TUBERCULOSIS: UK accused of 'covering up' G8's failure to cut deaths from TB

 04 January 2011

The UK is today accused of "covering up" the G8's failure to cut the death toll from tuberculosis in south Asia.
In a hard-hitting attack on UK policy, published by the Journal of the Royal Society of Medicine, three experts based in Bangladesh say the UK's strategy against the disease is aimed at preventing its spread to the west, rather than tackling the living conditions in deprived communities where TB is endemic.
Bruce Currey, Professor Quazi Quamruzzaman and Professor Mahmuder Rahman, all based at Dhaka Community Hospital in Bangladesh, accuse the UK's department for international development of glossing over the deaths of nearly half a million people.
The Department for International Development's (DfID) factsheet on progress towards the Millennium Development Goals, issued in December 2008, claims that in southern Asia, "progress in halting and reversing the spread of tuberculosis" is "almost met, or on target". It describes mortality as moderate.
"The Crown's term 'moderate mortality' covers up an annual tuberculosis death toll, estimated by WHO, of almost half a million people (460,003), mostly poor, in south Asia," say Currey and colleagues.
The three experts praise the UK's leadership at the G8 meeting in Okinawa in 2000, which pledged to "Reduce TB deaths and prevalence of the disease by 50% by 2010".
But, they say, the commitment was then watered down. The Millennium Development Goals, formulated by the United Nations in September the same year, put tuberculosis in a category with other infectious diseases and committed to "have halted and begun to reverse the spread" of all of them by 2015‚ " five years later than the target the G8 named".
The efforts of the UK focused on drug treatment‚ "the six-month regime of antibiotics that will cure TB but can be hard to maintain". Currey and colleagues say that insufficient attention has been paid to the poor housing, sanitation and nutrition that underlie TB.
Even when UK-funded drug trials were taking place in the slums of Madras (now Chenai) in the 1950s, they say, nobody stopped to ask why it was such an excellent laboratory for the experiment. And even now, tackling the "immuno-compromising stresses of poverty, migration, poor living conditions, decent employment and food security" are not part of the MDG goal against TB.
DfID's treatment-focused aim, says the paper, is not so much to reduce the incidence as to stop the spread of TB. "Poor men and women, and particularly children who are dying of poverty-induced tuberculosis and other opportunistic diseases of poverty, or couples who are infertile because of reproductive tuberculosis but not potentially contagious, are all occluded from the Crown's health strategy and from the interpretation of the MDG tuberculosis target," they write.
They say it is time to rethink, because the treatment-driven programmes are not succeeding in halting and reversing TB.
"It is now 2010, the deadline for the G8 millennial commitment. The latest WHO report (2009) suggests that the G8 target of reducing tuberculosis deaths by 50% has resulted in only an 11% reduction‚ "neither 'almost met' nor 'on target'," they say.
"The Millennium Development Goals should not be used as a fig leaf for the vertical global programme that is under-funded and failing to eradicate, or root out, the scourge of poverty and the risks underpinning preventable tuberculosis."
A DfID spokesperson said: "The data in this article refers to a factsheet published in 2008. The British government is totally committed to treating and preventing this deadly disease from spreading.
"That is why only last month the secretary of state announced treatment for an additional 56,000 people through the global fund.
"We will continue to help build better medical services in the poorest countries to ensure TB, like other major diseases, is effectively diagnosed and cured."
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