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Bulletin of the World Health Organization. 1955; 22:63-83.This paper presents the results of the tuberculin-testing of over 3,600 patients in tuberculosis hospitals and of nearly 34,000 schoolchildren in widely separated areas where arrangements could be made for specially trained personnel to work uniform materials and techniques. Both patients and children were tested with an intradermal dose of 5 TU, and the children were retested with 100 TU if the reactions were less than 5 mm. The results confirm those of earlier papers, that at least two different kinds of naturally acquired tuberculin sensitivity are found in many human populations: a high-grade sensitivity, designated as specific for virulent tuberculous infection, and a low-grade kind designated as non-specific, or not specific for tuberculous infection. Specific sensitivity is the kind found in tuberculous patients and in some schoolchildren everywhere. It follows a remarkably uniform pattern wherever it is found, apparently varying only in prevalence, not in degree, from place to place. In contrast, non- specific sensitivity varies both in prevalence and in degree. It ranges from nearly universal prevalence in some localities to almost complete absence in others, from a low degree to a relatively high degree approaching that of specific sensitivity. Non-specific sensitivity is not correlated with specific sensitivity and may have different causes in different places. (excerpt)
Lancet. 2005 Aug 13; 366(9485):603-605.In September, 2005, a summit of world leaders in New York, USA, will review progress towards the Millennium Development Goals. Three of the eight goals are explicitly health-related: to reduce child mortality by two-thirds between 1990 and 2015, to reduce maternal mortality by three-quarters, and to control HIV, tuberculosis, and malaria. A lack of progress by April, 2001, led Kofi Annan, the United Nations Secretary General, to establish a Global Fund to increase health investment, especially in Africa and Asia. The fund’s focus was control of HIV, tuberculosis, and malaria, which are diseases that kill more than 6 million people every year. To date, the Global Fund for AIDS, tuberculosis, and malaria has committed US$3 billion in 128 countries to support aggressive interventions against the three diseases. Nearly 11 million children and more than 0.5 million mothers die every year, yet progress towards mortality reduction targets has been poor despite the availability of cost-effective and scalable interventions. Investment in maternal and child health programmes has lagged far behind those for AIDS, tuberculosis, and malaria. The investment gap between what is needed and what is spent is large. Mothers and children, not for the first time, have lost out. Here, we put the case for a new Global Fund to reduce maternal, neonatal, and child mortality. (excerpt)
Lancet. 2005 Aug 13; 366:522.The Global Fund to fight AIDS, Tuberculosis and Malaria is in the middle of a public relations offensive. Since June this year, the Fund has been championing a campaign of public awareness to help build confidence in its activities by showing people around the world that “their country’s aid money saves lives”. It already seems to be working. Last week, the UK Department for International Development announced that it was doubling its yearly contribution to the Fund to £100 million for 2005 and 2006. And several donor governments, including the UK, answered the Fund’s plea to hastily fulfill all 2005 commitments by the end of July this year to trigger a full payment of US$435 million from the USA, which, by law, cannot pledge more than 33% of the total held in the Fund’s trustee account on July 31 each year. Despite the recent financial boost, the Fund is still anticipating a funding shortfall of US$700 million. Why is the Fund struggling to gain the credibility that will ensure financial security? (excerpt)
Human development report 2003. Millennium Development Goals: a compact among nations to end human poverty.
