wp/rc50/pr/4

WHO REGIONAL COMMITTEE FOR THE WESTERN PACIFIC DECLARES A "TUBERCULOSIS CRISIS" IN THE REGION

Fiftieth session of the Regional Committee for the Western Pacific
13 to 17 September 1999

WP/RC50/PR/4
17 September 1999

The World Health Organization's (WHO) Regional Committee for the Western
Pacific has declared a "tuberculosis crisis" in the Region.

It is estimated that about 355 000 people in the Region died from tuberculosis in 1998. The Committee, currently meeting in Macao to review WHO's work in the Region, noted that there has been a steady increase in notified tuberculosis cases during the last decade. Tuberculosis is a serious public health problem not only in developing countries, but also in newly industrialized and developed countries, according to the Committee. There has been little or no decrease in the number of tuberculosis cases in the Region's newly industrializing and industrialized countries partly due to the increase of TB in older persons and the number of new cases imported from countries with high TB prevalence.

Dr Shigeru Omi, WHO's Regional Director for the Western Pacific, said "it is simply unacceptable that the Region should be entering the new millennium with rising levels of tuberculosis."

Determined to reduce transmission of the disease in the Region, Dr Omi announced the launching of Stop TB in the Western Pacific Region, as a special WHO project.

Noting that the Region contains approximately 29% of global tuberculosis cases, Dr Omi called on all countries to support this special project: "If we have the political will, we can halve the number of tuberculosis cases in the Region within ten years."

With the tuberculosis problem growing, Dr Omi urged Member States to give high priority to intensifying TB control, using the WHO-recommended strategy, directly-observed treatment, short course (DOTS). "Yet, even though the problem is extremely serious, an affordable and cost-effective anti-tuberculosis strategy is already available," said Dr Omi. The total cost of drugs to treat one patient for six months ranges from US$ 20 to US$ 30.

DOTS, which can cure nine out of ten tuberculosis patients, stops transmission by addressing the source of infection. It also prevents the emergence of drug resistance by ensuring that patients take their medication regularly. Dr Omi cited China's experience with the introduction of DOTS in selected areas of the country: "The tuberculosis case fatality rate plummeted from 30% in 1991 to 7% in 1994. If DOTS is implemented regionwide, it will be possible for us to achieve similar gains across the Region, saving tens of thousands of lives every year," he told the Regional Committee.

The main constraint to wider DOTS coverage in the Region has been inadequate political and government commitment, resulting in neglect of tuberculosis control in the majority of the countries where the disease is most prevalent. If significant reductions in the number of tuberculosis cases are to be achieved, special efforts will be required in these countries. Efforts will also be required to adapt the DOTS strategy to many Pacific Island countries and areas where it has yet to be introduced.

The regional notification rate for infectious cases increased from 18 per 100 000 population in 1994 to 23 in 1998, a 28% increase. It is estimated that there were 1.96 million new cases of tuberculosis in the Region in 1998 and only 43% of these estimated cases were notified.

Although tuberculosis was declared a global emergency by WHO in 1993, only limited progress has been made in controlling the disease in the Western Pacific Region. As of 30 June 1999, only 18 of the Region's 34 countries and areas were implementing the DOTS strategy. Although the percentage of DOTS-treated tuberculosis patients increased from 30% of notified cases in 1996 to 46% in 1998, this still means that more than half of notified TB patients in the Region are not enrolled in a DOTS programme.

Another problem is HIV/tuberculosis co-infection. Although still low regionwide, in the Cambodian capital of Phnom Penh, the percentage of pulmonary tuberculosis patients with HIV infection almost doubled from 8% in 1994 to 15% in 1997. This percentage is expected to rise further over the next few years.

Tuberculosis in the Region will decrease only if case detection, cure rates and DOTS coverage are improved. At current DOTS implementation levels, the number of tuberculosis cases will not decrease for two decades. However, if DOTS coverage expands rapidly and is established regionwide by 2005, it is likely that the number of tuberculosis cases in the Region will be halved in ten years.

Dr Omi said that WHO will ensure that expanding DOTS coverage is at the very top of WHO's agenda. "I hope that all Member States will join with us to give the highest priority to tuberculosis control, using the DOTS strategy within the framework of health sector development. Working together, I am sure that we shall succeed in our target of halving the number of tuberculosis cases in the Region in ten years."