refined, scaled, managed, and ultimately adapted for new contexts, including Bangladesh's rapidly growing citiesand Afghanistan's remote mountainous regions. Summarizing past successes and current dilemmas, the book's ultimate aim is to advance efforts to eliminate poverty and disease globally. The public health challenges facing the world today demonstrate the critical need for large-scale thinking; lessons from BRAC's TB program can inspire others to think creatively about health delivery and advancing towards health for all.

Children and TB: A Researcher’s Perspective

When I first began researching children and TB, I started with a simple question: how many children get sick with TB each year?

As a researcher, I found this difficult to believe. TB has been around for thousands of years, so how it that we still don't have clear or comprehensive data? I needed to know more.

I dug a bit further and found that in 2009, the World Health Organization (WHO) estimated at least one million children became sick with TB. However, most countries only report on TB cases that are "sputum smear positive" (where TB bacteria are visible under a microscope). But only 10-15 percent of children have this kind of TB. That being said, it is likely that the majority of childhood TB cases go unreported - making it very difficult to determine the true burden of childhood TB that exists in the world.

To me, the lack of data highlights how neglected TB is as a children's health issue. Little has been done to prioritize childhood TB in national health programs and to eliminate the disease as a major killer of children. With this report, I hope to help change that.

Making the fight against childhood TB a global health priority is overdue. Please join me in taking action against childhood TB!

A Message from CORE Group’s Pediatric TB Interest Group

When I first got involved in the global TB world about eight years ago, one of my first questions was "Why don't TB programs treat children with TB?" I was told basically, from a public health perspective, it was because children aren't infectious. Well, as a mother of three, that rationale would not work for me if one of my children had TB. In fact, of course children with TB are treated in the U.S. It's a different story for children in low-income countries that are always at the back of the line for everything, TB care being no exception.

Since that time, the world of global TB has been evolving rapidly-becoming a more diverse, innovative field, and much more dynamic. Thanks to a few visionaries, we now believe it is both possible and worthwhile to protect children from this preventable, curable disease, and to successfully care for those children who have TB. This simple vision was not even seriously considered a mere eight years ago. How ironic considering this is a disease as old as humanity.

The bad news is that most children with TB in low-resource settings STILL DO NOT have access to protection, diagnosis, and treatment of TB. They suffer and die. The urgency is especially notable in high HIV settings.

What can we do to make up for lost time? We need to get proper systems into place to collect data on the prevalence of childhood TB and then use that data to hold everyone-including ourselves-accountable for doing something about it.

While that happens, we can begin now to work together to build pediatric TB prevention and care into all levels of global health, from global alliances to national health systems to community-level programs. This should include policies, protocols and resources for screening and referrals, contact tracing, services including diagnosis, treatment and preventative therapy, and community mobilization. Integrated program efforts are called for that link TB efforts with maternal health, child health (including nutrition), HIV, and all health programs. This will entail building strategic, logical and practical connections between people and programs that currently have few or no linkages whatsoever. And it all needs to be done from the perspective of the child and his or her family. How best to reach them, and provide care and treatment?

My grandmother, a physician, spent several years of her life in a TB sanitarium in the 1940s. When I was growing up, that seemed like ancient history to me. But, right now, as you read this, a child is coughing. TB is a real and present danger, trying, probably successfully, to steal her future. That child-and millions of others-need our help. Why aren't they getting it?

-------------------------------------------------------------------------------------------------------------

CORE Group's 60+ member and associate organizations reach 720 million people a year in 180 countries. (That's a tenth of the world's population) Historically, non-governmental organizations (and even Ministries of Health in some cases) were barred from getting involved with TB. Thus, our group has relatively little collective expertise in TB programming.

But we do have a LONG history of successfully working with communities and governments on pressing health and development problems in low-resource settings. CORE Group's multi-organizational TB Working Group seeks to accelerate the ease and pace with which our members can effectively integrated TB-including pediatric TB-care and control into their work. We have found, time and again, that if we all work together on these issues, progress comes quicker, and on a larger scale.

Children and TB: A Researcher’s Perspective

Think TB Is a Disease of the Past? Think Again!

ACTION Releases Eye-Opening Report on Children & TB
Children and Tuberculosis: Exposing a Hidden Epidemic

ACTION's enlightening analysis of the link between the burden of tuberculosis (TB) and the world's most vulnerable children — those who are malnourished, orphans, or living with HIV sheds light on a neglected epidemic. The report, Children and Tuberculosis: Exposing a Hidden Epidemic, is a reminder that TB is not a disease of the past and remains a leading killer, especially of children whose underdeveloped immune systems leave them particularly susceptible.

According to the World Health Organization, approximately 9 million people become sick with TB each year.¹ At least 10-15 percent of these cases are in children under 15 — but the percentage is probably much higher, because childhood TB is under-reported.²Despite these statistics and how long TB has been a known threat, we have yet to develop truly effective diagnostic tools, vaccines, or drugs specifically with kids in mind.

Dr. Jeffrey Starke, a leading TB specialist at Texas Children's Hospital, stated that childhood TB "is a fundamentally different disease than adult tuberculosis. Its proper diagnosis, treatment, and prevention require specific planning and resources. We must consider the unique nature of childhood TB if we're to successfully eliminate TB anywhere in the world."

It is through this eye-opening report that ACTION and our partners hope to call attention to the immediate need to stop neglecting TB and increase funding and research for this deadly but preventable disease to save children's lives.

¹WHO (2010). Global Tuberculosis Control 2010. Geneva, World Health Organization.

²Swaminathan, S. and Rekha, B. (2010). "Pediatric tuberculosis: global overview and challenges." Clinical Infectious Diseases Suppl 3:S184-94.

Learn More

Our Allies in the Fight Against Childhood TB

Share Your Story

We invite you to join us by sharing your stories related to children & TB — what you, family, or friends have experience or what you've witnessed in your advocacy — in the comment section below. Your story will appear here as well as on our ACTION Facebook page. Just like in our offline advocacy, we hope these stories will inspire action in our communities to help fight TB.

Tweet Your Support

For those of you on twitter, we will be tweeting the United States Senate (@SenateDems and @Senate_GOPs) asking them to fight childhood TB and not cut funding for TB programs.

Below are some sample tweets to help you get the word out about our new report! Feel free to write your own tweets if you'd like, just be sure to use the hashtag #kidsTB!

Childhood TB has been swept under the rug for too long. Together we can put a stop to it. Please join us in calling for action on childhood TB.

Voices In The Fight Against TB

This week the ACTION Project is pleased to announce two important advocacy tools in the fight against TB in Europe. These advocacy tools - ‘Tuberculosis - Voices in the fight against the European epidemic' and MDR-TB Action Plan represent important steps in combating TB and in raising TB awareness, marking a shared commitment in tackling the disease. Medical Anthropologist Jonathan Stillo pointed out, "TB takes people out of the workforce and puts them into a state of poverty. They are not just faceless statistics, they are mothers and daughters, fathers and sons, and they are suffering." We urge European governments and institutions to fully back, both politically and financially, the WHO's Action Plan and to listen to the voices of those most affected by TB.

VOICES IN THE FIGHT AGAINST TB:

The ACTION Project is giving TB a ‘human face' in its report ‘Tuberculosis - Voices in the fight against the European Epidemic' by looking behind the statistics to focus on the every-day challenges faced by TB patients and their careers in Europe. Within the report, patients, doctors, advocates and healthcare workers from seven European countries - Georgia, Latvia, Moldova, Romania, Russia, UK and Ukraine - tell of their experiences. For more stories from those fighting TB in Europe, click here.

ACTION PLAN TO COMBAT TB IN EUROPE

Yesterday morning, at a press conference in London, WHO Europe released its Action Plan to prevent and combat multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant TB (XDR-TB) in the WHO European Region. As a result of a variety of factors, including lack of resources and political will, drug-resistant TB strains have spread at an alarming rate in the Region.

WHO Europe's Action Plan was prepared in region-wide consultation with experts, patients and communities suffering from the disease. The Action Plan seeks to contain the spread of drug-resistant TB by achieving universal access to prevention, diagnosis and treatment in all Member States in the Region by 2015. WHO Europe predicts that full implementation of the Plan will prevent 263,000 cases of M/XDR-T and will save 120,000 lives and US$ 12 billion for Member States. For further information on TB in Europe, visit the TB Europe Coalition's website here or RESULTS UK's blog by clicking here.

Urine test for TB shows promise

Testing urine samples for specific chemicals could serve as a quick and painless way to detect tuberculosis (TB), according to Indian researchers.

The urine test offers a less invasive diagnostic method for an infectious disease that causes three million deaths and 10 million new cases worldwide each year. Developing countries account for 95 per cent of new infections and 98 per cent of deaths.

The Delhi-based International Centre for Genetic Engineering and Biotechnology (ICGEB) and the Lala Ram Sarup Institute of Tuberculosis and Respiratory Diseases, collaborated with the National University of Singapore to develop the test.

The test measures five specific chemicals present in urine, the researchers reported last month (July) in Analytical Chemistry, published by the American Chemical Society.

TB diagnosis relies mainly on a test to detect Mycobacterium tuberculosis in blood or sputum samples taken from the lung and examined under a microscope.

Diagnostic tests based on 'serum' - the clear liquid separated from clotted blood - are not sensitive, especially in people vaccinated against TB.

Drug-resistant cases need an expensive, sophisticated test that takes two weeks of culturing blood samples to detect the bacterium.

Developing countries prefer a simple test requiring minimum resources and trained personnel, and one that gives quick and easily interpreted results, the Delhi scientists observed.

Their technique measures five 'volatile organic compounds' (VOCs) in urine that have a low boiling point and vaporise at room temperature.

The team tested the method in 117 fresh cases of TB and found significantly different levels of these chemicals in TB patients, compared with healthy people.

It found a distinct pattern - three VOCs showed higher levels and two lower levels - in TB patients, not seen in healthy persons or in patients with lung ailments such as lung cancer or asthma.

"A major advantage of the proposed method is the non-invasive nature of urine collection. Urine is a comparatively safer matrix as compared to sputum and painless in collection as compared to blood," it added.

ICGEB scientist Ranjan Nanda, one of the authors of the paper, explained toSciDev.Net that this was the first stage.

Nanda's team plans to validate the findings from multiple sites across India and involve a larger number of patients using improved data acquisition methods.

The team also plans to profile other VOCs in urine samples "to identify the maximum number of molecules," Nanda said.

World TB Day 2011 - TB Elimination: Together We Can

Dr. Santiago Ramón-García

Treating Tuberculosis in Colombia

GAVI’s Use of Innovative Financing

New Treatment Potential Found in Popular TB Drug

Bayer Joins TB Battle

Bayer Healthcare has pledged its support to a Tuberculosis (TB) partnership by providing 620,000 tablets of the antibiotic moxifloxacin to the World Health Organization (WHO), which will make the tablets available to China's national TB program. In particular, the medicine will be used to fight multidrug-resistant TB.

"We have decided to make moxifloxacin available to provide quick support to those patients in need," Jörg Reinhardt, chairman of the board of management of Bayer HealthCare, said in a statement. "We were happy to follow the request from WHO because we believe that this is the right step to address an increasing medical need in patients affected with this serious disease and for whom there are only very limited oral treatment options available."

According to Bayer, multidrug-resistant TB does not respond to standard TB drugs and can take two years or longer to cure. "Some countries, especially the former Soviet Union, China and India, have a high incidence of multidrug-resistant TB," explained Bayer. "According to WHO, an estimated 440,000 multidrug-resistant TB cases and 150,000 deaths occurred in 2008. Multidrug-resistant TB occurs almost everywhere in the world, the main focus being in Asia. Nearly half of multidrug-resistant TB cases are estimated to occur in China and India."

The medicine provided by Bayer, moxifloxacin, is a broad-spectrum antibiotic, but is not approved for the treatment of TB or multidrug-resistant TB. However, WHO has included the medicine in treatment group III of its guidelines as part of a second-line TB regimen in patients with confirmed multidrug-resistant TB. Moxifloxacin will be administered in China in a highly controlled manner, with close monitoring.

"Together with the Global Alliance for TB Drug Development, Bayer's pharmaceutical division is working on the development of moxifloxacin as a treatment for drug-susceptible pulmonary TB. It is the aim of ongoing studies to show that use of moxifloxacin could reduce the length of treatment for drug-susceptible TB from six to four months. Bayer HealthCare intends to apply for the approval of moxifloxacin for the treatment of pulmonary TB as soon as clinical trials have been completed," said Bayer.