New York, New York, Oxford University Press, 2003. xv, 367 p.The central part of this Report is devoted to assessing where the greatest problems are, analysing what needs to be done to reverse these setbacks and offering concrete proposals on how to accelerate progress everywhere towards achieving all the Goals. In doing so, it provides a persuasive argument for why, even in the poorest countries, there is still hope that the Goals can be met. But though the Goals provide a new framework for development that demands results and increases accountability, they are not a programmatic instrument. The political will and good policy ideas underpinning any attempt to meet the Goals can work only if they are translated into nationally owned, nationally driven development strategies guided by sound science, good economics and transparent, accountable governance. That is why this Report also sets out a Millennium Development Compact. Building on the commitment that world leaders made at the 2002 Monterrey Conference on Financing for Development to forge a “new partnership between developed and developing countries”—a partnership aimed squarely at implementing the Millennium Declaration—the Compact provides a broad framework for how national development strategies and international support from donors, international agencies and others can be both better aligned and commensurate with the scale of the challenge of the Goals. And the Compact puts responsibilities squarely on both sides: requiring bold reforms from poor countries and obliging donor countries to step forward and support those efforts. (excerpt)
WORLD HEALTH. 1993 Jul-Aug; 46(4):3.The Director-General of WHO informs us that tuberculosis (TB) is responsible for 3 million deaths annually. TB is the major cause of death from 1 pathogen, making up about 25% of preventable adult deaths. Immediate action will save 30 million lives in the coming decade. In many areas of the world, TB is out of control. Most TB cases and more than 95% of TB deaths take place in developing countries. The number of TB cases in Europe and North America has increased considerably since the late 1980s. These countries cannot control TB unless developing countries greatly reduce TB as a health threat. TB takes on 8 million new victims each year. It is associated with AIDS. Persons infected with both HIV and TB are at a 25-fold increased risk of progressing to potentially fatal disease. Even though there are cost-effective tools to prevent and treat TB, they are not being used to their full potential. 6-8 months of consistent, uninterrupted heavy drug therapy is required for success. Some bacteria are becoming resistant to TB drugs because resources are not dedicated to making sure patients complete treatment. Curing infections as soon as possible stops TB transmission. TB control programs should include a health education component to increase the awareness of the need to complete TB drug therapy. It should also administer BCG vaccination to infants to prevent serious childhood TB. Political leaders need to restart weak or now defunct national TB control programs. WHO is working with governments in developing countries to implement effective TB treatment and prevention programs. Governments, public health officials, communities and the private sector need to unite to begin an immediate and extensive response to the global emergency of TB.
ECONOMIST. 1993 Nov 13; 99-100.The World Health Organization (WHO) eradicated smallpox in 1977. This was the first time that an effective vaccine disseminated through a systematically organized inoculation program had been so successful. In the aftermath, WHO launched the Expanded Program on Immunization (EPI) with the objective of eradicating measles, diphtheria, whooping cough, tetanus, tuberculosis, and polio. These diseases were chosen because all caused major child mortality and effective vaccines existed against each. After 16 years, 80% of the world's children have been immunized and many lives have been saved, but only patchy geographical coverage of immunizations has been achieved and each targeted disease in still with us. In light of this situation, program critics saw the need to take an alternative approach and launched the Children's Vaccine Initiative (CVI) in 1990. EPI concentrated on increasing the effectiveness of bureaucracy to delivery vaccines, but 5 clinic visits in the first 15 months of the baby's life were nonetheless needed for a complete regimen of inoculations against all 6 target diseases. The WHO bureaucracy had trouble incorporating improved vaccines as they were developed and in maintaining the cold chain. The CVI, however, has only minority participation by WHO and the different strategy of focusing upon the development of simpler, more robust vaccines. The CVI is striving to develop a combined vaccine against all 6 diseases which would be affordable, unaffected by changing temperatures, and administered orally in 1 dose shortly after birth. The WHO chief, Nakajima, conceded to the flaws of EPI and agreed to merge the program and its resources with CVI in January, 1994. This move will bring a great deal of program money to CVI. Regarding specific technologies, Virogenetics of Troy, New York, is testing canary-pox-based vaccines on people with the goal of securing a vaccine capable of effectively carrying 7 different antigens. Timed-release capsules are being tested as a means of dealing with the need for repeated doses and it appears that using heavy water to make polio vaccine increases the latter's resistance to heat; researchers are trying to find out why.
