TOP TB researchers are furious with the WHO, following a claim by the organisation that the global tuberculosis epidemic could soon be brought under control. The leading biomedical scientist who advises the WHO鈥檚 global TB programme has resigned in protest. TB experts fear that the WHO鈥檚 statements will fuel a dangerous complacency that could increase the death toll.
In the week before World TB Day, 24 March, the WHO put out press releases announcing a 鈥渂reakthrough鈥� in the control of the disease. This was to treat people by giving them a combination of drugs for six months under close supervision, a treatment known as directly-observed therapy, short-course, or DOTS.
Arata Kochi, the TB programme director at the WHO, added: 鈥淭his week-for the first time in the 6000-year history of TB-we have the tools, strategies and medicines to defeat the epidemic in all parts of the world.鈥� The press releases concluded that DOTS could halve the number of new cases of TB reported annually by 2007. The WHO claims that this could reduce the death toll by 10 million over the next decade, more than twice the figure anticipated by the most optimistic projection in one of the WHO鈥檚 own reports (see Figure).FIG-mg20780201.GIF
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Most TB experts dismiss this view as grossly optimistic. 鈥淭his is hyperbole,鈥� says Paul Fine, an epidemiologist at the London School of Hygiene and Tropical Medicine. DOTS has been around for a decade, TB researchers point out, and while there is no doubt that the therapy works well, bringing it to the majority of TB sufferers poses huge problems. Worldwide, only one in ten with TB is now being treated with DOTS. For the number of new cases to halve in a decade, the WHO admits that seven out of ten patients would have to receive DOTS.
The WHO鈥檚 press releases did not say how this would be achieved. But Richard Bumgarner, the TB programme鈥檚 deputy director, told 快猫短视频 that bringing DOTS to most of the world鈥檚 TB sufferers would need substantial additional funding.
The WHO鈥檚 statements have prompted Douglas Young of St Mary鈥檚 Hospital Medical School, a leading researcher in TB molecular biology, to resign from the global TB programme鈥檚 Technical and Research Advisory Committee. 鈥淚 obviously wasn鈥檛 doing a good job if they could put out a press release like that,鈥� he says.
Other scientists are equally angry. 鈥淚 am trying to calm down enough to have a civilised conversation,鈥� says Ann Ginsberg, who runs the $35 million TB research effort of the US National Institute of Allergy and Infectious Diseases near Washington DC. 鈥淚 don鈥檛 think we can control TB if DOTS is all we have. There is an urgent need for new drugs that don鈥檛 have to be taken for six months, and a vaccine.鈥� The last new drug for TB was developed in 1961, and the existing vaccine, BCG, in the 1920s. The vaccine is only partially effective.
The annual report of the WHO鈥檚 TB programme does recognise the need for research, devoting two of its 52 pages to a brief discussion of the priorities. But this was not mentioned in the press releases.
快猫短视频s are also incensed that the report seems to imply that much of the $60 million to $80 million spent globally each year on TB research is wasted. The report states that money 鈥渋s poorly spent, focusing mainly on biomedical investigations or high-tech products suitable for markets in industrialised countries鈥�.
TB researchers argue that the current epidemic can be blamed partly on a neglect of research following the success of earlier drugs. TB bounced back in the 1980s, fuelled by the immune deficiency caused by HIV and the emergence of strains of TB which are resistant to drugs.
Barry Bloom, a TB researcher at the Albert Einstein College of Medicine in New York says: 鈥淭he disparity between the judgment of the scientific community and the leadership of the WHO鈥檚 Global Programme on Tuberculosis on the need for investing in research raises serious concerns.鈥�
The leaders of the WHO鈥檚 TB programme say they are surprised by the row, and argue that the attacks are based on a misinterpretation of their message. The statements were not meant to imply that the epidemic is under control, says Bumgarner. 鈥淭he world needs more funding for TB research,鈥� he says. 鈥淚t would be a tragedy if public policy makers thought that we said that because something could be done, it had been done.鈥