The TB partnership, Stop TB, was formed by WHO in 2001, and comprises a network of international organizations, countries, donors from the public and private sectors, and governmental and nongovernmental organizations.

This is the second boost that China has had in recent weeks with regards to TB treatments. Last month, the Stop TB Partnership also announced that Aeras, a US-based product development organization and a member of the program's Working Group on New TB Vaccines, had signed a memorandum of understanding with the China National Biotech Group, with the aim of pursuing opportunities to jointly develop TB vaccines in China. Potential activities will cover the full spectrum of product development, including preclinical development, process development and manufacturing, and clinical development in TB.

According to Aeras, TB is a major public health priority in China where there are more than one million new TB cases every year. Globally, TB is reported to be responsible for 1.7 million deaths every year.

Shortage of Drug-Resistant TB Treatment Looms

While countries are rolling out new tests that will enable them to diagnose more patients with drug-resistant tuberculosis (DR-TB), a worldwide shortage of the drugs to treat these patients is likely, Médecins Sans Frontières (MSF) warns.

DR-TB can occur when TB patients do not complete their initial course of TB treatment. The only way to test for DR-TB is through cultures or via molecular testing - neither of which has been widely available in many high incident countries - until the advent of the GeneXpert, a two-hour molecular TB test released in 2010.

South Africa, which has the world's fifth-largest burden of multi-drug resistant (MDR) TB cases, will replace all microscope-based TB diagnoses with faster, more sensitive GeneXpert testing within two years, making it the world's largest user of the machine, according to Norbert Ndjeka, director of DR-TB, TB and HIV at the South African National Department of Health.

The GeneXpert machine - about the size of a milk crate - provides a fully automated nucleic acid amplification test (NAAT) that is effective in the early diagnosis of TB, MDR-TB, and TB patients co-infected with HIV, which is more difficult to diagnose.

Speaking at a recent meeting co-hosted by South African AIDS lobby group, the Treatment Action Campaign, human rights organization SECTION27 and MSF, Ndjeka said that national use of the GeneXpert machine could double the number of MDR-TB cases diagnosed.

But while more patients may get diagnosed, their access to treatment remains precarious as a limited number of approved drug producers keep many DR-TB prices high and supply uncertain, according to Dr Eric Goemaere, MSF's senior regional adviser.

Higher prices

The country cures about 42 percent of MDR-TB patients nationally, according to Ndjeka, but the national success rate masks provincial cure rates as low as 10 percent.

Treating MDR-TB patients takes up about half South Africa's TB budget and this proportion is expected to rise as the country diagnoses more cases with technology like the GeneXpert.

While DR-TB drugs remain expensive worldwide, South African activists have long complained that the country paid more than other countries that were able to access prices negotiated by the international procurement body, the Global Drug Facility. South Africa recently negotiated a US$33.8 million savings in TB drugs through its new TB drug tender, which also included DR-TB drugs such as capreomycin and moxifloxacin.

MSF has estimated that without lower DR-TB costs, South Africa will be spending as much as $630 million on treatment by 2015. At present, para-aminosalicylic (PAS), one of the world's oldest TB drugs - which has been reintroduced to MDR-TB treatment due to a lack of alternatives - can account for as much as half of MDR-TB treatment costs generally.

Ndjeka admitted that South Africa continues to pay higher-than-average prices for PAS as the drug has not been registered for use by South Africa's regulatory Medicines Control Council (MCC), which has been labouring for years under a backlog in drug registrations, including those of some fixed-dose antiretrovirals. The country now pays a private company to import the drug through a special application to the MCC.

Behind the shortages

The answer to why the prices of DR-TB drugs - even for an antiquated and highly toxic drug such as PAS - remain high is wrapped up in a range of market and regulatory dynamics that will likely mean a shortage, says Goemaere.

A drug starts with the active pharmaceutical ingredient (API), but the number of API producers for DR-TB is extremely low, and for some drugs there is only one, says Goemaere.

Many countries struggle to accurately forecast DR-TB drug needs, leaving API producers unable to forecast not only possible increases in demand but also the market: without an accurate idea of potential financial returns, would-be API producers have little reason to enter the DR-TB drug market.

In addition, difficulties in obtaining regulatory approval are another disincentive. "Because of this, our experience in MSF with stock supply is that we go from stock failure to stock failure," Goemaere remarked.

DR-TB drug capreomycin for example, has more than doubled in price in the past 10 years, according to a recent MSF report,DR-TB Drugs Under the Microscope.

MSF has called for countries to avert the looming crisis by improving drug forecasting, negotiating better prices and accelerating national medicines registrations.

Lancet Report on Global Fund Donors Doesn’t Tell the Whole Story

Ann Danaiya Usher's report in the August 6 Lancet (pp 471 to 472) on the state of pledges to the Global Fund to fight AIDS, TB, and Malaria has an incomplete understanding of the current state of donor country attitudes towards the Global Fund.

Usher rightly highlights that the Global Fund is likely to face a critical funding shortfall as it looks to sign off on the latest set of agreements for AIDS, TB, and malaria treatment and prevention programs for the next 5 years. Usher also correctly links this shortfall to the reaction of a handful of key donors to media pieces that ran in early 2011, ones that inflated the Global Fund's own reporting of $34 million lost to fraud, misappropriation, and miss-management in four Global Fund grant recipient countries. However, Usher's portrayal is only part of the story on attitudes donor towards the Global Fund, as she fails to mention important developments that point to sustained and renewed trust.

The Global Fund came out "strong" in the United Kingdom's Multilateral Aid Review, placing it in the top tier of multilaterals reviewed, and where it was noted that that it exhibited a "likely capacity for positive change." It performed similarly in Australia's very recent aid review. Its track record against the three diseases is seen by the Australians as a strong case for increased investment. Usher mentioned neither in her article.

The article focused largely on knee-jerk initial reactions reaction from a handful of donors to the media attention on fraud uncovered by the Global Fund itself, but left out recent statements and reactions from key donors. These include the recent pledge and endorsement from the Netherlands, which took place despite significant pressure on their overall aid budget. It was accompanied by a strong supporting statement by the Dutch Minister of International Cooperation, Ben Knapen, who was, "satisfied about the measures taken by the Fund ... and therefore sees no reason to reduce the Dutch contribution." Moreover, Stephen Harper, prime minister of Canada, while juggling a busy schedule at the Davos Economic Forum, insisted that Canada stands behind its investment in the Global Fund.

Usher also mentions that Italy, Spain, and Ireland have yet to make new pledges to the Global Fund, but leaves out that that is most likely due to significant budgetary constraints brought on by debt crises in those countries.

All donors eagerly await the final findings of the independent international panel assessing the risks in Global Fund grants, due out in September. I would hope for a more balanced piece from the Lancet after the completion of the panel's review, detailing donor reactions not only to panel findings, but to the implementation of the Global Fund's own reform agenda.

Mapping a New Course to Defeat Tuberculosis

It sounds like a bad case of the flu and at first that's what it feels like. "It's not something that falls on you like a ton of bricks, like other infections might, it's usually a slow moving process," he says.

Granny doesn't like going to the doctor so she puts up with "the flu" for two months, until she's "lost 30 pounds."

When she starts coughing up blood, she finally gives in. By that time, the grandkids are coughing too.

"I don't know the death rate, but it certainly is regularly lethal," says Patterson. He's speaking of tuberculosis, a disease that most Canadians never encounter except perhaps in a storybook set long ago. Hasn't TB long been banished from developed countries like Canada?

No it hasn't. Canada's TB incidence rate was 4.8 cases for every 100,000 people in 2009, a bit better than Australia (6.4 per 100,000) and a bit worse than the U.S. (4.1 per 100,000).

But TB in some of Canada's First Nations communities is far more prevalent. The rate among Aboriginals living on reserves, in fact, is 31 times higher than among non-Aboriginal Canadians, while among the Inuit the rate is 185 times higher, according to evidence presented for a 2010 report by the House of Commons Standing Committee on Health.

And Patterson is all too correct that tuberculosis kills. One out of 25 First Nations TB cases ended in death in Canada between 1990 and 2000, according to Health Canada. Older Aboriginal people are particularly vulnerable; one in five with TB over the age of 75 died.

"Tuberculosis is fundamentally a flag for poverty" says Patterson, who knows first hand. Every year since 1995, he has spent a few weeks working in northern Inuit communities. Tuberculosis, he says, is "a barometer of social privilege and the fact that no TB exists in the south among Caucasians, for all intents and purposes, and that it's highly prevalent among the reservations and among the Inuit is just the most graphic evidence of the extent of the disparity."

Patterson says this as his sail boat, The Sea Mouse, heads out of the harbour on Salt Spring Island, beginning the first leg of a sailing trip to Desolation Sound. Patterson, who allowed a reporter to sail along with him for a day, lives on Salt Spring and works at the hospital in Nanaimo. He is a well-known author who has written a memoir of sailing from Vancouver Island to Tahiti. He also has written a novel, Consumption, about how life in northern Canada changed drastically in the latter half of the 20th century and the role played by tuberculosis, formerly called consumption, in advancing these changes.

If Patterson seems consumed with the persistent toll taken by TB, he explains why as his boat slowly makes headway. "It's a manifestation of poverty and crowding." Housing in many indigenous communities is "desperate," he says. "The fact of endemic tuberculosis really reflects that."

Many working in TB prevention and control are hopeful a favourable shift in the wind is about to occur.

The First Nations and Inuit Health Branch of Health Canada is releasing an updated version of its 1992 TB Elimination Strategy later this year. The new strategy, called the First Nations and Inuit Health Branch National Strategy Against TB, 2011 will "reflect current knowledge, best practices and lessons learned since the 1992 release," according to an email from a Health Canada spokesperson.

The strategy is meant to include national targets that will assist in evaluating TB programs. It is unclear whether the new strategy will also adequately address the social conditions that allow TB to run rampant in Aboriginal communities, an aspect that Patterson and others say is key to effective prevention and control.

In response to questions regarding the inclusion of social targets in the new strategy a Health Canada spokesperson replied, by email, that the strategy "encourages collaboration within Health Canada and among key partners" to address the poor social conditions. Key partners mentioned specifically included: the Assembly of First Nations, Inuit Tapiriit Kanatami, First Nation and Inuit communities, provincial governments and health authorities, Aboriginal Affairs and Northern Development Canada and the Public Health Agency of Canada."

The response also says that the government has made significant investments to address these social conditions but that "improved collaboration among partners is essential to further reducing the incidence and burden of diseases."

"TB is a medical diagnosis, but it's a social disease," says Gail Turner, chair of the Committee on Health for Inuit Tapariit Kanatami, a national Inuit advocacy organization. TB rates have increased among the Inuit over the past 10 years and her organization is creating its own TB strategy designed specifically for Inuit communities.

TB is caused by Mycobacterium tuberculosis, bacteria that usually affect the lungs. It is spread when someone with active TB coughs or sneezes, releasing the bacteria into the air. If a healthy person is exposed to active TB, the infection could remain latent, reactivating at a later time if that person's immune system is weakened.

Crowded housing has long been considered a key risk factor for the spread of TB and just like the disease itself, northern Canada suffers a disproportionate percentage of housing needs in Canada.

The Conference Board of Canada's Centre for the North reported last year that up to 25 per cent of homes in northern Canada are crowded, compared with up to nine per cent of homes in southern Canada.

According to Health Canada, "First Nations communities with higher average housing densities have higher TB rates."

"I think you prepare a grid of the First Nations communities with the highest TB prevalence and incidence rates and you just go in and the first step of the response is medical, screening and contacts the next step is that summer you build 50 houses and keep doing it until the TB rate goes down. And it will. Every time there's a TB outbreak, that's just an argument for building 100 houses," he says.Turner cites another key factor in the fight to reduce TB: ready access to healthy food. Patterson agrees, based on what he's observed first hand.

"It's often people who are vulnerable for other medical reasons who develop tuberculosis which makes it doubly dangerous," he says. Consider, he says, the nutrition-sensitive illness of diabetes.

"Diabetes can be thought of as being to the indigenous people of North America what HIV is to Africa," he says. It "causes impaired immune function in anyone that has it, especially if blood sugars are poorly controlled."

According to Health Canada, "before, older people used to get diabetes, but now, Aboriginal people are getting it a lot younger because their traditional lifestyle has changed so fast." Eating healthy foods is the government's number one suggestion for avoiding diabetes, something that might be difficult for a community suffering from widespread food insecurity to do.