AMERICAN REVIEW OF RESPIRATORY DISEASE. 1992 Oct; 146(4):818-22.In May 1990 in Boston, Massachusetts, in the US, American Thoracic Society, the American Lung Association, and the International Union Against Tuberculosis and Lung Disease hosted the World Conference on Lung Health. At the end of the conference, participants adopted several resolutions calling on WHO and governmental and nongovernmental organizations to take specific actions to prevent and control lung diseases. The Conference adopted 7 resolutions pertaining to tuberculosis (TB) and AIDS, such as governments must ensure high quality care for TB and AIDS patients and strengthen TB and AIDS prevention programs. Since acute respiratory infections (ATIs), the leading cause of death in children, cause considerable suffering and death in children, the Conference asked WHO and government and nongovernment organizations to increase funding for provision, cold storage, and distribution of vaccines in developing countries, and for training care workers, and for programs to help parents recognize the signs and symptoms requiring medical attention. Other ARI-related resolutions included education about the risk and prevention of indoor air pollution and increased funding for research to develop heat-stable vaccines. Resolutions related to air pollution and health embraced tighter controls of emission of air pollutants, development of policies to protect indoor air, and more research into the hazards of indoor and outdoor air pollution. More research and gathering of accurate data on deaths and illness due to asthma were among resolutions related to asthma. Resolutions on smoking included a call for the end of all governmental support for the tobacco industry, including the import and export of tobacco products, and of all advertisements and promotions of tobacco products; for nonsmoking policies in all public places, especially health care facilities and schools; and for health workers to be societal role models by not smoking.
Tuberculosis control and research strategies for the 1990s: memorandum from a WHO meeting] Estrategias de control e investigacion de la tuberculosis en el decenio de 1990: memorandum de una reunion de la OMS.
BOLETIN DE LA OFICINA SANITARIA PANAMERICANA. 1993 May; 114(5):429-36.Mycobacterium tuberculosis, the pathogenic agent causing tuberculosis, is carried by one third of the world's population. Some 8 million new clinical cases of tuberculosis are diagnosed annually. Pulmonary tuberculosis is the most infectious clinical manifestation, tubercular meningitis is the principal form causing infant death, and tuberculosis may affect various other organs. Untreated tuberculosis has a fatality rate of over 50%. Chemotherapy greatly reduces the rate, but some 2.9 million persons die of tuberculosis each year because of the inadequacy of many national treatment programs. Tuberculosis is the most important cause of death from a single infectious agent in the world. An estimated one fourth of avoidable deaths to adults aged 15-59 in the developing world are attributed to tuberculosis. Tuberculosis is especially prevalent in Africa south of the Sahara and in Southern Asia. Two new obstacles threaten to aggravate the problem: the HIV epidemic and drug resistance. HIV infection is the most serious risk factor yet identified because it converts latent tuberculosis infection into active disease. In Africa almost half of all persons seropositive for HIV are also infected with tuberculosis. Ineffective treatment programs favor the formation of pharmacoresistent strains, and drug resistance has become a major problem in various parts of the world. Effective measures exist to control tuberculosis. Although it does little to protect adults against infectious forms of tuberculosis, the BCG vaccine prevents the most lethal forms. Coverage of infants the BCG is over 80% in the developing world as a whole, but under 60% in sub-Saharan Africa. Chemotherapy can cure almost all cases and convert cases with positive sputum into noninfectious cases, reducing transmission. Normal treatment must be administered over at least 12 months, straining the resources of health services in developing areas. The introduction of a shorter therapy has revolutionized treatment in some national programs, which have achieved cure rates of 80% in new patients. Evaluation of some national programs has demonstrated that well managed short duration chemotherapy is cost effective even under difficult conditions. Progress in controlling tuberculosis has been slower than expected in developing countries because of excessive optimism about the prospects for quick declines as occurred in the industrialized countries, and because of lack of resources. A well organized and vigorous international effort under World Health Organization leadership is required to bring the tuberculosis problem to the world's attention, mobilize assistance on a wide scale, and provide information and direct support to national programs. Research will be needed to adapt proven control techniques to local cultures, develop new drugs, shorten treatment regimens, and encourage greater patient compliance.