LARGE parts of the developing world are failing to halt the spread of
tuberculosis, says the WHO. A report on the 22 countries with the highest
incidence of the killer disease says that in 16, including South Africa, Russia
and Mexico, progress has stalled. In some of these countries, including Nigeria
and Ethiopia, the situation is rapidly getting worse.
The WHO suggests that the number of new cases worldwide will rise from the
current 7 million a year to 10 million by 2015. But this stark warning comes as
something of a U-turn. Last year, the WHO was attacked by leading researchers
for appearing to suggest that the disease was about to be brought under control
(This Week, 19 April 1997, p 4).
鈥淚t鈥檚 the inconsistency of the message that鈥檚 so unhelpful,鈥� says John
Moore-Gillon of St Bartholomew鈥檚 Hospital in London, a former WHO adviser on TB
and chairman of the British Lung Foundation. 鈥淏ut what they鈥檝e said this year is
right. It鈥檚 an extremely serious problem.鈥�
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Acknowledging that there is a global TB crisis, WHO officials are now pinning
the blame squarely on the shoulders of individual governments. They are
especially critical of countries such as Russia, Indonesia and South Africa,
which have enough money to beat TB but aren鈥檛 taking the threat as seriously as
they might. 鈥淚 call on the governments of these countries to give TB top
priority,鈥� says Arata Kochi, director of the WHO鈥檚 global TB programme.
Kochi and his colleagues want the countries singled out by the WHO to follow
those, such as Peru and Vietnam, that have embraced a strategy called directly
observed therapy, short course (DOTS). This involves giving patients a
combination of drugs for six months under supervision.
鈥淥ne million people were cured of TB in 1997,鈥� says Richard Bumgarner of the
WHO鈥檚 TB programme. DOTs is not the perfect solution, he admits, but it can make
major inroads. 鈥淚t鈥檚 not a Rolls-Royce; it鈥檚 a Volkswagen for use around the
飞辞谤濒诲.鈥�
The richer developing nations, such as Brazil and South Africa, might be
shamed into adopting DOTS by the WHO鈥檚 newly aggressive stance. But poorer
nations in Africa鈥攚here the disease鈥檚 incidence is increasing rapidly
(see Figure) will probably remain in the grip of TB. 鈥淢ost people in Africa
can鈥檛 even afford Volkswagens,鈥� says Paul Chinnock, editor of Africa
Health Medicine Digest.
鈥淲e need something that doesn鈥檛 involve six-month treatment,鈥� agrees Bill
Jacobs, a TB researcher at the Albert Einstein College of Medicine in New
York.
Hopes for new approaches rose this week as the British drugs company Glaxo
Wellcome announced plans to spend an extra 拢10 million on TB research.
Jacobs and his Albert Einstein colleagues will get some of this money to develop
vaccines based on live but weakened TB bacteria. 鈥淚鈥檓 very optimistic that
within 10 years we鈥檙e going to have something that will work,鈥� he says.