The exact interplay of TB and diabetes isn't clear yet, but Patterson says "anything that makes you sicker... increases your risk of TB."

According to the WHO, "the risk of developing tuberculosis (TB) is estimated to be between 20-37 times greater in people living with HIV than among those without HIV infection."

Patterson says HIV has not "gotten loose" among Aboriginal people in northern Canada to the same extent as on the West Coast, "but if that ever happens, TB will become a much more serious problem."

"It appears that HIV rates have been steadily increasing in First Nations and Inuit populations. They are at increased risk for HIV infections for several reasons. Social, economic, and behavioural factors such as poverty, substance use, including injection drug use, sexually transmitted diseases, and limited access to health services, have increased their vulnerability," according to Health Canada.

When tuberculosis takes hold in a place, says Dr. Pamela Orr, a professor of medicine at the University of Manitoba, the burden increases sharply on local health workers who already may be struggling with few resources in remote places.

Where "there's a very high rate of TB, they need a lot of local workers to deliver care and provide education to the community," says Orr. "They need more nurses."

Even a single TB diagnoses in a community can mean a lot of extra work for a community health nurse or worker, says Dr. Victoria Cook, the director of Tuberculosis Services for Aboriginal Communities, a department of the B.C. Centre for Disease Control.

Diagnosing someone with TB means starting him on treatment and making sure the treatment is going smoothly, says Cook, but "there's also the follow-up."

"TB is spread through the airborne route so it's something that can be spread from person to person," she says, and "there's a lot that goes into what we call contact tracing."

Contact tracing involves identifying people that may have been exposed to TB through contact with a patient, testing those contacts for TB and starting them on treatment if necessary. Potential contacts include family members, friends and health care workers. Effective contact tracing takes a lot of time says Cook. "It can be quite onerous."

According to Orr, technological resources are also in short supply in some areas.

For instance, "on the Labrador coast many of the communities don't have x-ray machines, so people have to be flown out if they have a cough," she says, "and their system of trying to get a sputum [sample] from a patient to a lab is difficult." Sputum is mucus that is coughed up from the lungs and is used to test for TB.

A spokesperson from Health Canada said in an email to The Tyee that "in 2011-2012, Health Canada is investing more than $9 million to support TB prevention, treatment and outbreak control for First Nations on-reserve across Canada and Inuit in Nunatsiavut."

Health Canada had not responded to a follow-up question asking how the $9 million would be allocated by posting time.

When the new First Nations and Inuit Health Branch National Strategy Against TB is released in the coming weeks, many on the front lines will be looking for benchmarks that can be used to hold authorities accountable for achieving progress.

Targets are crucial, says Orr, for understanding what's working and what's not in terms of TB programming. Right now, she says "there are no national performance targets that apply across the country for the general population or for sub-groups like the Aboriginals."

Cook, from the BC Center of Disease Control, says the new strategy should have ways of tracking how quickly and thoroughly First Nations are treated for TB. The plan could look at "what percentage of active cases of tuberculosis get started on treatment within the first 24 hours, what percentage of active cases of TB are treated with Directly Observed Therapy, what percentage of active cases of TB complete their treatment... how many people screened for tuberculosis actually get put on treatment for latent infection" and "looking at how many contacts are screened."

These "are absolutely reasonable targets to look at," Cook says "and are things that are useful to compare, not only internationally but actually from province to province."

"Part of the challenge has been... looking at accountability and outcome measurement," says Turner, of the Inuit Tapariit Kanatami's Inuit Committee on Health.

Turner says the best chance to eliminate TB in Inuit communities is with "an Inuit specific" strategy that is "designed by Inuit, delivered by Inuit." The ITK TB strategy is going through approval stages within ITK now.

In the meantime, those on the front lines against TB wait to find out how ambitious will be the new national strategy. Given that rates are highest among Aboriginals, The Tyee asked both the Public Health Agency of Canada and Health Canada to provide what, if any, specific targets related to Aboriginal communities will be included in the new strategy. PHAC's spokesperson sent an email with a target number for the general population instead, saying, "the strategy outlines a course of action to help reach the TB target incidence rate of 3.6 cases per 100,000 people by 2015 in Canada, in the spirit of the Global Plan to Stop TB." The Global Plan to Stop TB is a comprehensive plan for eliminating TB as a global public health issue.

Kevin Patterson is eager to see what new map the government is preparing to deal seriously with tuberculosis among the Aboriginal people he's come to know over the 16 years he has visited their communities and tended their sick.

"You can't have 15 people in a three bedroom house for about 100 different reasons, one of which is TB," he says. "And if the other 99 aren't good enough reasons, then we can use TB as a reason to improve the housing issues on reservations."

Patterson's boat chops through the waves as he considers Canada's response so far to TB and its social causes. He scans the horizon, and finds a word. "Shameful."

TB’s slow-motion Africa disaster

With the famine in Somalia a new threat to millions of lives, it might seem an unlikely time to call for increased spending on HIV/TB co-infection. But the disaster in the Horn of Africa has been years in the making, and due in no small part due to global neglect. Much could have been done, but wasn't, and now the world is responding after the fact, when lives have already been lost and aid much more difficult to provide.

As in Somalia, there is another longterm disaster stalking Africa that is the result of neglect. But unlike Somalia, it is absurdly simple to solve. It is estimated that less than five per cent of the millions of individuals being treated for HIV infection have been screened for TB, which is the primary killer for those living with HIV. This is despite the fact that screening is very simple. Eight questions are asked, and if the results are positive the patient is given a medical test. Treatment is less than $20 per year.

It is estimated that two million HIV survivors will die from preventable TB in the next three years.

dollars in the process, or we can be proactive and easily save lives. TB might be less dramatic than dust storms and packed refugee camps, but the results are the same.

Making AIDS History: Update from amfAR Capitol Summit

"We didn't give up when we didn't have the answers, so we can't give up now that we do." Regan Hofmann, Editor-in-Chief, POZ magazine.

Last week we attended a Capitol Hill summit, "Making AIDS History: Ending the Epidemic" organized by the Foundation for AIDS Research (amfAR), marking the progress made to date and the incredible opportunity we have to turn the tide against the disease. The event boasted appearances by TV personalities Whoopi Goldberg, Chris Matthews, National Institute for Allergy and Infectious Diseases Director Dr. Anthony Fauci, U.S. Global AIDS Coordinator Ambassador Eric Goosby, Global Fund to Fight AIDS, TB and Malaria Director Dr. Michel Kazatchkine and members of Congress including House minority leader Nancy Pelosi (D-CA) and Representative Jim Himes (D-CT) and Senator Mike Enzi (R-WY).

With such a star-studded cast and evidence-based modeling in hand, the Kennedy Caucus Room in the Russell Senate Office Building maintained a high level of enthusiasm throughout the afternoon. From both the global and domestic lens, the message was the same: we have the tools to end HIV/AIDS - it's now a matter of making it reality.

New research proves what scientists have suspected for years - that antiretroviral therapy (ART) stops the spread of HIV - making ART a tool for both treatment and prevention.[1] ART is also a critical tool in the fight against TB. It reduces the risk of TB disease by two-thirds, cuts recurrence rates in half, and improves the survival of HIV patients with TB.[2] Now that we know the enormous impact of ARTs on HIV transmission, Dr. Fauci reminded us that only 42% of people living with HIV have access to this lifesaving medication.[3] We know what must be done, but will we have the resources to do it?

Hope for ending AIDS is severely undercut by the U.S. government's budgetary environment and lack of knowledge about what we are able to achieve. Members of Congress who attended the event appeared worried about our ability to find resources to conquer HIV/AIDS. Reps. Nancy Pelosi and Rep. Barbara Lee (D-CA) reminded us that current budget discussions have a real impact on our ability to end the epidemic. Rep. Jim Himes pointed out that nearly half of his colleagues would not be able to explain what PEPFAR is, nor what ART stands for.

So what can we do about this? According to Cokie Roberts, contributing senior news analyst for National Public Radio, we must continue to advocate for funding of HIV/AIDS programs and research. Chris Collins, Vice President and Director of Public Policy at amfAR pointed out, "with the evidence in hand, policymakers now face a choice: investing strategically today to accelerate the end of AIDS, or paying for the response to the pandemic for generations to come." We need to advocate with our members of Congress and let them know what a critical time it is for ending the AIDS epidemic. From both a moral and fiscal perspective, it makes sense to scale up our investments in HIV rather than cut back.

It's our job to create the political will to end AIDS, and turn the tide against TB-HIV co-infection. We have the research, we just need to turn it into action.

[1] Reynolds, S.J. et al. (2011). "HIV-1 transmission among HIV-1 discordant couples before and after the introduction of antiretroviral therapy." AIDS 25(4): 473-477.

[2] Lawn, S.D. et al. (2011). "Antiretroviral therapy and the control of HIV-associated tuberculosis. Will ART do it?" International Journal of Tuberculosis and Lung Disease 15(5): 571-581.

Dr. Ramón-García listed amongst top influentials in Global Health by Grand Challanges Cana

This year, RESULTS Canada began supporting the work of Dr. Santiago Ramón-García, a tuberculosis researcher at the University of British Columbia's Department of Microbiology by helping to endorse his application for research funding from Grand Challenges Canada (http://www.grandchallenges.ca/). Dr. Ramón-García's project seeks to identify new drug combinations of existing medications that combat tuberculosis with greater efficacy than current therapies.

We are happy to announce that Dr. Ramón-García has now been listed as one of 19 Canadian Rising Stars in Global Health by Grand Challenges Canada and will receive funding to help take his bold, idea to the next level. Each of the 19 innovators will receive a grant of $100,000. If their ideas are robust, effective, and proven, the innovators will be eligible for an additional scale-up grant of up to $1 million for each proposal.

Dr. Ramón-García's project, which would dramatically shorten the current TB treatment regimen and also address the serious and emerging global threat of multi-drug resistant and extensively drug resistant TB has the potential to save millions of lives around the world.

Globally, TB is a major cause of suffering and mortality worldwide. There are 9.4 million new cases of TB reported annually and 1.7 million people die from the disease each year. Despite the devastation, today's TB drugs are more than 40 years old and must be taken for 6-9 months. Erratic or inconsistent treatment breeds drug resistant strains.

The emergence of drug-resistant strains has reaffirmed TB as a global public health emergency. Drugs used to treat multi-drug resistant (MDR) and extensively drug resistant (XDR) TB are less potent, more toxic, prolonged, and much more expensive than the drugs used to treat standard TB. Multi-drug resistant TB drugs can cost US $5000 or more, and extensively drug resistant TB treatment is far more expensive. Alternative therapies are urgently needed both to shorten the duration of the current TB treatment, as well as to treat MDR- and XDR-TB.

Funding from Grand Challenges will have a huge impact in propelling this project forward, and moving the therapies closer to being in the hands of the people who need it, no matter their location or financial means. This Canadian-led solution to cut the most deadly strains of TB-using innovative combinations of existing TB drugs- will dramatically alter the scope of global TB control, thereby easing the death toll in a few years, rather than a few decades.

New TB drug-resistance test shows promise but needs investment for those diagnosed to be cured

Two research studies in this week's PLoS Medicine suggest that a new automated DNA test for tuberculosis (Xpert MTB/RIF), which can detect TB within 2 hours and has been endorsed by the World Health Organization, can significantly increase TB detection rate compared to other tests, particularly in HIV positive patients who have a high risk of being infected with TB, including multidrug resistant TB. An accompanying Essay and Perspective highlight the economic challenges and implications of such diagnostic tests.

In the first study, led by Stephen Lawn from the Desmond Tutu HIV Centre at the University of Cape Town in South Africa, the authors collected sputum from HIV-infected adults with no current TB diagnosis who were enrolling at an HIV treatment clinic in a South African township. The authors then compared the diagnostic accuracy of Xpert MTB/RIF with several other tests, including liquid culture (the reference test).

Nearly a fifth of the patients had culture-positive TB and Xpert MTB/RIF identified three-quarters of these patients. Furthermore, the new test had a low false-positive rate and was able to detect all cases of smear-positive, culture-positive TB but only 43.4% of smear-negative, culture-positive cases from a single sputum sample. The new test also correctly identified rifampicin resistance, a marker for multidrug resistant TB, in all four patients who had this form of TB, but incorrectly identified resistance in three patients with drug-sensitive TB.

The authors say: "In this population of individuals at high risk of TB, intensive screening using the Xpert MTB/RIF assay increased case detection by 45% compared with smear microscopy, strongly supporting replacement of microscopy for this indication. " They continue: "However, despite the ability of the assay to rapidly detect rifampicin-resistant disease, the specificity for drug resistant TB was sub-optimal."

