Tuberculosis & Polio
Tuberculosis is an air-born contagious disease. Only a small number of germs, or bacilli, need to be inhaled in order to contract the disease. One infected person is likely to infect a further ten or fifteen people. TB bacilli can lie dormant for many years, and are more likely to attack when a person’s immune system is weak. It is estimated by the WHO that one person per second is infected with TB bacilli. Therefore, one third of the world’s population is currently infected with the disease. People with HIV are more likely to contract the disease. However, only five to ten per cent of people (without HIV) are likely to become infected.
The WHO estimated that in 2005, 1.6 million people died of the disease, the majority of these deaths occurring in Africa. This was due to an epidemic in Africa in the 1990’s, however, since then, the numbers of newly contracted people has dropped. It is estimated by the WHO that the rates of TB are falling across the regions of the world (Africa, Americas, Eastern Mediterranean, Europe, South East Asia and the Western Pacific), however, due to population increase, the rates of TB may actually be rising in some regions such as Africa and the Eastern Mediterranean.
Many of those suffering from HIV often die of tuberculosis. As HIV weakens the immune system, the TB bacilli are activated and increase the chances of becoming seriously ill. TB is a leading cause of death amongst those that are HIV positive, and HIV is the single largest cause of the infection rate of TB in sub-Saharan Africa since 1990. The WHO has formed the TB/HIV Working Group which develops an international strategy on combating HIV and TB.
Another issue that faces the WHO, national governments and the countless NGOs and CSOs is the fact that new strains of TB have become increasingly drug resistant. Drug resistant TB emerges when a patient either does not receive medicine regularly, when the wrong medicine is prescribed, or when an incomplete course of the medication is taken. Multi-drug resistant TB (MDRTB) is especially dangerous because as it is resistant to two of the most powerful drugs against TB and threatens the control of the disease. MDRTB is mainly found in the former Soviet Union. However, MDRTB is treatable with up to two years of chemotherapy or second line TB drugs which are more expensive that first line drugs. The emergence of extensively drug-resistant TB (XTB) is another cause of concern in the fight against TB. It is seen amongst many patients who also have HIV, and it also poses a serious threat to the control of TB.
The WHO decided that a new global strategy was needed by 2006, and the ‘Stop TB’ strategy was launched. At the heart of the strategy lies DOTS (Directly Observed Treatment, Short-course). DOTS is estimated to have reached twenty two million people in the period 1995-2006. Six points were added to the ‘Stop TB’ strategy, which recognized the new threat of MDRTB and HIV/TB, as well as working with local communities and empowering affected people. The six components of the Stop TB Strategy are:
1. Pursuing high-quality DOTS expansion and enhancement: Making high-quality services widely available and accessible to all those who need them, including the poorest and most vulnerable, requires DOTS expansion to even the remotest areas. In 2004, 183 countries (including all 22 of the high-burden countries- which account for 80% of the world's TB cases) were implementing DOTS in at least part of the country.
2. Addressing TB/HIV, MDR-TB and other challenges: Addressing TB/HIV, MDR-TB and other challenges requires much greater action and input than DOTS implementation and is essential to achieving the targets set for 2015, including the United Nations Millennium Development Goal relating to TB (Goal 6; Target 8).
3. Contributing to health system strengthening: National TB control programmes must contribute to overall strategies to advance financing, planning, management, information and supply systems and innovative service delivery scale-up.
4. Engaging all care providers: TB patients seek care from a wide array of public, private, corporate and voluntary health-care providers. To be able to reach all patients and ensure that they receive high-quality care, all types of health-care providers are to be engaged.
5. Empowering people with TB, and communities: Community TB care projects have shown how people and communities can undertake some essential TB control tasks. These networks can mobilize civil societies and also ensure political support and long-term sustainability for TB control programmes.
6. Enabling and promoting research: While current tools can control TB, improved practices and elimination will depend on new diagnostics, drugs and vaccines.
