People with drug-resistant tuberculosis are neglected by governments

People with drug-resistant tuberculosis (TB) are neglected by governments

The countries that report high burden of tuberculosis (TB), particularly, drug-resistant strains of TB, are the ones not moving fast enough to provide life saving treatment. According to the International medical humanitarian organization, Medecins Sans Frontieres (MSF) or doctors without borders, less than one percent of those with multi-drug resistant TB (MDR-TB) get access to proper treatment as per the International standards of treatment and care guidelines of World Health Organization (WHO). Even the Stop TB Partnership agrees that about three per cent of those with MDR-TB might be receiving proper treatment.

"Only 3% of people who have MDR-TB have access to effective treatment. We have compelling evidence that we know how to prevent and treat MDR-TB and treatment success rate is 80% in low resource setting. Its intervention is complex but is effective, feasible and is cost-effective" stressed said Dr Ernesto Jaramillo, Medical Officer, Stop TB Department, World Health Organization (WHO) at the 3rd Stop TB Partners' Forum in Rio de Janeiro, Brazil.

Dr Mario Raviglione, Director of the WHO's Stop TB department, said that "the WHO Global Tuberculosis Control Report 2009 confirms the notion that there might be more than half a million MDR-TB cases every year. 54 countries have reported extensively drug-resistant TB (XDR-TB) to us."

As ministers from high-burden multi- and extensively- drug-resistant TB (M/XDR-TB) countries gather from 1-3 April 2009 in Beijing, China, for a high-level ministerial meeting on M/XDR-TB, MSF calls on them to commit to treating more people with MDR-TB, and to conducting necessary research to improve current treatment options.

The WHO reports that there are more than 500,000 new MDR-TB cases each year, but that under 30,000 people were detected and notified last year and only 3,681 are known to have started treatment according to international guidelines and with quality-assured medicines.

“The slow progress in treating people with MDR-TB is particularly striking because high-burden MDR-TB countries are definitely not the least developed in the world,” said Dr. Tido von Schoen-Angerer, Director of MSF’s Access to Essential Medicines Campaign. “They have the capacity to act, and need to make this a priority and put people on treatment.”

MSF is concerned that many countries, particularly those that are classified by WHO as ‘high-burden’, like China, South Africa or India, are not doing enough to provide treatment to patients in need. In addition, not providing appropriate treatment further contributes to the spread of drug-resistant TB.

China, for example, has a quarter of the world’s MDR-TB cases. Answering to an initial request made by the Chinese National TB Programme, MSF then failed to obtain the authorisation to provide care for MDR-TB patients in inner Mongolia, despite two years of negotiations with national, provincial and regional authorities. MSF has now abandoned its attempts to open the project.

“Not being able to act when there are people that need life-saving treatment is extremely frustrating,” said Meinie Nicolai, MSF Director of Operations. “Because we did not manage to reach an agreement, we could not put a single patient on treatment. And because they can’t get treated anywhere else, many people will have died while we were stalled in meetings these past two years.”

“Crucially, high-burden countries have the skills and some of the resources needed to conduct the research to improve MDR-TB treatment,” says Dr. von Schoen-Angerer. “The Beijing meeting is an opportunity for high-burden countries to take the lead in addressing this crisis, by setting targets to put more patients on treatment, by agreeing to import quality-assured drugs, and by establishing a joint research effort to improve existing treatment.”

In 2007, MSF treated 574 patients for MDR-TB in 12 projects including in South Africa, India, Uzbekistan, Georgia and Armenia.

According to the World Health Organization (WHO), the countries with the highest burden of MDR-TB are India (131,000 cases), China (112,000), Russia (43,000), South Africa (16,000) and Bangladesh (15,000).

The High Level Ministerial Meeting on M/XDR-TB is being organized by WHO, the Ministry of Health of the People's Republic of China and the Bill and Melinda Gates Foundation.

This meeting is likely to bring together health ministers and other stakeholders from 27 high M/XDR-TB burdened countries, including justice and science ministry delegations and representatives from international agencies, civil society, research communities and the corporate sector.

"We have been able to convince the ministers of health of 27 high burden M/XDR-TB countries to come to the Beijing meeting and commit to achieve the targets of the Global Plan to Stop TB" said Dr Ernesto Jaramillo, Medical Officer, Stop TB Department, WHO at the 3rd Stop TB Partners' Forum in Rio de Janeiro, Brazil.

"The 2nd Global Plan to Stop TB which was launched in 2006 had laid out specific targets for MDR-TB, to provide universal access to diagnosis and treatment of MDR-TB by year 2015" said Dr Jaramillo.

The 27 countries represented will be Armenia, Azerbaijan, Bangladesh, Belarus, Bulgaria, China, the Democratic Republic of Congo, Estonia, Ethiopia, Georgia, India, Indonesia, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, the Republic of Moldova, Myanmar, Nigeria, the Philippines, the Russian Federation, Pakistan, South Africa, Tajikistan, Ukraine, Uzbekistan and Viet Nam.

The highest levels of MDR-TB ever recorded were reported by WHO in its 'Anti-tuberculosis Drug Resistance in the World' report in February 2008 with nearly half a million new MDR-TB cases emerging worldwide. According to the new WHO report (Global Tuberculosis Control report 2009), the levels of multi-drug resistant TB might be more than half a million as previously thought.