In a smaller study led by Lesley Scott from the University of the Witwatersrand in Johannesburg, South Africa, the authors compared the performance of Xpert MTB/RIF on a single sputum sample with that of smear microscopy, liquid culture and two other nucleic acid amplification tests (MTBDRplus and LightCycler MTB) in 311 adults suspected to have TB in Johannesburg, South Africa, a region where many adults are HIV-positive. Although these findings are likely to be affected by the study's small size, the results suggest that Xpert MTB/RIF may provide a more accurate rapid diagnosis of TB than smear microscopy and other currently available tests in regions where HIV and TB are endemic.

The authors conclude: "The Xpert MTB/RIF test has superior performance for rapid diagnosis of Mycobacterium tuberculosis over existing ... smear microscopy and other molecular methodologies in an HIV- and TB-endemic region. Its place in the clinical diagnostic algorithm in national health programs needs exploration."

In an Essay in the same issue, David Dowdy from the University of California in San Francisco, and colleagues discuss the challenges of economic analysis of diagnostic tests for tuberculosis, and argue that standard cost-effectiveness analyses may give misleading results when blindly applied to the scale-up of TB diagnostics.

To be useful to both policy-makers and decision-makers, the authors suggest that such analyses should establish society's valuation of false-positive tests relative to false-negative tests; evaluate the consequences of false-negative and false-positive diagnoses when new diagnostics are implemented in field settings; and set local cost-effectiveness thresholds for disease-specific interventions.

Furthermore, a Perspective by Carlton Evans from the Universidad Peruana Cayetano Heredia in Lima, Peru (not involved in any of the research studies here) stresses that although the new MTB/RIF-test has the capacity to be a "game-changer" in TB diagnosis, the new research in this week's PLoS Medicine raises important points of concern as the field progresses to implementation of this innovative technology. He emphasizes the shameful context that almost 2 million people die each year from TB, and very few of them would have been saved by any diagnostic test.

Evans says; "Specifically, these deaths occur in mainly HIV-negative people, almost all of whom die from drug-susceptible TB, principally because of the inadequacy of basic, inexpensive health care provision for this curable infectious disease."

Lack of awareness, facilities resulted in low TB detection rate

The Tuberculosis(TB) detection rate is still low in Manipur comparing to the national detection level.

It's because of lack of awareness,facilities and poor communication due to geographical location.

This was disclosed by the State Tuberculosis Officer Dr O Manihar (Retd) on the sideline of the day long consultation meeting for recommendations on greater care and control of TB in Sadar hills under Manipur's Senapati district at Manipur Press Club today.

The consultation which was attended many representatives of the various NGOs and social organisations based in Senapati district was organized by Institute of Rural Development and Training Centre under the sponsorship of Global Health Advocates(GHA) .

The state has so far achieved an average of 60 percent TB detection rate against the 70 percent national detection rate since the launching of Revised National TB Control Programme(RNTCP) nine years ago,Dr Manihar added.

Dr Sapana Naveen and Christo Mathew of GHA which had organized similar consultation programmes in Thoubal district on July 5 last also spoke during the day's interaction session.

Interestingly Senapati,Tamenglong and Chandel have the low detection rate comparing to other remaining districts.

Tribals dominated Senapati has recorded only about 50 percent detection rate in the recent past.It has just 28 percent detection rate last year against state's average of around 64 per cent.

Information Education and Communication officer K Deben of State TB Cell who also attended the consultation meet speaking to this reporter informed that the multi-drug resistance (MDR)rate is also high in Senapati comparing to other districts of the state.

On the other hand Kuki-Chin-Zomi dominated Churachandpur district has the largest number of children having Tuberculosis cases comparing to other districts of the state.

So far more than 1000 TB patients have been given free medication under the state TB cell.

According to official records, as many as 31,471 TB patients were given proper treatment out of 37,420 cases detected in the year 2009.One thousand people die daily due to TB which is caused by bacilli called Mycobacterium Tuberculosis.

A Day in the Life of a TB Worker

When Farhad Jameel, case manager at Gwinnett County's tuberculosis control clinic, arrives at work each morning, he collects his surgical mask and several large Zip-loc bags containing the individual medications for four to six homebound tuberculosis (TB) patients living in the county. He will spend the next three hours driving around the county to watch patients take their medications.

Each day Jameel sees a handful of patients who take medications only a few days per week and a few others who are taking medications every day, either because their TB was only recently diagnosed or because they cannot tolerate the larger doses required for skipping days.

As a case manager, it is not in Jameel's job description to watch homebound patients take their medication, a measure required by state law in order to ensure medications are taken properly and that multi-drug-resistant TB doesn't develop. This is the responsibility of a TB outreach worker, but since the East Metro district's funding for an outreach worker ran out in December of 2010, Jameel and his colleagues have been doing double duty in a region whose TB rates are among the highest in the state.

In 2010, the East Metro district of the Georgia Department of Community Health, which covers Gwinnett, Newton and Rockdale counties, saw 65 new cases of TB. Fifty-six of those were in Gwinnett County, making the county second in the state for new TB cases between DeKalb's 86 cases and Fulton's 51. These three most populous counties in the state alternate among the top three spots each year.

"With construction and the housing boom, there were suddenly a lot more people in Gwinnett and fast," said Donna Burel, LPN at the tuberculosis control clinic. Since 2001, 70 percent or more of new TB patients have been foreign-born residents of the county. The October 2008 Georgia Epidemiology Report cited Gwinnett's booming population and high concentration of immigrants from countries in which TB is endemic as the major hurdles to eliminating the infection in the county.

Highly contagious, TB must be tightly controlled by state and local public health authorities.

So Jameel can spend half his day doing outreach, his maximum case load was cut from 15 to seven, while his colleagues, who are especially bombarded with new cases in the spring and summer months, absorb Jameel's load.

As the district's only outreach worker, Jameel feels the burden. "I think each county needs two to three outreach workers just to do DOT [direct observe therapy]," Jameel says. In fact, according to CDC recommendations, counties with TB rates like Gwinnett's need 4.3 full-time outreach workers to administer medications and conduct contact investigations. Jameel's half-days spent on the road mean Gwinnett has half an outreach worker. For Gwinnett's caseload, the CDC recommends a total of 13 full-time dedicated TB staff. Gwinnett has 10.3, including one who is on loan from the district office and could be taken away at any time.

"Funding and staffing depend on how many patients you have in your county, but with the recent economic crisis, we are not meeting those funding and staff requirements," says Jameel.

Conversely, if TB rates go down in a given county, the state will assume the county can do with less funding for prevention and control. Michael Redmond, RN, the East-Metro district's tuberculosis control program manager, says that when this happened in New York in the 1980s, there was an immediate upswing in TB cases.

TB disease is the result of infection with the tuberculosis bacteria. Most infections become the non-contagious and asymptomatic latent TB (LTBI). One in ten cases of LTBI converts to the contagious, symptomatic active TB disease. Stress, poor nutrition, an immune system compromised by other illnesses, or a number of other risk factors can cause the conversion to active TB. So LTBI must be indentified and treated in order to prevent this conversion and the further spread of disease. Typically affecting the lungs, TB can infect any part of the body, such as the spine, the joints, the eye or the brain. Passed through the air, via coughing, sneezing or otherwise transmitting infected saliva into the air, pulmonary TB is the most contagious form, but all forms, if untreated, can be fatal.

According to state law, when a patient is diagnosed with TB or suspected of having TB, his or her health care provider must report it to the health department in the patient's county. The health department then takes over the case, administering medication in person daily, monitoring the patient monthly for up to 12 months, and investigating the patient's contacts to identify any other cases of TB or LTBI.

"For active TB patients, every dose every day must be observed by a TB worker," Jameel says. Children under the age of five, whether they have active disease or latent infection, must also take their medication in front of a health professional each day.

This means most of the county's active TB patients, 27 as of the end of June, report to the health department daily or several times a week to take up to five drugs needed to treat the disease, while children may take medications under the supervision of a school nurse. But, in part because the poor and the elderly are particularly susceptible to TB, some TB patients are homebound.

Jameel has driven more than 10,000 miles in a quarter on his DOT route. Stopping at houses in Lawrenceville, Snellville, Norcross and other areas, he dons a surgical mask before knocking on the doors of contagious patients, typically those within the first two to four weeks of treatment. At some homes, he is in and out in a just a few minutes. At others, he stays to answer questions about symptoms or side effects the patient may be experiencing. In some homes, spouses, siblings or children of the patient may be undergoing treatment for LTBI themselves.

Some of Jameel's time -- and that of other TB workers - is spent conducting contact investigations, during which a TB worker tries to reach and screen anyone who had contact with a TB patient during active infection.

"We need staff and time to conduct contact investigations and go out and screen people, but if case loads go up, we'll have just enough time to address active patients," said Redmond.

Each time a new case is identified, case managers initiate contact investigations to discover who may be at risk of having contracted the disease from the new patient. Contact investigations could be limited to just the immediate family or they could include all of a patient's co-workers, classmates or fellow church members. The extent of the investigation depends on the patient's lifestyle. More complicated investigations can take months to complete. Contact investigations are crucial to containing the infection.

In June, 11 investigations were underway: 10 for patients in the district and one for a patient elsewhere. Gwinnett County may contribute to investigations in other districts or even other states if the patient is suspected to have had contacts in the county while contagious.

Once he's back at the clinic, Jameel gets back to his cases. Case managers are responsible for all active cases of TB. A case can remain active for up to twelve months after diagnosis. Clinic nurses handle the latent TB patients who continue to come to the clinic for monthly evaluations until they are free of infection.

As of June, in addition to its 27 active patients, the clinic was seeing 118 latent patients, and one multi-drug-resistant patient.

Regardless of whether a patient has a private doctor, case managers follow active TB patients from the time their disease is reported to the health department until they no longer have active TB.

"One of the hugest obstacles is to help a new patient understand that directly observed therapy is something that works for you, not something that's being imposed on you. It's not just because there is a trust issue but to make sure these pills are doing what they are supposed to do for you," said April Garcia, one of the clinic's four case managers.

When patients start treatment, they will take four drugs until lab work - coordinated by the case manager and conducted on site - determines to which medications the patient is responding. This typically takes about two months. At this point, the patient is taken off two of the drugs.

TB drugs can also have serious side effects, including liver damage. Patients' liver function is monitored in the on-site lab at the Gwinnett clinic. If a patient's liver reacts to the drugs, the patient is taken off all drugs until the liver normalizes then each drug is gradually reintroduced or second-line drugs are used. This extends the treatment time and, thus, the time the patient is considered active.

In addition to monitoring patients' sensitivity to the drugs, case managers follow the patient's weight to make sure the involuntary weight loss associated with TB has stopped. Regular sputum tests conducted at the clinic determine if the patient is still contagious.

Garcia says the role also extends beyond clinical functions. She's helped patients find housing, and she's helped them find the fastest, most affordable taxi when they were without transportation to the clinic.

Georgia's regulations for the treatment and control of TB are similar to those in other states and in accordance with CDC recommendations. Without strict monitoring of treatment, the risk is too great for the spread of TB and the development of multi-drug-resistant strains, which can be spread as well.

"A contagious infectious disease is a public issue," Jameel says. "When you have a contagious disease, it's not just the problem of the patient himself; it also becomes the problem of the people around him."

Breakthrough TB Study Finds Rapid TB Test Effective in Children

Diagnosing a child with TB is difficult - so difficult, in fact, that the vast majority of childhood TB cases go unreported. Most young children aren't able to cough up the sputum (phlegm) needed to diagnose the disease, and the most widely used TB test only detects 10 to15 percent of childhood cases. But this may not be the case for much longer.

This week, researchers in South Africa announced the results of a study that showed the newly endorsed TB diagnostic, Xpert MTB/RIF, is effective in children. This new test is able to detect twice as many children with TB as the widely-used microscopy method and in only a fraction of the time (less than two hours!) While the test still relies on a child's ability to cough up sputum, health workers in the study gave the children saline that made it easier to produce it.

Although Xpert has not yet been approved for use in children, this study shows we are getting closer to the goal of a fast, reliable TB test for children. Xpert was endorsed by the World Health Organization for use in adults last December and represents the very latest in TB diagnostics. Instead of using a microscope, this revolutionary tool uses DNA technology to rapidly identify TB bacteria in less than two hours without the need for a high-tech laboratory. It can detect TB even in people living with HIV - something previous diagnostics have failed to do well -and can tell if a patient suffers from a drug-resistant strain of the disease.

