By Jeorge Sampaio

So far H5N1 avian influenza has killed 166 persons according to the World Health Organization (WHO). In contrast, HIV/AIDS, tuberculosis (TB) and malaria combined kill 6 million people every year. Though it is affordably curable, TB is still a worldwide pandemic growing at 1 percent a year and killing 5,000 people every day.

Despite good progress, TB is not going away. In 2005 more people died from TB than in any year in history and predictably TB will remain one of the world's top 10 causes of mortality in the next decade, especially in Africa, the region hardest hit by this disease.

Of 9 million new tuberculosis cases each year, 400,000 are highly contagious multi-drug-resistant. MDR-TB results from interrupted or incomplete treatment of standard tuberculosis or from person-to-person transmission.

MDR-TB is growing worldwide, with the highest rates in countries of the former Soviet Union around the European Union, in India and China. MDR-TB does not respond to standard TB drugs and predictably, if not properly treated, it can become extensively drug-resistant (XDR-TB). XDR-TB strains have now been found in all regions of the world.

So far, 26 countries have reported XDR-TB cases associated with HIV infection, with an extremely high mortality rate.

MDR-TB and XDR-TB are entirely man-made and occur as a result of poorly-managed TB care and control programs. They pose a critical global health threat and require urgent global action on care and prevention.

This is why we face a real emergency. It is past time for the world political leaders to take extra action promoting global public health, particularly in developing countries.
 
In my personal view, four overarching but overdue issues deserve immediate attention and call for strong extraordinary action by the international community.

First, the fight against TB has to be kept high on the global agenda. The emerging XDR-TB is a new major public health emergency and requires appropriate measures.

In the early 1990s an outbreak of drug-resistant TB in New York City cost US$1 billion to contain. Unfortunately, obvious lessons were not learned and future outbreaks such as XDR-TB were not prevented.

Research and development by G8 and other high-income countries into new tools to effectively fight TB have been neglected and under-funded over more than 40 years.

XDR-TB underlines the need for immediate and substantial investment in prevention and in the development of new TB care as the current available tools are outdated and insufficient. The Stop TB Partnership's Global Plan to Stop TB (2006-15) has identified an annual research funding requirement of US$900 million to deliver urgently needed new diagnoses, drugs and a vaccine.

Moreover, without an overall increase in aid, by 2015 the shortfall between aid needed to achieve the UN Millennium Development Goals (MDGs) concerning TB and actual delivery will stand at more than US$30 billion. It is obviously more affordable to fill this gap than to pay for the human and economic losses produced by the epidemics.

Second, improved coordination in the fight against AIDS and TB is a critical point to improve health worldwide. HIV/AIDS and TB together generate a noxious synergy that accelerates each other's progression and has led to an explosion of TB cases in regions of high HIV prevalence. In some Sub-Saharan regions up to 77 percent of TB patients also have HIV. This is why curable TB remains the leading killer among HIV-infected people.

In order to control TB in high HIV settings far more collaboration between TB and HIV/AIDS programs must be implemented. For instance, it is sobering to recognize that only 0.5 percent of estimated HIV patients are currently tested for TB and only 7 percent of TB patients are tested for HIV worldwide. This is a shockingly dramatic shortfall.

In this regard, I have put forward the idea of a meeting of the influential stakeholders -- such as G8 countries, the European Union, the World Bank, the Global Fund, UNAIDS, WHO, USAIDS, OGAC, foundations, companies, associations, NGOs and governments of high-burden countries to lay down concrete steps for global coordination of TB and HIV activities. We still have to do a great deal of work.

Third, Africa must be top priority on the international and European agendas because it is not acceptable that Africa remains a continent at risk.

Sub-Saharan Africa faces the greatest health challenges, with 11 percent of the world's population and 24 percent of the global burden of disease, yet only 3 percent of the world's health workers. Nearly two-thirds of the world's HIV-infected adults and children live in Sub-Saharan Africa and 72 percent of all AIDS-related deaths occurred there in 2006.

Africa accounts for a large proportion of all TB cases, with some countries showing 300 cases per 100,000 inhabitants (compared with 12.6 cases in EU and 4.6 in the US per 100,000). Last year, TB was declared an emergency in the African region because of its overall disruptive human, social and economic impact. According to available data, in high-burden countries TB is estimated to cause an economic loss of 4 percent of the GDP annually.

We must wake up, demand greater efforts of our governments and ask world leaders to scale up political commitment to the fight against the main infectious diseases plaguing Africa. Health is a public global good and it has to be ensured for all.

Fourth, strengthening health systems should be a major concern.

Promoting a global plan to strengthen health systems is a key issue in achieving most of the health related MDGs. This requires improving infrastructures and investing in laboratories. It also involves addressing the lack of health workers facing many developing countries.

Fifty-seven countries, most of them in Africa and Asia, face a severe health work force crisis. WHO estimates that a total of more than 4 million health-care workers, are needed to fill the gap. Without prompt action, the shortage will worsen.

Efforts should focus on broad measures that affect population's wellbeing. For instance, consideration should be given to the adoption of a code of good practice in healthcare worker migration to prevent a permanent brain drain from poor countries to rich countries and to encourage the return of skilled migrants to their own countries.

MDGs are intended to translate into concrete achievements some basic human rights for all. As there are still millions of human beings living and dying in the most dramatic poverty, achieving these goals by 2015, as agreed, is a moral commitment and a political responsibility for the international community.

The multilateral cooperation and coordination approach is very important if we are to make policies work, to avoid or reduce duplication and waste and to achieve the desired Millennium Goals in time.

Three out of the eight MDGs concern health issues such as reducing child mortality, improving maternal health and combating HIV/AIDS, malaria, TB and other infectious diseases. Global health is thus recognized as a matter of human rights and a key dimension of human safety and development.

To realize these very basic rights worldwide, we cannot afford further delays or work at cross-purposes. We need to double our efforts, to do more and better.

Emergencies just won't wait.

The author, former President of Portugal, is UN Secretary-General Special Envoy to Stop Tuberculosis.

(China Daily via agencies March 28, 2007)