The threat of MDR-TB and XDR-TB can be halted but few of the 27 high MDR-TB burdened countries have response plans in place. Many of these countries are not even properly equipped to diagnose drug-resistant TB.

"We need political commitment from the countries. The XDR-TB task force had met in April 2008 in order to assess the progress we had made in response to MDR-TB and XDR-TB. The Task Force came up with lot of positive things, major progress in many areas. However the number of people on treatment was far below the target. One of the clear recommendations coming out of the XDR-TB Task Force meeting was to convene a high level ministerial meeting where we can get ministers of countries responsible for the 85% of the global M/XDR-TB burden, to achieve the target of universal access to diagnosis and treatment of MDR-TB by 2015" explained Dr Jaramillo.

Countries with low resources are building their capacities to make things happen. Lesotho was able to make a state-of-the-art laboratory for diagnosis of MDR-TB in six months. "We have countries like Nepal, Philippines, Peru that despite of weakness in health systems are providing universal access to MDR-TB diagnosis and treatment" said Dr Jaramillo.

"So far the Green Light Committee (GLC) mechanism, which is an initiative of WHO, and has played an instrumental role in leading the response, began with only one country in the year 2000 - Philippines. Now 8 years later we have 58 countries that have 116 projects approved by GLC. However we have less than 20% of countries that are moving towards scale up country wide of these interventions" said Dr Jaramillo.

Dr Jaramillo expressed his concern that "Countries are not moving fast enough in order to prevent the death of 1000 people with MDR-TB every day."

Vice Premier of China, the Director-General of WHO and very likely that Bill Gates and ministers of health confirmed so far from 21 high burden M/XDR-TB countries will be taking part in the Beijing meeting opening next week.

"We are expecting that this will be a watershed meeting in response to M/XDR-TB" said Dr Jaramillo.

"After this meeting we will like to move towards a World Health Assembly (WHA) resolution. The resolution of WHA is powerful in the sense that countries really commit to do things. After the Beijing meeting, one month later, the Government of China has agreed to submit a proposal of a resolution to the WHA in order to accelerate the response to M/XDR-TB" shared Dr Jaramillo.

Investing in research is also necessary. Treating MDR-TB is complex, lengthy and involves the use of drugs that can cause severe side effects and are not optimally effective. There is therefore an urgent need to speed up the development of newer, better tests and drugs, and to conduct studies to optimise MDR-TB treatment.

People with drug-resistant tuberculosis are neglected by governments

People with drug-resistant tuberculosis (TB) are neglected by governments

The countries that report high burden of tuberculosis (TB), particularly, drug-resistant strains of TB, are the ones not moving fast enough to provide life saving treatment. According to the International medical humanitarian organization, Medecins Sans Frontieres (MSF) or doctors without borders, less than one percent of those with multi-drug resistant TB (MDR-TB) get access to proper treatment as per the International standards of treatment and care guidelines of World Health Organization (WHO). Even the Stop TB Partnership agrees that about three per cent of those with MDR-TB might be receiving proper treatment.

"Only 3% of people who have MDR-TB have access to effective treatment. We have compelling evidence that we know how to prevent and treat MDR-TB and treatment success rate is 80% in low resource setting. Its intervention is complex but is effective, feasible and is cost-effective" stressed said Dr Ernesto Jaramillo, Medical Officer, Stop TB Department, World Health Organization (WHO) at the 3rd Stop TB Partners' Forum in Rio de Janeiro, Brazil.

Dr Mario Raviglione, Director of the WHO's Stop TB department, said that "the WHO Global Tuberculosis Control Report 2009 confirms the notion that there might be more than half a million MDR-TB cases every year. 54 countries have reported extensively drug-resistant TB (XDR-TB) to us."

As ministers from high-burden multi- and extensively- drug-resistant TB (M/XDR-TB) countries gather from 1-3 April 2009 in Beijing, China, for a high-level ministerial meeting on M/XDR-TB, MSF calls on them to commit to treating more people with MDR-TB, and to conducting necessary research to improve current treatment options.

The WHO reports that there are more than 500,000 new MDR-TB cases each year, but that under 30,000 people were detected and notified last year and only 3,681 are known to have started treatment according to international guidelines and with quality-assured medicines.

“The slow progress in treating people with MDR-TB is particularly striking because high-burden MDR-TB countries are definitely not the least developed in the world,” said Dr. Tido von Schoen-Angerer, Director of MSF’s Access to Essential Medicines Campaign. “They have the capacity to act, and need to make this a priority and put people on treatment.”

MSF is concerned that many countries, particularly those that are classified by WHO as ‘high-burden’, like China, South Africa or India, are not doing enough to provide treatment to patients in need. In addition, not providing appropriate treatment further contributes to the spread of drug-resistant TB.

China, for example, has a quarter of the world’s MDR-TB cases. Answering to an initial request made by the Chinese National TB Programme, MSF then failed to obtain the authorisation to provide care for MDR-TB patients in inner Mongolia, despite two years of negotiations with national, provincial and regional authorities. MSF has now abandoned its attempts to open the project.

“Not being able to act when there are people that need life-saving treatment is extremely frustrating,” said Meinie Nicolai, MSF Director of Operations. “Because we did not manage to reach an agreement, we could not put a single patient on treatment. And because they can’t get treated anywhere else, many people will have died while we were stalled in meetings these past two years.”