For years, TB went undiagnosed in vulnerable groups such as women, children, and people living with HIV. Now we have the opportunity to fight TB and ensure all children have access to TB diagnostics and treatment -but we need to make the investment. As a new technology, Xpert is highly cost-effective but still fairly expensive to introduce. The support of PEPFAR, the Global Fund, and international bodies like the World Bank will therefore be vital to developing countries that need Xpert in order to turn the tide against TB and HIV.

President Arthur quarantines immigrants, July 18, 1884

President Chester Arthur issued a proclamation giving the federal government the power to quarantine persons entering the United States to avoid the spread of "pestilence." The proclamation did not mention the name of the disease from which Arthur was seeking to protect the public: tuberculosis.

Two years earlier, the bacillus that causes tuberculosis had first been identified by Robert Koch, a German physician. Koch received the 1905 Nobel Prize in medicine for the discovery.

Prior to 1890, individual states, rather than Washington, regulated immigration into the United States. While several states maintained their own quarantine rules, Arthur saw a need to broaden the federal government's powers to intervene in order to avert a potential health crisis. Moreover, Arthur served as president during a depression, when increasing numbers of Americans opposed allowing people to emigrate from European and Asian nations, where tuberculosis was rampant.

Arthur advised states and cities with ports of entry to "resist the power of the disease and to mitigate its severity." He effectively authorized people to report to the federal government any persons suspected of carrying highly contagious diseases.

It is now "relatively uncommon," according to Neil Schluger, a professor at Columbia University's Mailman School of Public Health, for persons to enter the U.S. with an active case of tuberculosis.

"Most of those persons don't come legally," Schluger said. "If you try to legally immigrate, ... you actually have to be screened for tuberculosis in your home country, so if you're coming here on a residence visa, ... you have to have an X-ray in your home country and it's got to show that you don't have contagious TB before you can come in."

Capreomycin shortage: symptom of a bigger problem in multidrug-resistant tuberculosis

There is currently a worldwide shortage of quality-assured capreomycin, a key drug in any regime to treat multidrug resistant (MDR) TB. This shortage has occurred because Akorn-a US manufacturer and the only supplier of capreomycin to the Global Drug Facility-has had a problem with the supply of the active pharmaceutical ingredient. This situation is not unique to capreomycin: in 2010 there was a global shortage of kanamycin, similarly as a result of having only a single manufacturer producing quality-assured injections and a problem with the active pharmaceutical ingredient.

The current shortage of capreomycin could result at a country level in MDR-TB patients not completing the required length of treatment or delay patients starting treatment, with the associated increase in morbidity and mortality.

Of the 9.4 million new tuberculosis (TB) cases diagnosed each year, approximately 5% are multidrug resistant (MDR). MDR-TB treatment is demanding for patients, requiring a complex treatment course lasting 18-24 months, and using a minimum of five different antibiotics that often add up to more than 20 tablets a day.

One of the group of drugs required are injectable antibiotics that must be given for a minimum of 8 months. These drugs-kanamycin, amikacin, and capreomycin-are key to any treatment regimen for MDR-TB. There are a limited number of manufacturers globally who produce quality-assured formulations of these drugs, and changes in the producers in the MDR-TB market has resulted in single manufacturers supplying the global demands. The MDR-TB treatment regimen has been plagued with drug shortages for many years due to this situation .

MSF currently supports TB care for over 25,000 patients in 29 countries, and is providing treatment to over 1000 patients with MDR-TB in 15 countries. The number of patients enrolling in MDR-TB programmes is increasing each year. MSF is using its emergency stock to bridge the shortfall and are advising their projects on ways to prevent patients' treatment being compromised by the low stock levels.

Prior to the increase in the rate of MDR-TB, the use of some of these antibiotics was declining, so their production capacity decreased accordingly. This has led to the limited availability and high cost of quality assured second line medicines to treat MDF-TB.

There are manufacturers in China, India, South Africa and the former Soviet Union who provude injectable antibiotics for MDR-TB treatment but their compliance with World Health Organization (WHO) quality assurance standards is unknown. All manufacturers of these drugs need to meet internationally recognised quality standards to ensure efficacious treatment and prevention of further resistance.

One mechanism to ensure the quality of drugs is the WHO Prequalification Programme, which evaluates both the product and manufacturer. Today, there are two main mechanisms that are internationally recognised to ensure the quality assurance of a medicine: WHO prequalification and the approval of a stringent regulatory authority.

The lack of quality-assured manufacturers involved in MDR-TB drug production, combined with growing demand, has contributed to the increased price of these drugs. The average price of treating a patient with MDR-TB is approximately US$9000, compared with $19 for drug-sensitive TB. Capreomycin significantly contributes to this increase in cost (as well as moxifloxacin, para-aminosalycilic acid, and cycloserine). The price of capreomycin has risen from $4 to $8 a unit, after manufacturer Eli Lilly, which had been subsidising the cost, ceased production. The new quality-assured manufacturer for capreomycin was not able to offer the same prices, although they are still offering some subsidies.The other major injectable agent, amikacin, has increased in price by 991% since 2001.³ This and other cost increases could be attributed to monopoly situations for some drugs and manufacturers who were subsidising the supply of certain drugs leaving the TB market.

WHO and other partners created the Green Light Committee (GLC) in 2000 to respond to the need for affordable second-line drugs. It has been largely unsuccessful in providing a large market force to drive down prices. The GLC is currently undergoing a restructuring to try and increase access to quality-assured products and encourage the scale up of DR-TB programmes. Some countries and projects not currently in GLC programmes are purchasing these important drugs from either pharmaceutical companies with non-approved products or at increased cost from approved companies, and in some cases not starting MDR-TB patients on the appropriate treatment. MSF has recently published, in collaboration with the Treatment Action Group (TAG) and Partners in Health (PIH), a report into these global initiatives and the extent of certain countries' scale up of MDR-TB programmes (http://www.msfaccess.org/fileadmin/user_upload/diseases/tuberculosis/TB_report_TreatmentScaleUp_ENG_2011_01.pdf).

With the improvements in TB diagnostics, especially with the new Xpert MTB/RIF test, MDR-TB is becoming faster and easier to diagnose, and the numbers requiring treatment is expected to grow exponentially as a result. Even without this expected increase in diagnosis, only 10% of the current estimated MDR-TB cases in the high burden MDR-TB countries, and 11% globally, have been started on treatment.² This could mean that there are, at least, more than half a million potential patients needing second-line treatment now, even before the expected increase with new diagnostics.

The current stock rupture of capreomycin should be seen as a wake-up call to everyone involved in the management of MDR-TB. There is an urgent need to develop novel funding mechanisms to incentivise new manufacturers to enter, and to retain current manufacturers' engagement, in the global TB market, to ensure uninterrupted supply of quality assured medicines. While this key debate is left unaddressed, we will continue to see severe shortages of critical MDR-TB drugs, and with a likely greater frequency as the demand increases. This will have devastating implications for both the individual and the public health of the community.

2011 Publications

Children and TB: Exposing a Hidden Epidemic
ACTION (September 2011)
ACTION's enlightening analysis of the link between the burden of tuberculosis (TB) and the world's most vulnerable children - those who are malnourished, orphans, or living with HIV sheds light on a neglected epidemic. The report, Children and Tuberculosis: Exposing a Hidden Epidemic, is a reminder that TB is not a disease of the past and remains a leading killer, especially of children whose underdeveloped immune systems leave them particularly susceptible.

Tuberculosis: Voices in the fight against the European epidemic
TB Europe Coalition | ACTION (September 2011)
Having Tuberculosis (TB) is a global epidemic. However, this report aims to draw much needed attention to the fact that TB is not a mysterious disease in a distant land. TB in Europe has been on the rise over the past decade; affecting men, women and children from across the region and from vastly different communities. Despite the devastating impact that TB has on these communities, genuine political action to tackle the disease at the regional level remains to be seen. Contained in this report are seven case studies telling the human side of the story - patients, doctors, health care workers and advocates speak out about their experiences, achievements and the challenges faced in tackling this regional epidemic. tuberculosis.

Chehera: The Human Face of TB
GHA India (March 2011)
The real lives and faces behind the disease inspired Global Health Advocates India to harness the power of art through a collaboration with the Art For Change Foundation — a group of socially conscious artists — to create an exhibition dedicated to those who battle with TB.

A gallery showing was organized on World TB Day, 2011 where the public were invited to see powerful images that truly illustrate the challenge that this scourge presents. The exhibit allowed these artists to transcend the physical world of TB to one where art becomes a window into emotions, experiences, perspectives, aspirations, and dreams. Inside the attached PDF are 88 pgs of images and personal accounts from the artists who created them, as well as some insightful and informative statements from those on the ground fighting TB. "Chehera: The Human Face of TB" should inspire you to educate yourself further and do what you can to help stop the spread of tuberculosis.

Chehera: The Human Face of TB

Brought to us by our partners at GHA India, they recently attended an art exhibit that harnessed the power of art and imagery to spread the message of tuberculosis (TB) to the masses who still are unfamiliar with this deadly disease. Read further to download a PDF containing the powerful images from the exhibit. We must extend special thanks to "Art for Change, the vibrant group of socially conscious artists who made this happen.

New Report Shows Global Response to MDR-TB Has Been Slow

A new report released recently and compiled by the Treatment Action Group, Medecins Sans Frontieres and Partners In Health says that international efforts aimed at scaling up treatment of multi-drug resistant tuberculosis (MDR-TB) have been slow due to weak government action, low funding and a "sluggish response by international support mechanisms," BMJ News reports.

The report is based on data from India, Russia and South Africa. "The countries reviewed had insufficient access to quality assured laboratory diagnostic capacity, resulting in delays in diagnosis and an enduring burden of undiagnosed patients. Quality care was also jeopardized by limited access to quality assured drugs and unpredictable and expensive drug supplies," BMJ News writes. "WHO fully shares the report's conclusion that governments need to tackle the issue much more vigorously than most have so far. Tackling TB is difficult; tackling MDR-TB, as this report makes clear, is even more challenging," Mario Raviglione, director of the WHO's Stop TB Department, said.

Rapid TB Test Reliable in Kids

A rapid automated test for tuberculosis -- already recommended by the World Health Organization for disease detection in adults -- proved more effective than smear microscopy for identifying Mycobacterium tuberculosis infection in children, a large prospective study found.

Using two induced sputum samples from children whose median age was 19.4 months, the Xpert MTB/RIF test detected 75.9% (95% CI 64.5 to 87.2) of cases of tuberculosis, according to Mark P. Nicol, PhD, of the University of Cape Town in South Africa, and colleagues.

In contrast, smear microscopy only detected 37.9% (95% CI 25.1 to 50.8), the researchers reported online in The Lancet.

Diagnosis of tuberculosis -- particularly in the lower-income parts of the world where the disease flourishes -- typically has relied on smear microscopy.

However, smear microscopy is less sensitive than culture, such that the results in children often are negative even when cultures subsequently confirm the infection.

But cultures can take up to six weeks, and quicker decisions are needed for optimal treatment outcomes.

The worldwide increase in drug resistance to anti-tuberculosis agents has further heightened the need for a rapid, highly sensitive and specific test for both diagnosis and for identification of drug sensitivity.

The Xpert MTB/RIF utilizes nucleic acid amplification to detect both the organism and its sensitivity to rifampin, one of the first-line drugs to treat tuberculosis. In adults, a single test detected 98.2% of cases of tuberculosis that were smear-positive and 72.5% of those that were smear-negative.

Accordingly, the World Health Organization endorsed the test for adults at risk for drug-resistant disease or who were HIV-infected.

But the test had not been evaluated for use in children, so Nicol and colleagues enrolled 542 children ages 15 and younger who were admitted to the hospital for suspected pulmonary tuberculosis.

All children had at least one sputum induction procedure, and a second was done in 385.

Specimens were tested by both smear microscopy and with automated MTB/RIF testing, and positive specimens were then cultured.

Among children for whom at least one induced sputum sample was tested with MTB/RIF, 16% had definite tuberculosis, 48% had possible tuberculosis, and 37% did not have the disease, the researchers found.

They also found at least one positive MTB/RIF test in 74.3% of the children classified as having definite tuberculosis, in 2.8% of those with possible tuberculosis, and in none of those who did not have tuberculosis.

In children with at least one test, the overall sensitivity was 58.7%, specificity was 99.4%, positive predictive value was 94.4%, and negative predictive value was 93.1%.