The ‘Stop TB’ campaign has a deadline of 2015 as its goal for further controlling the disease. It also hopes to achieve other goals including completing Millennium Development Goal 6, Target 8: to halt and begin to reverse the incidence of TB by 2015. Wider goals include to reduce TB prevalence and death rates by fifty per cent relative to the 1990 figures, as well as eradicating TB as a public health problem by 2050 (this will be met when TB cases are the equivalent of one case per million people).
Despite the many problems facing the WHO, the UN, national governments and NGOs and CSOs, some progress has been made. In 2005, the WHO estimated that sixty per cent of the smear-positive cases were treated by DOTS, which was just short of their target of seventy per cent. Of those treated by DOTS in 2004, eighty-four per cent were treated successfully, which is very close to their target of an eight-five per cent success rate. Unfortunately the cure rates in Africa and Europe were significantly below the goal, with DOTS successful seventy four per cent of the time in both these regions. If the ‘Stop TB’ strategy is implemented successfully, TB prevalence and death rates in all regions, with the exception of Africa and Eastern Europe, should be halved by 2015.
In 1988, the World Health Organization (WHO) met in Geneva at the annual World Health Assembly. It was decided to implement a four-point strategy in order to combat one of the most common diseases in the developing world at that time, polio. The target completion date was set as 2000. The four points were as follows:
- Attaining high routine coverage (at least 80%) with at least 3 doses of Oral Polio Vaccine (OPV)
- Providing Oral Polio Vaccine (OPV) to children 0 – 59 months during National Immunization Days (NIDS)
- Implementing Acute Flaccid Paralysis (AFP) Surveillance
- Conducting mop up immunization when polio is reduced to focal transmission.
Since immunization against polio began, the Western Hemisphere, Western Pacific Region and Europe (three of the WHO’s zones), have been cleared of polio. However, in the developing world, eighty per cent of polio cases are found in children under the age of five. Therefore immunization and vaccination are priorities for the WHO.
In 1999, eleven years after the meeting in Geneva, the WHO urged member states with high levels of polio to improve and speed up the process of polio eradication. This called for ‘national immunization days (NIDS) where every child in the country could be given a vaccine against one or several diseases. ‘Mop up’ vaccination campaigns began, and these efforts have shown success, as the circulation of polio across the world has been limited.
By 2004, there were only nine countries in Africa that still had polio virus outbreaks. However, a resolution made by Health Ministers in September 2004 stating that national governments, the WHO, the UN and countless NGOs and CSOs would combine efforts and work in order to eradicate the disease. The issue of polio was also included at an African Union summit in January 2005.
This commitment showed great results as within one year of the reaffirmation of Health Ministers of their commitment to polio eradication. There were only 819 cases reported in Africa in 2005, with ninety-four per cent of these cases occurring in one country, Nigeria. Since then, however, a new vaccination process saw case numbers drop by seventy-five per cent in a one year period between 2006 and 2007.
When polio immunization becomes more commonplace, other vaccinations have also been able to be delivered. This has been a knock on effect of the widespread immunization campaign against polio. There has also been an expansion in hospitals and laboratories set up especially to deal with polio. However these facilities can also be used in combating and providing information on other diseases.
Despite the success of the WHO efforts to combat polio, routine immunization needs to continue to improve in Africa and elsewhere. The target set by the WHO in 1988 to immunise eighty million children in Africa was nearly reached, as seventy-seven million children were immunized.
There still are challenges remaining in Africa and other areas where polio is classed as an epidemic. Community acceptance and participation in the vaccination process is still difficult in some rural areas. Other elements associated with sub-optimal health systems are crucial, however, the successes of polio vaccination in Africa has shown the need for immunization and monitoring those at risk in developing countries. More resources and funding are required in order to be able to finally defeat polio.
The most pressing issue that needs to be dealt with in order to completely eradicate the polio disease involve an increase in immunization in Africa’s polio trouble spot, northern Nigeria. Coverage and immunization campaigns need to be stepped up, as well as further involvement with communities where polio is rife. An increase in rapid response and prompt investigation needs to be prioritised by the WHO in order to tackle cases of polio. However, the WHO aims to have completed the interruption of polio outbreaks by 2009.