“Crucially, high-burden countries have the skills and some of the resources needed to conduct the research to improve MDR-TB treatment,” says Dr. von Schoen-Angerer. “The Beijing meeting is an opportunity for high-burden countries to take the lead in addressing this crisis, by setting targets to put more patients on treatment, by agreeing to import quality-assured drugs, and by establishing a joint research effort to improve existing treatment.”

In 2007, MSF treated 574 patients for MDR-TB in 12 projects including in South Africa, India, Uzbekistan, Georgia and Armenia.

According to the World Health Organization (WHO), the countries with the highest burden of MDR-TB are India (131,000 cases), China (112,000), Russia (43,000), South Africa (16,000) and Bangladesh (15,000).

The High Level Ministerial Meeting on M/XDR-TB is being organized by WHO, the Ministry of Health of the People's Republic of China and the Bill and Melinda Gates Foundation.

This meeting is likely to bring together health ministers and other stakeholders from 27 high M/XDR-TB burdened countries, including justice and science ministry delegations and representatives from international agencies, civil society, research communities and the corporate sector.

"We have been able to convince the ministers of health of 27 high burden M/XDR-TB countries to come to the Beijing meeting and commit to achieve the targets of the Global Plan to Stop TB" said Dr Ernesto Jaramillo, Medical Officer, Stop TB Department, WHO at the 3rd Stop TB Partners' Forum in Rio de Janeiro, Brazil.

"The 2nd Global Plan to Stop TB which was launched in 2006 had laid out specific targets for MDR-TB, to provide universal access to diagnosis and treatment of MDR-TB by year 2015" said Dr Jaramillo.

The 27 countries represented will be Armenia, Azerbaijan, Bangladesh, Belarus, Bulgaria, China, the Democratic Republic of Congo, Estonia, Ethiopia, Georgia, India, Indonesia, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, the Republic of Moldova, Myanmar, Nigeria, the Philippines, the Russian Federation, Pakistan, South Africa, Tajikistan, Ukraine, Uzbekistan and Viet Nam.

The highest levels of MDR-TB ever recorded were reported by WHO in its 'Anti-tuberculosis Drug Resistance in the World' report in February 2008 with nearly half a million new MDR-TB cases emerging worldwide. According to the new WHO report (Global Tuberculosis Control report 2009), the levels of multi-drug resistant TB might be more than half a million as previously thought.

The threat of MDR-TB and XDR-TB can be halted but few of the 27 high MDR-TB burdened countries have response plans in place. Many of these countries are not even properly equipped to diagnose drug-resistant TB.

"We need political commitment from the countries. The XDR-TB task force had met in April 2008 in order to assess the progress we had made in response to MDR-TB and XDR-TB. The Task Force came up with lot of positive things, major progress in many areas. However the number of people on treatment was far below the target. One of the clear recommendations coming out of the XDR-TB Task Force meeting was to convene a high level ministerial meeting where we can get ministers of countries responsible for the 85% of the global M/XDR-TB burden, to achieve the target of universal access to diagnosis and treatment of MDR-TB by 2015" explained Dr Jaramillo.

Countries with low resources are building their capacities to make things happen. Lesotho was able to make a state-of-the-art laboratory for diagnosis of MDR-TB in six months. "We have countries like Nepal, Philippines, Peru that despite of weakness in health systems are providing universal access to MDR-TB diagnosis and treatment" said Dr Jaramillo.

"So far the Green Light Committee (GLC) mechanism, which is an initiative of WHO, and has played an instrumental role in leading the response, began with only one country in the year 2000 - Philippines. Now 8 years later we have 58 countries that have 116 projects approved by GLC. However we have less than 20% of countries that are moving towards scale up country wide of these interventions" said Dr Jaramillo.

Dr Jaramillo expressed his concern that "Countries are not moving fast enough in order to prevent the death of 1000 people with MDR-TB every day."

Vice Premier of China, the Director-General of WHO and very likely that Bill Gates and ministers of health confirmed so far from 21 high burden M/XDR-TB countries will be taking part in the Beijing meeting opening next week.

"We are expecting that this will be a watershed meeting in response to M/XDR-TB" said Dr Jaramillo.

"After this meeting we will like to move towards a World Health Assembly (WHA) resolution. The resolution of WHA is powerful in the sense that countries really commit to do things. After the Beijing meeting, one month later, the Government of China has agreed to submit a proposal of a resolution to the WHA in order to accelerate the response to M/XDR-TB" shared Dr Jaramillo.

Investing in research is also necessary. Treating MDR-TB is complex, lengthy and involves the use of drugs that can cause severe side effects and are not optimally effective. There is therefore an urgent need to speed up the development of newer, better tests and drugs, and to conduct studies to optimise MDR-TB treatment.

What do Varun Gandhi's pronouncements mean?

What do Varun Gandhi's pronouncements mean?