Among children who were HIV positive -- about one-quarter of the total population -- the sensitivity of the MTB/RIF test was higher than in HIV-negative children (100% versus 85.4%, P=0.042).

For children with two induced sputum results, the specificity of the test was 98.8% (95% CI 97.6 to 99.9).

And for HIV-positive children with two induced sputum tests, the specificity was 100% (95% CI 95.5 to 100).

The MTB/RIF test also detected 100% of cases that were positive on smear microscopy, as well as 61% of cases that were negative on smear microscopy.

With a second test, the sensitivity in smear-negative cases increased by 27.8%, the researchers reported.

In addition, a per-sample analysis found that the MTB/RIF test identified all of the 70 cases that were rifampin-susceptible as well as two that were resistant.

Although the test was not as sensitive in cases where smear microscopy was negative, the yield still was twice that of the conventional rapid test.

The MTB/RIF test "is widely anticipated to replace smear microscopy in resource-poor settings where HIV coinfection or drug-resistant tuberculosis are common, and our results suggest that its use is a major improvement over use of smear microscopy," stated Nicol and colleagues.

And although the WHO recommendation for adults is for a single MTB/RIF test, the findings of this study suggest that children whose initial results are negative should have a second test.

The researchers noted that for this type of testing to be widely implemented, local clinics will need to provide facilities suitable for sputum induction, with training of staff and measures to prevent transmission.

Limitations of the study included enrollment only from specialized facilities, where patients may have had more severe disease, and small numbers of resistant cases.

In a comment accompanying the study, Eduardo Gotuzzo, MD, of Universidad Peruana Cayetano Heredia in Lima, Peru, called for urgent additional research into this approach to testing.

"Unless fast, cheap, point-of-care tests that can also detect multidrug-resistant tuberculosis are researched, efforts to control tuberculosis will not succeed because while patients await diagnosis and adequate treatment, disease transmission will continue," Gotuzzo warned.

Integrating TB Services With Maternal Health and HIV/AIDS Services: Moving From Data to Action

Elizabeth Do, RESULTS Educational Fund Global Health Intern, recently attended a talk on "Maternal Health Challenges in Kenya: What Research Evidence Shows" at the Woodrow Wilson International Center for Scholars in Washington, DC. She left with more questions than answers. Questions that should embolden us to propose important changes in the intergration of health services not only in Kenya, but in the many areas where TB is prevalent.

"Though improvements have been made in the recent past, [we] have not yet met the international standards." — Geoffrey Mumia Osaaji, Professor at the University of Nairobi (Kenya) and moderator

This week I attended a talk on "Maternal Health Challenges in Kenya: What Research Evidence Shows" at the Woodrow Wilson International Center for Scholars in Washington, DC. Despite huge increases in public expenditures, Kenya's maternal mortality ratio has worsened over the last two decades, rising from 380 to 530 maternal deaths per 100,000 live births.

While the panel discussed various potential causes for this increase (lack of access to family planning, education) — they all agreed on one suggestion to fight maternal death: integration of health services and health supply chains. Maternal health services shouldn't be delivered separately; instead, when visiting clinics during pregnancy women should receive a wider range of health services. One example used was HIV/AIDS, which accounts for approximately 14 percent of maternal deaths in Kenya. The panel concluded that in order to confront this, all pregnant women accessing prenatal care must also have access to HIV/AIDS services.

But what about Tuberculosis (TB)? I wondered. Why did none of the panelists mention integrating TB services with maternal health and HIV/AIDS services? At the end of the presentation, I asked the panelists about this but did not receive a very clear answer. This shows that we need to continue raising the issue of TB in pregnancy. We need to ensure that all governments — not just Kenya — incorporate TB services into maternal and child health programs.

Of course, this requires both investments in healthcare by the government and great political will. Not only will the Kenyan government need to increase its health care funding to 15 percent of the budget (right now it is 8 percent), but it will also need to enact legislation that is both effective and efficient. What this means is that some sort of monitoring and evaluation system will have to be set up and used to see what is going well and what isn't. Since these changes are mostly top-down in its approach, our role here would most likely be one rooted in advocacy and research, or as one contributor from Nairobi put it, one requiring "political will" and "good use of data."

We have a job to do as well. As anyone who went to the RESULTS International Conference knows, RESULTS/RESULTS Educational Fund already has the "political will" to bring about important change. As this event presented today, we also need to be programmatic in moving from evidence/data to action. We need to ask ourselves, what are our priorities and why? How will our proposed changes affect the lives of others and to what scale? What will be the cost per outcome achieved? We have to be ready to answer these questions when we propose change. Let's go out there and find the answers.

MDR-TB Patients Share Their Stories

Multidrug-resistant tuberculosis (MDR-TB) is daunting. Full stop. Enduring the toxic treatments and social isolation necessitated over the two years of treatment is something most of us cannot even imagine. Increased global attention to MDR-TB and intimidating statistics referring to the 440,000 cases of MDR-TB each year still obfuscate the heart of the issue: that going through MDR-TB treatment is something few of us understand.

As ACTION partner RESULTS UK wrote last week, Médecins Sans Frontières (MSF or Doctors Without Borders) launched a new blog to give us a glimpse into the lives of those living with MDR-TB. Called TB & ME, the new blog hosts entries from MDR-TB patients in India, Uganda, and Swaziland which humanize the experience of undergoing treatment, highlight the gaps in service delivery, and call for new tools and drugs to prevent and treat the epidemic. Patients don't just blog, they also respond to each others' entries - forming an online support group around the world.

In a rather upbeat entry, Churchill Opera, a 34-year-old man from Kitgum, Uganda writes, "Since I last wrote, the treatment that I'm taking has shown improvement. The drugs that I am taking are now giving me more energy. I'm very happy about this."

Opera's entry ends on a more serious note: "Most of the time when I wake up in the morning, I [have] been experiencing joint pain and have not slept well. So, when I wake up, I don't have much energy, I'm weak and cannot move around. The thing is, I feel like moving around and doing things. According to doctor, this is a side effect of the drugs I am taking and will go. That is why most of the time, if I take my drugs, I just lie on my bed. I'm tired all the time. I wish I could get up and sweep and clean my compound, but when I try, I find I just don't have."

ACTION is excited about MSF's venture and commends the work they are doing to support and treat MDR-TB patients worldwide. Everyone undergoing MDR-TB treatment has a powerful story to tell andwe look forward to learning from these select stories and connecting our advocacy work to this great support network.

TB & ME joins the ranks with other useful online tools that educate the global community on the realities of TB and what actions are needed.

Notes from Sao Paulo: The Global Fund’s Partnership Forum

Blog contributed by Labib El-Ali, Multilateral Campaigns Coordinator, Advocacy to Control TB Internationally

I am currently attending The Global Fund to Fight AIDS TB and Malaria's fourth Partnership Forum* in Sao Paulo, Brazil.

Like everyone else in the room, I work on these issues every day and yet I was still moved during the opening plenary by a speech made by Jacqueline, a young Brazilian woman who contracted HIV/AIDS from her mother. Born with the disease, Jacqueline spoke about what it meant for her as a child to come to terms with the fact that she will have to live with the burden of it for the rest of her life, and be saddled with a daily dose of anti-retroviral (ARV) drugs that set her apart from her peers, reinforcing the already powerful stigma that she had to face.

The fact that Jacqueline is alive, healthy, and empowered today to tell her story alone is testament to the urgency of extending universal access to life saving ARVs to anyone living with HIV. It is also worthwhile to note that later in the day, a panelist in the closing session remarked that it was not so much the availability of the ARVs that Jacqueline dwelled on, but the many different steps, services, and people (doctors, counselors, and other care providers) that enabled her to not only treat and come to terms with her illness, but to be empowered against it, to not let it rule her life. It was all the pieces of the community and health system that made that possible.

Powerful as the prologue was, the most moving moment of Jacqueline's story was when she introduced the audience to Hector, her baby boy, who was born HIV free, thanks to preventive therapy to prevent vertical (mother to child) transmission. Jacqueline was visibly moved and unable to continue from there, except to say that he was her reason for living. Needless to say, she brought the possibility of a world where no child is born with HIV so much closer to the Forum's participants.

Jacqueline's is only one story, but highlights the power that the Global Fund has to save the lives of and change the future for millions of people and thousands of communities around the world. It is not hard to imagine what dignity and life saving treatment Global Fund financing has brought to people suffering from malaria, TB, and AIDS - women and men - including neglected and vulnerable transgendered, drug user, prisoner, and migrant communities.

We all need this daily reminder that our work is connected to people we may never meet, but whose lives depend on smart work and increased funding for equal access to medicines.

MPs from major donor countries to the Global Fund were present to hear Julia's story, and will walk away from the Forum with even more conviction of what is possible if the Fund is replenished fully. As we approach the midterm replenishment of the Global Fund, possibilities like a born-hiv-free world, as well as bending the curves of the three diseases, will be critical in engaging donors for increased investment in the Fund.

*The Partnership Forum is hosted by the Global Fund to draw on the knowledge and experience of 400 delegates from the Global Fund secretariat, communities affected by the three diseases, technical partners (i.e. UNAIDS, Roll Back Malaria the Stop TB Partnership, the World Health Organization), members of Country Cooperation Mechanisms (CCMs), the private sector, Members of Parliament and global health advocates.to shape the Global Fund's strategy for financing through 2016.

Thoughts from the UN High-level meeting on AIDS

Blog contributed by David Bryden of the Stop TB Partnership

I was privileged to attend last week’s UN meeting on HIV/AIDS on behalf of the Stop TB Partnership. The highlight for me was seeing a diverse array of international civil society groups working to persuade negotiators from countries all over the world to take on bold commitments that would actually defeat the HIV/AIDS epidemic. Despite some setbacks, there were some important victories thanks to this coordinated pressure! Online coverage of the UN meeting by Democracy Now gives a great sense of the momentum that was created, here’s an interview with ACTION TB-HIV champion Lucy Chesire.

UN member states agreed to scale up access to antiretroviral treatment to 15 million people by 2015. Reaching that target will do a lot to save lives, including helping to prevent active TB. In fact, the promised funding provides a portion specifically for TB treatment. The declaration also includes a commitment to reduce TB deaths by 50 percent by 2015, and to “improve TB screening, TB prevention, access to diagnosis, and treatment of TB and drug-resistant TB.”

Reaching this great achievement took a lot of hard work on many different fronts. In the weeks leading up to the meeting, civil society groups engaged in a sophisticated lobbying campaign directed at country missions. These groups, including ACTION’s dynamic partner in France, AIDES, provided a detailed critique of drafts of the final declaration. Groups from Africa, including Treatment Action Campaign (South Africa), met with high level officials of numerous African countries. We presented a list of “non-negotiables” to the country missions, including strong provisions on human rights, tuberculosis, resources, HIV prevention, and many other issues. Countries in Latin America played a key role in pushing the document in a progressive direction.

We also heard a powerful denunciation by Alexei Kurmanoevskii, from the Centre of Studies on Discrimination, Xenophobia and Extremism of Republic of Tatarstan. Alexei spoke about the plight of prisoners, and injecting drug users who lack reliable access to appropriate TB and HIV treatment. Tatayana Afanasiadi, a woman living with HIV/AIDS from Ukraine, returned to this theme when she spoke before the entire General Assembly of the UN.

One of the more fascinating side events during the meeting was sponsored by Doctors Without Borders and gave the governments of South Africa and Brazil the opportunity to talk about their leadership on TB-HIV. The chairman of the National Empowerment Network of Persons Living with HIV/AIDS in Kenya (NEPHAK), Mr. Nelson Otuoma, said “it is high time our governments invested in the latest TB diagnosis technology, such as GeneXpert” – check out the video of the event here. At other events, faith-based groups talked about their commitment to ramp up action on TB-HIV, and filmmaker Jonathan Smith told us about his exciting film project to expose the crisis of TB in the gold mines in South Africa.

Many voices came together last week, now it is up to people who care all over the world to take this message to decision-makers in governments, especially those who make funding decisions.

RESULTS Educational Fund Executive Director Joanne Carter Makes Statement on GAVI U.S. Pledge

"Today the United States made a strong commitment to a global plan to save 4 million lives by vaccinating 250 million children by 2015, pledging $450 million over three years to the GAVI Alliance. We congratulate the Obama Administration on this decision and pledge our support to ensure this funding is delivered. We also welcome USAID Administrator's Rajiv Shah's commitment to host a high-level conference on GAVI next year, which will be an important moment to assess our progress and hold donors accountable for their commitments.

