No, this blog is not about Mr Blair's imminent (we hope) departure - it's about tuberculosis.
TB was declared a 'global emergency' by the World Health Organisation (WHO) as long ago as 1995, but too little has been done (does that surprise anybody?) and things are getting worse. With the inexorable rise in the number of cases and the inevitability that some patients will not follow through with the whole course of medication no matter how closely they are watched (Directly Observed Treatment is now the norm), some strains of TB developed that were Multi-Drug Resistant (MDR-TB), and the process has now progressed a stage further with some that are Extensively Drug Resistant (XDR-TB). That means that both the first-line drugs and the second-line ones are ineffective against it, and there's not a lot the doctors can do apart from palliative care and trying to ensure the patient doesn't infect anybody else.
This is a killer infectious disease, made more so by its symbiotic relationship with HIV/Aids. It seems to this observer that it is glaringly obvious that we should be doing all we can to stop XDR-TB spreading, while trying to clean up the pool of people infected with ordinary TB and MDR-TB so that no new XDR strains develop. Whatever it costs to do that, it will cost much more later if we don't. We can't even hope that XDR-TB will stay safely 'over there' in the developing world (a cynical, inhumane viewpoint in any case). It's too late for that: every G8 country has already had cases of XDR-TB. In an increasingly globalised world that was inevitable.
So what are we going to do about it? The UK's Department for International Development has come up with a plan: cut back the funding of the Global Fund to fight Aids, TB and Malaria (GFATM). Brilliant! At a stroke it ensures that TB remains a global emergency, that MDR-TB and XDR-TB become worse problems, and that we will have more MDR-TB cases here - and it saves money (in the short term - see above!)
To be more specific, there is a GFATM board meeting going on as I write, and one of the questions it is considering is by how much the Fund should seek to expand by 2010. France, Germany, Italy, the EC and the civil society delegates are pushing for $6-8 billion (still not a figure in any way commensurate with the size of the problem), but the UK, the USA and Japan want to keep it down to $4-6 billion. Not for the first time, I hope that my government loses in an international negotiation.
64% of funding for TB control currently goes through GFATM, as well as 67% of funds to fight malaria and 21% of funds for HIV/Aids. The numbers need to go up not down.
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