Varun Gandhi has chosen the shortcut to fame. Until yesterday he was an ordinary member of BJP. Today he is a nationally important leader in this party and in the same league as L.K. Advani and Narendra Modi for subscribing to virulent communal views. For a leader of BJP to have said the kind of things that Varun Gandhi said was not very surprising. BJP’s USP is anti-Muslim or anti-minority ideology. Remove the anti-Muslim, anti-Pakistan or anti-minority plank and BJP or the larger Sangh Parivar will face an identity crisis. In this sense the Hindutva organizations are basically reactionary. They have always used vitriolic language to attract attention and used violence to make their presence felt. Starting with Mahatma Gandhi’s assassination, the Babri Masjid demolition, Nuclear test, Gujarat massacre to the Orissa and Karnataka anti-Christian violence there are plenty of examples. They don’t have a constructive or positive agenda. They tried to project an ‘India Shining’ slogan of their achievements in the last general elections which backfired.

What was surprising was that these communal statements came from Varun Gandhi. Born to a Sikh mother and having a Parsi grandfather one would not expect Varun to be a hardcore Hindutva activist. Why did he say the things that he said? Did he say them himself or was he coached? Was it a case of a new convert trying to prove more faithful? Or, the BJP is using a new fodder in the old cannon? The BJP, which was feeling rudderless before the general elections with infighting and uninspiring leadership, suddenly has got a shot in the arm. The party has been electrified. Suddenly it is back to its basic anti-Muslim agenda after trying very hard to project itself as a genuine progressive alternative to the Congress Party. Narendra Modi tries very hard to sell the image of Gujarat as a model of modern development and doesn’t like the 2002 genocide of the Muslims to be remembered. In the last assembly elections the BJP Chief Ministers preferred to talk about their development achievement rather than focus on Congress’ failure to handle the Mumbai terrorist attack. But it finds that like a drug addict the only thing that inspires its cadres is the anti-Muslim venom.

The RSS must realize that the communal card cannot be played over and again. Human being by nature is a pacifist and likes to live in harmony with other human beings around him. He may get carried away once or twice by communal frenzy but sooner or later he realizes that it ultimately harms him. It was easy to gather people once to demolish Babri Masjid. It is difficult to bring them again to Ayodhya for the construction of the temple. Most of the Sadhus and Mahants in Ayodhya are now opposed to the Ram Mandir construction campaign as this movement has destroyed their peace and income. Narendra Modi cannot afford to repeat the 2002 massacre. The hate speeches of Sadhvi Rithambara or Uma Bharti don’t move people any more. Hence the BJP was looking for a new leader who could spew fire. But it must realize that Varun Gandhi cannot sustain in politics if he keeps repeating what he said in Pilibhit. People will stop going to his meetings after a while.

The reaction to Varun Gandhi’s communal statements in Pilibhit was that was shock from within and without his party. Even though some leaders of BJP, who now want to capitalize on his statements, have started supporting him. His cousins Rahul and Priyanka also expressed dismay. But then the Congress Party has used the communal card whenever it suits it. The only difference between the BJP and the Congress is that the former is ideologically communal and the later is opportunistically communal. Rahul Gandhi who would now like to be seen as a more moderate and liberal member of the Gandhi family needs to be reminded that it was not long back when campaigning in UP Assembly elections he had said that if there was a Prime Minister from the Gandhi family in 1992, the Babri Masjid would not have been demolished, raising doubts over the secular credentials of other leaders within the Congress Party. Worse still, and probably as crude as Varun Gandhi’s, was his statement that his grandmother Indira Gandhi should be given the credit for dismemberment of Pakistan . There were objections raised by Pakistanis on this statement. What was the need for Rahul Gandhi, who otherwise appears a very sensible person, to say those communal things? Was he any different from Varun Gandhi is making those statements?

It is a symptom of a disease which afflicts the India politics. The politicians don’t mind playing with the sentiments of the people if it can help them fetch votes no matter what the consequences. They can say and do the most atrocious things and know that they enjoy certain immunity so that they’ll never be punished. Navjot Singh Sidhu got back his Parliamentary seat after being convicted for a murder. Other criminals hope that their crimes will be pardoned by the courts so that they may remain active in politics. Politics, in fact, provides an immunity from punishment. On top of it Varun Gandhi is trying to gain mileage from this incident by trying to project himself as a martyr by getting arrested. This is sheer desperation.

The interesting fallout of the Philibhit incident is that now the two most upwardly mobile young leaders of India ’s two major parties are members of the same family. Or is one cousin being used to check the rise of the other who most certainly will be India ’s PM one day? Whatever may be the reason behind Varun Gandhi’s pronouncements he has degraded Indian politics down to one more level. He and his party may stand to gain in the short run but the Indian politics in the long run is the loser. One only hopes that the damage caused by him will be contained and he will not become a model to be imitated by other youth in society. If his performance from political stage were to be repeated by lesser mortals in real life it could cause havoc with peace and harmony in society.


Dr Sandeep Pandey

(The author is a Ramon Magsaysay Awardee (2002) for emergent leadership, member of National Presidium, People's Politics Front (PPF), heads the National Alliance of People's Movements (NAPM) and did his PhD from University of California, Berkeley in control theory which is applicable in missile technology. He taught at Indian Institute of Technology (IIT) Kanpur before devoting his life to strengthening people's movements in early 1990s. He can be contacted at: ashaashram@yahoo.com. Website: www.citizen-news.org)

What do Varun Gandhi's pronouncements mean?

What do Varun Gandhi's pronouncements mean?