"New vaccines to help prevent the biggest killers of children - pneumonia and diarrhea - will accelerate our progress on stopping needless disease and death. These new vaccines are game changers, and it is heartening that even in a challenging budget environment, the U.S. can seize new opportunities presented by medical innovation. With foreign aid currently accounting for less that 1 percent of the federal budget, our leadership on global health and our commitment to the poorest people on the planet must not fall victim to senseless budget cuts.

"The GAVI Alliance is an innovative and effective global partnership, which helps deliver new and underutilized vaccines in poor countries, and its efforts have already saved more than five million lives. With significant new funding commitments from the U.K., Australia, Japan, France, and many other donors, this is truly a shared global effort.

"It will ultimately be up to Congress to fulfill this U.S. commitment to help turn the tide against the leading childhood killers. We look forward to working with members of Congress to ensure that this pledge is fully met, and other funding for global health and poverty alleviation remains a top priority."

United States Agreed to Pledge $450 Million Over the Next Three Years to GAVI

United Nations General Assembly Adopts A New Political Declaration On HIV/AIDS

ACTION (Advocacy to Control TB Internationally) Director Kolleen Bouchane issued the following statement in response to the United Nations General Assembly's adoption today of a new political declaration on HIV/AIDS.

"This morning at the United Nations High Level Meeting (HLM) on HIV/AIDS, the UN General Assembly adopted an ambitious new declaration demonstrating a serious commitment to intensify the global response to the AIDS epidemic, including by addressing TB as the leading killer of people with HIV. The declaration comes 30 years after the illness that came to be known as AIDS was first described, 10 years since the first UN Declaration of Commitment on HIV/AIDS, and five years after the 2006 UN Political Declaration on HIV/AIDS.

"As the declaration acknowledges, the world has made substantial progress against AIDS. Less than a decade ago, virtually no one living with HIV/AIDS in low-income countries was receiving antiretroviral therapy (ART) - now 6.6 million people have access to these life saving drugs. The rate of new infections has declined by more than 25 percent in over 30 countries, and HIV deaths have declined more than 20 percent in the last five years.

"Recent research shows that providing early ART can reduce transmission by 96 percent. Building upon this knowledge, the declaration represents another milestone in the fight against AIDS by setting a target of reaching 15 million individuals with ART access by 2015. Now, governments, the private sector, communities, and civil society must act to fulfill this target, and doing so will go a long way to preventing new infections.

"ACTION is grateful for work of many including the Brazil and Thailand country delegations, who proved to be instrumental in moving this declaration forward, as well as the powerful voices coming from the Treatment Action Campaign, Health GAP, Treatment Action Group and Medicins Sans Frontieres, among others who were able to secure this strong commitment.

"We commend UN member states for recognizing the vital importance of the Global Fund to Fight AIDS, Tuberculosis and Malaria to the global AIDS response, and for calling on donor governments to provide the highest level of financing to meet its resource needs. We call for an emphasis on tuberculosis and TB/HIV in the next round of programs to be approved in order save an additional million lives from TB/HIV by 2015.

"We also commend the member states for committing to investing in accelerated research for new diagnostics to treat TB in people living with HIV - a critical step to stop the leading killer of people with HIV.

"Despite these considerable commitments, we remain alarmed by the weakening of key language from earlier drafts aimed at addressing TB, the leading killer of people living with HIV/AIDS. The dilution of previously considered commitments is unfortunate, especially given new scientific modeling unveiled at the UN this week by the Stop TB Partnership in collaboration with the World Health Organization and UNAIDS showing that one million additional lives could be saved by 2015 by more aggressively treating and preventing TB disease in people living with HIV.

"Previous drafts of the declaration included explicit commitments to fully implement the Global Plan to Stop TB 2011-2015, including $9.6 billion committed for research and development of new TB tools appropriate for use among people living with AIDS - an essential component of the AIDS response. We are disappointed that the United States delegation moved to strike these commitments from the declaration shortly before the text was made final.

"Despite the shortfalls, ACTION celebrates the achievements in this new declaration and remains committed to a more ambitious target on TB and TB-HIV. We urge global leaders to fight TB-HIV as a single disease with scaled-up and focused funding through direct aid and the Global Fund to Fight AIDS, Tuberculosis and Malaria. By doing so, leaders will have the opportunity to cut TB-HIV deaths by 80 percent and save an additional million lives by 2015."

ONE.org: Stop AIDS. Treat Tuberculosis.

ACTION Project Director Kolleen Bouchane: We Can Save a Million More Lives

TB/HIV Activist Lucy Chesire @ NYC AIDS March, June 8, 2011

We Demand That World Leaders Keep Their Promises to Fight Global AIDS!

Hundreds of AIDS and TB activists took to the sweltering streets of midtown Manhattan today to demand that world leaders keep their promises to fight global AIDS. The march coincided with this week's UN High Level Meeting on AIDS (or HLM, in acronym-happy UN parlance), which marks a decade since leaders convened and issued the first political declaration on AIDS.

Since then, leaders have issued a steady stream of promises, commitments, and speeches calling for the end of the epidemic. And while we've made historic gains against AIDS since then, the positive rhetoric on display at this week's meeting belies a simple stark fact: AIDS funding is now declining.

If the trend continues, world leaders will snatch defeat from the jaws of victory. Consider this:

We've never been better positioned to turn the tide against the pandemic, and leaders are now backpedaling? We can't let them!

You may not have been in NYC to march (and sweat) with us, but you can take action right from your computer or smart phone. We're sending world leaders a million messages to save a million lives. Go to http://www.action.org and join the chorus!

For inspiration, check out this video of Lucy Chesire - a Kenyan nutritionist living with HIV who nearly lost her life from TB - call on UN leaders to account for their promises!

“Don’t Talk About Us. Talk to Us.”

That was one of the key messages of the In Women's Words event sponsored by UN Women and UN AIDS in collaboration with the Global Coalition on Women and AIDS and the ATHENA Network as the United Nations' high level meeting on HIV/AIDS got underway in NY this week. The session focused on focused on the specific needs of women in girls in the fight against HIV. The panel featured prominent speakers such as UN Women Executive Director Michelle Bachelet, and UNAIDS Executive Director Michel Sidibe. Dissapointingly, though the speeches were moving and passionate, there little mention of tuberculosis (TB) - the 3^rd largest killer of women worldwide and the biggest killer of those living with HIV/AIDS.

TB and AIDS have formed a super-epidemic which disproportionately impacts pregnant women and the poor. As highlighted in ACTION's brief on women and tuberculosis, of the 3.6 million women who developed TB in 2008, 500,000 are now dead. HIV infection greatly exacerbates the risk of contracting TB, putting women between 15 and 44 and their children at a dual risk. Furthermore, TB infection during pregnancy makes interventions to prevent mother to child transmission less likely to succeed.

One loud voice on the panel challenged this - Alicia Keys. Kudos to Keys, co-founder of Keep a Child Alive and to those who support her work there for highlighting this issue and putting themselves forward as critical leaders on a holistic fight to save women and families.

Keys and Keep a Child Alive well know - what so many others seem yet to understand - that by integrating TB-HIV services which focus on effectively diagnosing and treating people for TB, and increasing access to TB preventative therapy for people living with HIV, we can save a million additional lives by 2015. That would be an 80% reduction in deaths!

The Stop TB Partnership in cooperation with UNAIDS and the WHO released scientific modeling on Monday - a blueprint for saving these million lives. Now it is time for leaders and for all of us to take ACTION!

Global leaders urged to take action and save an additional million lives

New York, NY - Advocates urged global leaders to act in response to new scientific modeling released today by the Stop TB Partnership, showing that between 2011 and 2015 it is feasible to avert over one million deaths caused by a dual infection of HIV and tuberculosis (TB). The modeling was released on the eve of the United Nations High Level Meeting on HIV/AIDS in New York City.

"The world's most devastating viral epidemic and the world's most devastating bacterial epidemic have merged together, with each one fueling the other," said Kolleen Bouchane, director of ACTION. "We will hear soaring speeches from world leaders on AIDS this week, and they're important. More important, however, is that once the speeches are over, leaders return home and deliver the basic services that will save the lives of people in their countries."

The modeling, conducted by epidemiologists at the Stop TB Partnership and the World Health Organization, describes the anticipated result of more effectively diagnosing and treating people with TB and improving access to TB preventive therapy among people living with HIV. The model demonstrates that it is feasible to reduce deaths from TB-HIV disease by 80 percent between 2011 and 2015. The cumulative impact would be to save one million lives by 2015.

"This modeling shows that we can save a million people from an untimely death, and we can do it with technology and knowledge we already have," said Bouchane. "We've made historic progress against AIDS over the last 30 years, but the epidemic is evolving. We need to get serious about addressing HIV and TB as a single disease or we are going to lose both fights and millions more lives."

The modeling is released on the heels of a game-changing new AIDS study, which not only demonstrates that early antiretroviral HIV therapy (ART) reduces the spread of HIV by 96 percent, but it also dramatically reduces the risk of developing TB. Paradoxically, this new evidence comes at a time when governments have begun scaling back AIDS funding.

"U.S. global health investments must continue to follow where the evidence leads. We have the treatment and diagnostics, and now we have the evidence and modeling that demonstrates we can stop TB-HIV in its tracks." said John Fawcett, legislative director of RESULTS Educational Fund, host of the ACTION Secretariat. "Proposed cuts in Congress to global health funding are irrelevant to the deficit and would roll back the progress we've already made by allowing the dual epidemics to continue spreading."

Particularly in sub-Saharan Africa, the AIDS virus has teamed up with Mycobacterium tuberculosis - the bacterium that causes TB - to spawn a dual epidemic. One out of every three people worldwide carries a dormant TB infection, which awakens into contagious and often lethal TB disease when HIV weakens the immune system. Even though ART has made HIV/AIDS a manageable chronic illness for millions, one in four people living with HIV ultimately dies of tuberculosis.

Time to Act! Save a Million Lives From TB-HIV!

In many parts of the world, the epidemics of HIV/AIDS and tuberculosis have merged together, forming a super-epidemic. The human toll is staggering. But new scientific modeling shows that we can reverse it, saving a million lives from TB-HIV disease between now and 2015. But world leaders must act. That’s why we need you. Leaders are convening this week at the United Nations to chart the future global response to HIV/AIDS. Join us in sending a million messages — fight AIDS and TB together to save a million lives!

Tweet your support

The following leaders and institutions can influence whether or not we save a million lives from TB-HIV disease. Use Twitter to send them a message!

@Kazatchkine – Michel Kazatchkine, Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria

Donate to save a life

Read the new Save a Million Lives brochure

TB vaccines: getting them out of the lab

International tuberculosis (TB) experts are gathering today — World TB Day — in France to discuss advances in research into vaccines.

But the reason there is no effective vaccine to prevent the roughly ten million new cases and two million deaths from TB each year has little to do with the science. There are already 11 vaccines in clinical trials whose progress has slowed or stalled because the funding has dried up.

That is why the TuBerculosis Vaccine Initiative (TBVI), an independent organisation that promotes the development of TB vaccines, is launching a new funding model today.

Joris Vandeputte, senior vice-president of advocacy and resource mobilisation at TBVI, tells SciDev.Net that US$1.5 billion is urgently needed to translate basic research into market-ready vaccines over the next decade. A single TB vaccine can cost up to US$300 million to develop.

Basic research has been adequately funded, he says, resulting in around 40 candidate vaccines because of a huge research effort over the past decade. In addition to the 11 in the faltering trials, a further 30 are languishing in laboratories, some of them in developing countries, waiting to be tested.

But the "second chunk" of funding, needed to get the candidate vaccines through clinical trials, is missing — so vaccine development has effectively stopped, he says.

Under the new funding model, the European Union would provide loans to fill the gaps, possibly through the European Investment Bank. The loans would be administered by the TBVI and paid back once the vaccines start making money.

The model takes into account various logistical difficulties facing the researchers, such as the bottleneck caused by the lack of capacity in clinical trials, by calculating in the costs needed to tackle such issues.

"We will have to look to the east — China, India, Russia — to do more clinical trials," he says, in an attempt to overcome this bottleneck. But he maintains that once there is a new vaccine, it will attract a huge market.

Around 90 per cent of countries currently vaccinate their children against TB with the Bacillus Calmette-Guérin (BCG) vaccine, using 100 million doses each year. BCG protects children from severe forms of TB but does not protect adults from pulmonary TB — the most common and infectious form of the disease.

