Jorge Sampaio, UN Special Envoy to the Stop TB Partnership, outlines the future of the fight against tuberculosis

March 24th is World TB Day, which marks the 125th anniversary of Robert Koch’s discovery of the TB bacillus. Why is it important to mark this occasion?

Because 125 years after the discovery of the Koch bacillus, TB is still a worldwide pandemic growing at 1% a year and killing 5000 people everyday, though being a preventable and curable disease.

Since the past World TB Day, what are the greatest successes and challenges?

Global rates for case detection and treatment success have increased. A new Global Plan to Stop TB for 2006-2015 was launched last year. This is good news. Now the bad news is the multi-drug resistant TB (MDR-TB) and the emergence of extensively drug-resistant TB (XDR). MDR-TB is growing worldwide and it does not respond to standard TB drugs. If not properly treated, it can become extensively drug-resistant. So far 26 countries have reported XDR-TB cases associated with HVI 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 program. As a global health threat, they are the biggest challenge to TB control.

You’ve said that the fight against TB needs more visibility and high level political leadership. How have you facilitated both and what more can be done?

This is an ever endless task…

As a lawyer by profession and because of my political career I feel able to make political advocacy for TB control. TB control is a matter of public health and therefore needs good public policies.

In my own personal view, four overarching but overdue issues deserve immediate attention and call for strong extra action by the International Community.

First, keeping fight against TB high on the global agenda, particularly because of the emergence of multidrug-resistant and extensively drug-resistant TB, which poses a new major public health threat and requires extra action.

Second, improving co-ordination in the fight against AIDS and TB.

Third, Africa. Africa must be top priority and put at the highest spot on the international and European agenda because it is not acceptable that it should remain a continent at risk. Sub-Saharan Africa faces the greatest health challenges, with 11% of the world’s population and 24% of the global burden of disease, yet only 3% of the world’s health workers.

Four, strengthening health systems. Promoting a Global Plan to strengthen health systems is a key issue in achieving most of the health related MDGs.

In the past few years, a great deal of attention has been paid to HIV/AIDS via media campaigns, political will, and global advocacy initiatives.  TB, which causes almost 2 million deaths per year is not treated with the same level of urgency.  Why is this a mistake?

This a big shame because TB is a preventable and curable disease!

We should not have to bear the burden of witnessing a preventable and curable disease kill millions of people year in, year out. Inaction will mark our consciences and impair our sense of citizenship. It also suggests a lack of morals and a failure of global governance.

The Global Plan to Stop TB for 2006-2015 sets clear targets under a 2015 timeline: save 14 million lives; treat 50 million patients; produce the first new TB drug in 40 years.

This can be done. There are no reasonable excuses that prevent investment in TB control being scaled up. The goals outlined in the Global Plan are ambitious but achievable. They form the basis that guarantees the TB-related UN Millennium Development Goal - to halt and reverse incidence by 2015 - are met.

Can you speak about the connection between TB and HIV/AIDS and explain why co-infection mandates addressing the diseases in tandem?  

One of the main points I always emphasize is the need to stimulate a co-ordinated approach to HIV-AIDS and TB. HIV-TB 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 order to control TB in high HIV settings, far more effective collaboration between TB and HIV/AIDS programs and communities must be implemented.

I do think that the Global Plan to Stop TB and DOTS TB programs as well as UNAIDS plans for universal access and HIV-AIDS programs represent an appropriate framework to scale up TB/HIV collaborative activities. But some gaps remain to be filled in at least two mains areas: political and resource commitment to collaborative TB/HIV activities; prevention, early diagnosis and rapid treatment of TB in People Living with HIV/AIDS (PLWHA).

What can the private sector do to raise public awareness about TB and persuade world leaders to fund and implement the Global Plan, which aims to achieve enormous progress towards TB elimination?

The private sector is a decisive partner to help building support and awareness among policy-makers within and outside the health sector.

The corporate sector has a responsibility to ensure health and safety in the workplace and to promote the well-being of workers. But companies should also contribute to strengthening global health security, to promoting global health equity and to enhancing good governance for global health.

You’ve mentioned that you don’t have sufficient funding for the Global Plan to Stop TB. How are you working to ameliorate this problem and what can the private sector do to facilitate your goal?

I have been touring G8 countries and key policy-makers (eg World Bank, European Union, foundations and multinational corporations) to generate political support and mobilize resources for TB control.

Advocacy to mobilize policy makers and main stakeholders to ensure the financial resources required to fund fully the Global Plan for 2006-2015 is critical. Without an overall increase in aid, by 2015 the shortfall between aid needed to achieve the Millennium Development Goals concerning TB and actual delivery will stand at more than 30 billion dollars!

At present, according to WHO figures, the total cost of the Global Plan to Stop TB for the ten-year period (2006-2015) is estimated at US$ 56.2 billion, of which US$ 25.3 billion is currently available, leaving a funding gap of US$ 30.8 billion. It is obviously more affordable to fill this gap than to pay for the economic loss produced by the epidemics.

In my view, joining the Global Business Coalition is a good way for the corporate sector to facilitate these goals.

Jorge Sampaio is the UN Special Envoy to the Stop TB Partnership.

In 1989, he was elected Mayor of Lisbon and re-elected in 1993. As mayor, he introduced new concepts and methods for planning, management, integration and urban development.

From 1990 to 1995 he was President of the Union of Portuguese-speaking Cities (UCCLA) and in 1990 was elected Vice-President of the Union of Iberian-American Cities. He was also elected President of the Eurocities Movement (1990) and President of the World Federation of United Cities (1992).

In 1995, Jorge Sampaio stood for President of Portugal and was elected on the first ballot and sworn in as President in March 1996. He was re-elected five years later in 2001.

During the last decade, President Sampaio has made important contributions to several issues related to the European affairs, and to almost all the challenges currently facing the international community, including HIV-AIDS, drugs, children, human rights and independence for East Timor.