Varun Gandhi has chosen the shortcut to fame. Until yesterday he was an ordinary member of BJP. Today he is a nationally important leader in this party and in the same league as L.K. Advani and Narendra Modi for subscribing to virulent communal views. For a leader of BJP to have said the kind of things that Varun Gandhi said was not very surprising. BJP’s USP is anti-Muslim or anti-minority ideology. Remove the anti-Muslim, anti-Pakistan or anti-minority plank and BJP or the larger Sangh Parivar will face an identity crisis. In this sense the Hindutva organizations are basically reactionary. They have always used vitriolic language to attract attention and used violence to make their presence felt. Starting with Mahatma Gandhi’s assassination, the Babri Masjid demolition, Nuclear test, Gujarat massacre to the Orissa and Karnataka anti-Christian violence there are plenty of examples. They don’t have a constructive or positive agenda. They tried to project an ‘India Shining’ slogan of their achievements in the last general elections which backfired.

What was surprising was that these communal statements came from Varun Gandhi. Born to a Sikh mother and having a Parsi grandfather one would not expect Varun to be a hardcore Hindutva activist. Why did he say the things that he said? Did he say them himself or was he coached? Was it a case of a new convert trying to prove more faithful? Or, the BJP is using a new fodder in the old cannon? The BJP, which was feeling rudderless before the general elections with infighting and uninspiring leadership, suddenly has got a shot in the arm. The party has been electrified. Suddenly it is back to its basic anti-Muslim agenda after trying very hard to project itself as a genuine progressive alternative to the Congress Party. Narendra Modi tries very hard to sell the image of Gujarat as a model of modern development and doesn’t like the 2002 genocide of the Muslims to be remembered. In the last assembly elections the BJP Chief Ministers preferred to talk about their development achievement rather than focus on Congress’ failure to handle the Mumbai terrorist attack. But it finds that like a drug addict the only thing that inspires its cadres is the anti-Muslim venom.

The RSS must realize that the communal card cannot be played over and again. Human being by nature is a pacifist and likes to live in harmony with other human beings around him. He may get carried away once or twice by communal frenzy but sooner or later he realizes that it ultimately harms him. It was easy to gather people once to demolish Babri Masjid. It is difficult to bring them again to Ayodhya for the construction of the temple. Most of the Sadhus and Mahants in Ayodhya are now opposed to the Ram Mandir construction campaign as this movement has destroyed their peace and income. Narendra Modi cannot afford to repeat the 2002 massacre. The hate speeches of Sadhvi Rithambara or Uma Bharti don’t move people any more. Hence the BJP was looking for a new leader who could spew fire. But it must realize that Varun Gandhi cannot sustain in politics if he keeps repeating what he said in Pilibhit. People will stop going to his meetings after a while.

The reaction to Varun Gandhi’s communal statements in Pilibhit was that was shock from within and without his party. Even though some leaders of BJP, who now want to capitalize on his statements, have started supporting him. His cousins Rahul and Priyanka also expressed dismay. But then the Congress Party has used the communal card whenever it suits it. The only difference between the BJP and the Congress is that the former is ideologically communal and the later is opportunistically communal. Rahul Gandhi who would now like to be seen as a more moderate and liberal member of the Gandhi family needs to be reminded that it was not long back when campaigning in UP Assembly elections he had said that if there was a Prime Minister from the Gandhi family in 1992, the Babri Masjid would not have been demolished, raising doubts over the secular credentials of other leaders within the Congress Party. Worse still, and probably as crude as Varun Gandhi’s, was his statement that his grandmother Indira Gandhi should be given the credit for dismemberment of Pakistan . There were objections raised by Pakistanis on this statement. What was the need for Rahul Gandhi, who otherwise appears a very sensible person, to say those communal things? Was he any different from Varun Gandhi is making those statements?

It is a symptom of a disease which afflicts the India politics. The politicians don’t mind playing with the sentiments of the people if it can help them fetch votes no matter what the consequences. They can say and do the most atrocious things and know that they enjoy certain immunity so that they’ll never be punished. Navjot Singh Sidhu got back his Parliamentary seat after being convicted for a murder. Other criminals hope that their crimes will be pardoned by the courts so that they may remain active in politics. Politics, in fact, provides an immunity from punishment. On top of it Varun Gandhi is trying to gain mileage from this incident by trying to project himself as a martyr by getting arrested. This is sheer desperation.

The interesting fallout of the Philibhit incident is that now the two most upwardly mobile young leaders of India ’s two major parties are members of the same family. Or is one cousin being used to check the rise of the other who most certainly will be India ’s PM one day? Whatever may be the reason behind Varun Gandhi’s pronouncements he has degraded Indian politics down to one more level. He and his party may stand to gain in the short run but the Indian politics in the long run is the loser. One only hopes that the damage caused by him will be contained and he will not become a model to be imitated by other youth in society. If his performance from political stage were to be repeated by lesser mortals in real life it could cause havoc with peace and harmony in society.


Dr Sandeep Pandey

(The author is a Ramon Magsaysay Awardee (2002) for emergent leadership, member of National Presidium, People's Politics Front (PPF), heads the National Alliance of People's Movements (NAPM) and did his PhD from University of California, Berkeley in control theory which is applicable in missile technology. He taught at Indian Institute of Technology (IIT) Kanpur before devoting his life to strengthening people's movements in early 1990s. He can be contacted at: ashaashram@yahoo.com. Website: www.citizen-news.org)

Neglect of TB control among indigenous communities unethical

Neglect of TB control among indigenous communities unethical

The need to include indigenous people in the Global Plan to Stop TB was echoed by many participants at the 3rd Stop TB Partners' Forum in Rio de Janeiro, Brazil (23-25 March 2009).