A more effective vaccine would save huge amounts on treatment, which costs European countries alone about US$3 billion a year.

But even if the money for trials becomes available and an effective vaccine emerges, further problems may await. Data to be published later this year in a special vaccines issue of the journal Tuberculosis show that some developing countries may be reluctant to accept new TB vaccines.

Several factors seem to determine whether countries are prepared to shoulder the costs of a new vaccine campaign, including whether the vaccine has been tested in their own country.

The study's authors conducted 86 structured interviews with public health clinicians, politicians and senior civil servants from health and finance ministries in countries with the highest burden of the disease: Brazil, Cambodia, China, India, South Africa, Mozambique, Romania and Russia.

Lew Barker, senior medical advisor at the Aeras Global TB Vaccine Foundation in the United States, says their study sought to gauge the opinions of people in high-burden countries who are likely to be involved in making decisions about whether to adopt TB vaccines when they become available.

"None of the respondents, when asked about the most important public health issues and needs of their country, spontaneously mentioned TB," Barker says. Instead, primary, rural and mother-and-child healthcare, as well as HIV/AIDS, were identified as the most pressing issues.

"However, when TB was mentioned [by the interviewer], they uniformly said this is a very serious problem and, by and large, they said it's also a neglected problem that needs and deserves more attention then it gets," Barker adds.

Respondents in the survey welcomed the development of better TB vaccines, but around 20 per cent said it was unlikely that such vaccines would be taken up in their countries, and many more were undecided. In most of the vaccine roll-out scenarios presented, less than half said they were willing to commit to a new vaccine and provide funding. One of the main reasons was that they wanted to see strong efficacy data from clinical trials in their own country.

Political priorities

Vaccine deployment might take 20–30 years to reap healthcare benefits because 95 per cent of cases are latent and may take years to show up, and most vaccines only target people who have not been exposed to TB (around one third of the world's population has been exposed), so there will be a long tail of cases before the hoped-for elimination of TB in 2050, Barker says. This explains why other issues such as HIV are given political priority.

Barker concludes that robust data showing efficacy of 90 per cent, rather than a more realistic 60 per cent, and from studies in the countries concerned, are likely to be needed for the introduction of new TB vaccines.

Opokua Ofori-Anyinam, senior clinical development manager at GSK Biologicals, a vaccine manufacturer, said researchers should engage with policymakers to make sure that, after spending millions of dollars on trials and testing vaccines in thousands of individuals, they end up with vaccines that policymakers will want to deploy.

"These are the things we have to think about ahead of time," Ofori-Anyinam tells SciDev.Net.

Vandeputte says the TB research community must engage with the media and policymakers to put TB onto national political agendas.

But he points out that Aeras' market research, presented by Barker, found a mixed response and that the proportion of decision-makers who would go for a new vaccine is bigger than those who would not. Engagement and advocacy before a new vaccine reaches the market may also help convince the undecided.

Focus on the vaccine

Michel Greco, chair of the working group on new TB vaccines at the Stop TB Partnership, says: "I am not one of those people who think that as soon as we have a good TB vaccine it would be taken up. Countries are very wary of potential problems, so they go slowly."

But he adds that although studies are needed to address uptake issues and pave the way for the future deployment of TB vaccines, the priority should be on designing and testing vaccines rather than worrying about their subsequent uptake.

Helen McShane, a TB vaccine researcher at the University of Oxford, United Kingdom, whose vaccine MVA85A is currently in phase IIb clinical trials, told SciDev.Net: "The more effective a vaccine is, the more likely that it will be taken on. It will also depend on cost — I think if you have a very effective vaccine at affordable prices for the developing areas of the world then it will be taken on."

She adds: "There may be certain countries where you have to do some studies in that country to get some safety data but, although those are all important factors, I don't see them as the biggest challenge — the biggest challenge is that we need to get a vaccine that works."

Face Masks Can Help Cut TB Transmission

Simple face masks worn by patients infected with tuberculosis may significantly reduce the transmission rates to non-infected patients, suggests study.

The study was conducted in a specialized airborne infections research facility in South Africa, which was designed to allow study of methods to control the spread of TB. Transmission rates were measured using healthy guinea pigs exposed to infected patients."We found that when infectious patients with multidrug resistant tuberculosis (MDR-TB) wore face masks while they were hospitalized, the face masks helped decrease the transmission of tuberculosis by 50 percent compared to when the patients did not wear face masks," said study author Ashwin Dharmadhikari, associate physician at Harvard Medical School's Brigham and Women's Hospital.

The masks may represent a simple way to reduce TB transmissions in areas with limited resources and widespread TB. "This is especially important when one thinks about the importance of protecting health care workers and other patients from getting TB when these vulnerable individuals might be in the same room as a TB patient," said Dharmadhikari.

A Billion Dollar Gap

It seems like just recently ACTION and the global health community put all hands on deck to ensure a robust Global Fund replenishment. In the U.S., ACTION celebrated the government’s commitment of $4 billion, which despite being lower than the global need, was a major feat in itself. In our field, oftentimes advocacy wins are short lived. On the heels of releasing its impressive 2011 results report, the Global Fund to Fight AIDS, Tuberculosis and Malaria reaffirmed last week that despite amassing $11.7 billion in 2010’s donor replenishment, they will face more than a $1 billion shortfall.

The Global Fund’s 2011 results report, launched on May 19th, demonstrates the remarkable impact the Fund has had on AIDS, TB and malaria to date. The Global Fund has saved 6.5 million lives since 2002, 4.1 million of them from successful TB treatments [1]. That number is so massive, it’s nearly impossible to comprehend it.

In 2009, the Global Fund provided 65% of international TB funding for the 22 high-burden countries, making it an extremely important player in the global fight against TB. In fact, with Global Fund support, more than 7.7 million cases of TB were treated between 2002-2010, including an increased number of MDR-TB cases as well [2].

In order to achieve the Global Fund’s targets for TB, MDR-TB and TB-HIV, as well as additional targets for HIV and malaria, the resource gap must be filled. Despite the global financial crisis, the replenishment in 2010 garnered $11.7 billion in donor pledges. This figure, however, is below the lowest estimated demand from recipient countries for this time period. In order to reach the lowest case scenario, at least $1 billion is needed for 2011-2013.

Given the Global Fund’s demonstrated importance and impact, especially given its role in the fight against global TB, donors need to step up to fill this gap. To ensure the effective use of current levels of resources, the Global fund will reconsider the rate of program scale-up and determine cost-effective investments to ensure they continue to save millions of lives.

The Global Fund’s impressive results should motivate advocates and policymakers to make a mid-term replenishment a reality in order to address this funding shortfall. Not doing so will jeopardize advances made to date and slow progress in the fight against AIDS, TB, and malaria. We cannot let this hapen, especially in the wake of impressive results.

Global Fund to Fight AIDS, TB and Malaria—Post Board Meeting Excitement!

It's been an exciting week! Joanne Carter, RESULTS/RESULTS Educational Fund's executive director, just returned from the Global Fund to Fight AIDS, Tuberculosis and Malaria's Board meeting brimming with excitement about what was achieved.

One of these exciting outcomes was the approval of Martin Dinham, former Director General of the UK Department for International Development as Board Chair and Dr. Mphu Ramatlapeng, Minister of Health of the Kingdom of Lesotho, as Vice-Chair. Dr. Ramatlapeng (who gave her acceptance address in Russian!). Both will be positive forces on the Board and help the Global Fund achieve even greater successes.

As always the Global Fund Board is working towards the highest standards of transparency and accountability and reviewed a recommended set of reforms from the Board's Comprehensive Reform Working Group. The Plan for Comprehensive Reform addresses five reform areas where "early gains" can be made. The reforms range from fiduciary controls to value for money, partnerships, business model, and governance. The Board also formally approved an independent high level panel which will review the Global Fund's fiduciary controls and oversight mechanisms to support the reform agenda as well as eligibility, prioritization and cost-sharing criteria for Round 11.

These outcomes and others have all of us at ACTION very excited about the launch of the call for proposals for the 11th Round of Global Fund grants (Round 11) in August and the opportunity to save even more lives through increasing the number and quality of these proposals, as well as fighting TB and HIV co-infection and eliminating TB as a major killer of women and children.

The Power of Activism: TB vs. HIV

NIH to Join Multi-center Clinical Trial of New Tuberculosis Vaccine

Related Links

Related Stories

Addressing the Evolving Needs of Haiti’s Women and Children Two Years After the Earthquake

The Future of Public-Private Partnerships

On TB and Building a Safer Global Neighborhood

10 Years On, Funding Crisis Threatens the Global Fund’s Effort to End AIDS

On Its Tenth Anniversary, Support for The Global Fund Is Strong in Germany

TDR-TB and XXDR-TB: Frequently Asked Questions

Development Assistance for Health as the MDG Deadline Approaches

The Global Fund: Then and Now

Zambia-based CITAM+, a Community Initiative for TB, HIV/AIDS & Malaria, Joins ACTION Partnership

MSF Steps Up TB Detection and Prevention

ACTION partners selected to serve on new Global Fund for AIDS, TB, and Malaria Committees

The Rise of Totally Drug-Resistant TB: Implications For Africa

Thoughts on a visit to Aeras

Marking a “Polio Free” Year in India

Totally Drug Resistant TB? I can’t even imagine.

Kenya’s TB campaign proves a success

“Electronic nose” shows promise for sniffing out TB

What Steve Jobs Can Teach Us About AIDS

AIDS 2012: Submit A Workshop Proposal

Impact the profile of TB-HIV at the conference

WHY SHOULD I SUBMIT A WORKSHOP?

HOW DO I SUBMIT A WORKSHOP?

Remarks by Stephen Lewis, Co-Director of AIDS-Free World at ICASA

AIDS 2012: Call for Abstracts

Why Should I Submit An Abstract?

How Do I Submit An Abstract?

What Are the Submission Categories?

Global Fund Forced to Cancel Funding Round, Jeopardizing Health of Millions

Global Health Advocates India: Not a Toy Story

Journée mondiale contre la pneumonie

Pneumonia kills babies: to protect them = vaccinate!

Pneumonia - No Longer A Silent Killer of Children

Tuberculosis is thriving in Texas

Saving For a Rainy Day

Voices in the Fight

Candlelight Vigil and Services for Winstone Zulu

Nigeria: TB Cases Drop, but Progress Face Poor Funding

Contribute to the Winstone Zulu Memorial Fund

ACTION Remembers Winstone

ACTION remembers Winstone as a friend, colleague, and tireless advocate. Here, staff and partners reflect on Winstone's life and work through personal stories and memories.

Tribute to Winstone

"There have been so few TB survivors who have stepped forward to share their stories. We need more advocates like Winstone to tell the world about TB and the effect it has on so many millions of people." -Nelson Mandela

Share Your Tribute to Winstone

Memorial Slideshow

The story of Shanta, neighbor and care provider: How BRAC is making tuberculosis history

Not missing a dose: Shahida, a patient, recounts her experience with BRAC

Rana, the garment worker: No longer stigmatized, TB patients open up about their experiences

WHO Urges Russia to Step Up TB Fight

New Global TB Report: the Time to Act is Now

Reflecting on Children and TB in Kenya

Turkmenistan’s TB lab services use new luminescent microscopy

Africa: Rota-virus vaccine to be rolled out

Texas School Outbreak Reminds Us of a Forgotten Disease

TB and HIV: A Deadly Combination for Children

TB smoking toll’could reach 40 million by 2050

Putting Pledges In Action! GAVI Approves 37 Countries for Vaccine Financing

Children And TB: Exposing a Hidden Epidemic (Webinar)

HIV/AIDS, Tuberculosis And Malaria Are Still Emergencies

Vaccines Against Major Childhood Diseases to Reach 37 More Countries

Making Tuberculosis History: BRAC Releases New Book On Their TB Program

Children and TB: A Researcher’s Perspective

A Message from CORE Group’s Pediatric TB Interest Group

Children and TB: A Researcher’s Perspective

Think TB Is a Disease of the Past? Think Again!

Learn More

Our Allies in the Fight Against Childhood TB

Share Your Story

Tweet Your Support

Voices In The Fight Against TB

VOICES IN THE FIGHT AGAINST TB:

ACTION PLAN TO COMBAT TB IN EUROPE

Urine test for TB shows promise

World TB Day 2011 - TB Elimination: Together We Can

Dr. Santiago Ramón-García

Treating Tuberculosis in Colombia

GAVI’s Use of Innovative Financing