"We demand inclusion of indigenous peoples in the Global Plan to Stop TB strategy and have launched a strategic framework aimed at addressing tuberculosis among indigenous peoples. The Stop TB Strategy builds on the successes of directly observed treatment shortcourse (DOTS) while also explicitly addressing the key challenges facing TB. Its goal is to dramatically reduce the global burden of tuberculosis by 2015" said Wilton Littlechild, Regional Chief, Assembly of First Nations.

There are approximately 370 million indigenous peoples globally in more than 70 countries. Although programmes have been designed to combat TB, indigenous populations globally have been left out of such efforts due to cultural barriers, language differences, geographic remoteness, and economic disadvantage. TB rates among indigenous people are consistently higher than general public. During the five year period 2002-2006, the first nations TB rate was 29 times higher than others born in Canada - for the Inuit, it was 90 times higher. Pacific islanders and Maoris are 10 times more likely to contract TB than other people living in New Zealand. In Kalaallit Nunaat, Greenland, residents have a risk rate more than 45 times greater than Danish born citizens.

"These challenges will not be easily met - but they can be met by ensuring indigenous peoples are true partners in global TB control. We have a comprehensive and achievable plan to stop indigenous TB globally, but to realize our goal we need support" said Chief Littlechild.

Indigenous people have a consistent pattern of health inequality across a variety of jurisdictions from resource poor to the resource rich. Indigenous health inequalities are multi-faceted, and are both social and political in nature.

"Indigenous leaders will continue to work with the United Nations Permanent Forum on indigenous issues, the World Health Organization (WHO) and the Stop TB Partnership in addressing indigenous TB globally" further added Chief Littlechild.

Highlighting the problem of TB treatment default and risk of developing drug-resistant forms of TB in indigenous people, Chief Littlechild said that "we wish to establish a secretariat to collect data of TB programmes in indigenous communities. Due to a broad range of reasons, indigenous people aren’t able to access TB-related treatment and care services and if they are, then they are more likely to default, increasing the risk to develop drug resistance" said Chief Littlechild. With the High Level Ministerial meeting on multi- and extensively- drug-resistant TB (M/XDR-TB) going to open in Beijing, China (1-3 April 2009) later this week, it is indeed a clear message from indigenous communities for their Health Ministers to commit to responding to their specific issues regarding TB control.

In response to another question, Chief Littlechild said that "human rights based approach calls for genuine partnership and indigenous communities can be part of the solution."

The inequities faced by indigenous communities are much severe than in general population. "Countries like Canada report that poverty has gone down but poverty in indigenous communities has gone up. In prisons too there are a significant number of indigenous communities. There are host of other life conditions that put these people at an elevated risk of infectious diseases like TB - overcrowded housing and lack of access to safe drinking water are just few of those challenges" said Chief Littlechild.

The strategic framework to control TB among indigenous populations was developed through consultations with indigenous leaders, TB experts and health advocates from over 60 countries. It is designed to take an indigenous approach that links the right to health, education, housing, employment, and dignity. It is based on equality of opportunity to the highest level of health attainable world wide. It will serve as a tool to build a social movement to raise awareness of indigenous TB, to develop targets and messages, to pilot interventions and to monitor TB trends among indigenous peoples. An important component to this framework calls upon indigenous peoples to demand access to TB prevention and treatment measures in their communities.

- Bobby Ramakant

Neglect of TB control among indigenous communities unethical

Neglect of TB control among indigenous communities unethical

The need to include indigenous people in the Global Plan to Stop TB was echoed by many participants at the 3rd Stop TB Partners' Forum in Rio de Janeiro, Brazil (23-25 March 2009).

"We demand inclusion of indigenous peoples in the Global Plan to Stop TB strategy and have launched a strategic framework aimed at addressing tuberculosis among indigenous peoples. The Stop TB Strategy builds on the successes of directly observed treatment shortcourse (DOTS) while also explicitly addressing the key challenges facing TB. Its goal is to dramatically reduce the global burden of tuberculosis by 2015" said Wilton Littlechild, Regional Chief, Assembly of First Nations.

There are approximately 370 million indigenous peoples globally in more than 70 countries. Although programmes have been designed to combat TB, indigenous populations globally have been left out of such efforts due to cultural barriers, language differences, geographic remoteness, and economic disadvantage. TB rates among indigenous people are consistently higher than general public. During the five year period 2002-2006, the first nations TB rate was 29 times higher than others born in Canada - for the Inuit, it was 90 times higher. Pacific islanders and Maoris are 10 times more likely to contract TB than other people living in New Zealand. In Kalaallit Nunaat, Greenland, residents have a risk rate more than 45 times greater than Danish born citizens.

"These challenges will not be easily met - but they can be met by ensuring indigenous peoples are true partners in global TB control. We have a comprehensive and achievable plan to stop indigenous TB globally, but to realize our goal we need support" said Chief Littlechild.

Indigenous people have a consistent pattern of health inequality across a variety of jurisdictions from resource poor to the resource rich. Indigenous health inequalities are multi-faceted, and are both social and political in nature.

"Indigenous leaders will continue to work with the United Nations Permanent Forum on indigenous issues, the World Health Organization (WHO) and the Stop TB Partnership in addressing indigenous TB globally" further added Chief Littlechild.

Highlighting the problem of TB treatment default and risk of developing drug-resistant forms of TB in indigenous people, Chief Littlechild said that "we wish to establish a secretariat to collect data of TB programmes in indigenous communities. Due to a broad range of reasons, indigenous people aren’t able to access TB-related treatment and care services and if they are, then they are more likely to default, increasing the risk to develop drug resistance" said Chief Littlechild. With the High Level Ministerial meeting on multi- and extensively- drug-resistant TB (M/XDR-TB) going to open in Beijing, China (1-3 April 2009) later this week, it is indeed a clear message from indigenous communities for their Health Ministers to commit to responding to their specific issues regarding TB control.

In response to another question, Chief Littlechild said that "human rights based approach calls for genuine partnership and indigenous communities can be part of the solution."

The inequities faced by indigenous communities are much severe than in general population. "Countries like Canada report that poverty has gone down but poverty in indigenous communities has gone up. In prisons too there are a significant number of indigenous communities. There are host of other life conditions that put these people at an elevated risk of infectious diseases like TB - overcrowded housing and lack of access to safe drinking water are just few of those challenges" said Chief Littlechild.

The strategic framework to control TB among indigenous populations was developed through consultations with indigenous leaders, TB experts and health advocates from over 60 countries. It is designed to take an indigenous approach that links the right to health, education, housing, employment, and dignity. It is based on equality of opportunity to the highest level of health attainable world wide. It will serve as a tool to build a social movement to raise awareness of indigenous TB, to develop targets and messages, to pilot interventions and to monitor TB trends among indigenous peoples. An important component to this framework calls upon indigenous peoples to demand access to TB prevention and treatment measures in their communities.

- Bobby Ramakant

Speak-Your-World: Sexual health rights of HIV sero-discordant couples

Speak-Your-World

Sexual health rights of HIV sero-discordant couples

Denying sexual and reproductive health services to people living with HIV (PLHIV) or HIV sero-discordant couples increases their vulnerability to sexually transmitted infections (STIs) and makes it harder for women to protect themselves against sexual violence and unwanted pregnancies. At the 3rd Stop TB Partners' Forum, this correspondent was narrated an inspiring testimonial of a HIV sero-discordant couple that has taken up the responsibility of taking care of each other, and live with HIV/TB with dignity and care.



"For the last few years I have been falling ill with different illnesses. In 2005, I went with my wife for HIV testing. She explained she wasn't going to divorce me if I tested positive. She just wanted to know what was making me sick" saidChrispin Siang'ombwa from Community Initiative for Tuberculosis, HIV/AIDS and Malaria (CITAM) in Zambia, who was also a member of the on-site HDN Key Correspondent team at the 3rd Stop TB Partners' Forum in Rio de Janeiro, Brazil (23-25 March 2009).

"I tested HIV positive and she tested negative. The first thing she did was to hug me" shares Chrispin.

"Before I tested positive for HIV, I had tuberculosis (TB) three times in 1995, and TB relapses in 1997 and 2004" says Chrispin.



"As TB is curable I continued to work in a meat processing industry's sales and marketing division. However because of my illnesses, I lost my job in 2004. I felt so frustrated and when I was leaving I told my General Manager that it is better that I go home and die at home as no one cares about my health in my workplace" recollects Chrispin.



"My wife was so touched, and supportive. Later my wife was invited to a workshop related to HIV and when she came back she related my illness to HIV. She counseled me and I hope people can imagine how one feels on getting counseling by one's own wife. She said she is not saying that I have HIV but she is helping me to take care of my health and both of us need to find a solution - she don't want me to be sick or to die and they have a long life to live together. I developed a fear that as she already knows her HIV status (negative) and if my status comes out positive then I was afraid of thinking the outcome" said Chrispin.



"One day I told her that I am afraid that if I test positive for HIV, she may go for divorce. She counseled me and said she wants to take care of my health. She took me to a hospital and we took the test" shares Chrispin.



Chrispin and his wife were asked to come to the hospital after three days to collect their reports.



"We didn't go to pick up the test results for five days and finally I was counseled if I was ready to take the result. At the end of counseling the counselor posed a question to my wife on her response to a situation if wife's result is HIV negative and husband's result is HIV positive. She said whether the result is HIV positive or negative, he is my husband. I was also asked a similar question and I too responded in the same way. We were given the envelopes and we opened our own envelopes. I was HIV positive and she was HIV negative. She hugged me and sat down with me for a while. She said that she loves her husband and don't want him to die. She said she will encourage him to take care of his health and go for the treatment. She continued loving me" says Chrispin.



"The counselor said that we are a very unique couple - and she was earlier counseling a different couple in a similar situation (HIV sero-discordant couple), but they were fighting and blaming... instead my wife was so supportive, understanding and loving" said Chrispin.



"Anti-retroviral therapy (ART) clinics in Lusaka (Zambia) were very few in those times, so we selected a clinic which was very far from my community because I was afraid of people from my community seeing me going to an ART clinic" says Chrispin. He began taking ART in January 2006.



"At every clinic visit, my wife was with me. My wife never lost hope and she was there on my side. I withdrew myself from the community, and I wasn't seeing anyone. Now I understand the high-levels of HIV-related stigma I was confronted with, particularly self-stigma" says Chrispin.



One day on a TV, I saw a news about a conference on HIV/AIDS being organized in Lusaka. I thought I need to attend this conference. When I went there the conference registration was already closed but one lady directed me to a room where people living with HIV (PLHIV) were meeting" shares Chrispin.



"This room was fully packed - later I understood this is where I belong. I came to know about Treatment Advocacy & Literacy Campaign (TALC). Later I discussed forming support groups for PLHIV with my wife, and a lady from our local church helped me come up with a list of six members who were in a similar situation" says Chrispin.



"Later at TALC, a journalist came from local radio and TV station to interview four PLHIV on stigma and discrimination and I was one of the four selected. Many months passed by and I had nearly forgotten about this interview" says Chrispin.



"This programme was aired. My four children were told by their friends that your daddy is on TV and my children went to the neighbourhood and saw the TV show where I was revealing my HIV status. My children's friends said they are sorry to hear that their father is HIV positive" shares Chrispin.



"My children later said to me that they also have a right to be consulted before my going public about HIV status" says Chrispin.



Chrispin and his wife have four lovely children.



"I sat down with my children to have a discussion later that evening. My eldest son said that he wasn't aware of my HIV status and they are worried about my health. He was concerned about my health and my going public regarding my HIV status without consulting my own children. I was too touched. I apologized to my children and said that peer influence led me to do this on TV, and pleaded forgiveness if possible. Children said that they love me as their father just as before, and my going public will help them in schools as they will get information" shares Chrispin.



"My eldest son went for HIV test to support me, and get more information related to HIV. My youngest son is in grade 6, and found some information about HIV from school, and brought it back to me" shares Chrispin the inspiring story of a family united together in Zambia.



Chrispin always consistently uses condoms in every sexual act with his wife, because they love each other and want to take good care of each other. "Condoms are always available in our bedroom, we take care of ourselves of using condoms and have protected sex always - because we truly love each other and want to take care of each other and our children" says Chrispin.



Many health providers assume that people with HIV or HIV sero-discordant couples do not have sex and fail to provide them with the information they need to prevent further transmission. The healthcare services to meet sexual and reproductive healthcare needs of PLHIV and sero-discordant couples need to be available as well.



Chrispin's experiences from his own life on how they as a family are unitedly dealing with HIV and tuberculosis are undoubtedly an inspiring testimony of how affected communities can demonstrate leadership in coming up with best solutions to their own problems.



Health-care workers need to recognise the specific sexual and reproductive needs of PLHIV in order to help them protect their own health and the health of their families.

- Bobby Ramakant

Speak-Your-World: Sexual health rights of HIV sero-discordant couples

Speak-Your-World

Sexual health rights of HIV sero-discordant couples

Denying sexual and reproductive health services to people living with HIV (PLHIV) or HIV sero-discordant couples increases their vulnerability to sexually transmitted infections (STIs) and makes it harder for women to protect themselves against sexual violence and unwanted pregnancies. At the 3rd Stop TB Partners' Forum, this correspondent was narrated an inspiring testimonial of a HIV sero-discordant couple that has taken up the responsibility of taking care of each other, and live with HIV/TB with dignity and care.



"For the last few years I have been falling ill with different illnesses. In 2005, I went with my wife for HIV testing. She explained she wasn't going to divorce me if I tested positive. She just wanted to know what was making me sick" saidChrispin Siang'ombwa from Community Initiative for Tuberculosis, HIV/AIDS and Malaria (CITAM) in Zambia, who was also a member of the on-site HDN Key Correspondent team at the 3rd Stop TB Partners' Forum in Rio de Janeiro, Brazil (23-25 March 2009).

"I tested HIV positive and she tested negative. The first thing she did was to hug me" shares Chrispin.

"Before I tested positive for HIV, I had tuberculosis (TB) three times in 1995, and TB relapses in 1997 and 2004" says Chrispin.



"As TB is curable I continued to work in a meat processing industry's sales and marketing division. However because of my illnesses, I lost my job in 2004. I felt so frustrated and when I was leaving I told my General Manager that it is better that I go home and die at home as no one cares about my health in my workplace" recollects Chrispin.



"My wife was so touched, and supportive. Later my wife was invited to a workshop related to HIV and when she came back she related my illness to HIV. She counseled me and I hope people can imagine how one feels on getting counseling by one's own wife. She said she is not saying that I have HIV but she is helping me to take care of my health and both of us need to find a solution - she don't want me to be sick or to die and they have a long life to live together. I developed a fear that as she already knows her HIV status (negative) and if my status comes out positive then I was afraid of thinking the outcome" said Chrispin.



"One day I told her that I am afraid that if I test positive for HIV, she may go for divorce. She counseled me and said she wants to take care of my health. She took me to a hospital and we took the test" shares Chrispin.



Chrispin and his wife were asked to come to the hospital after three days to collect their reports.



"We didn't go to pick up the test results for five days and finally I was counseled if I was ready to take the result. At the end of counseling the counselor posed a question to my wife on her response to a situation if wife's result is HIV negative and husband's result is HIV positive. She said whether the result is HIV positive or negative, he is my husband. I was also asked a similar question and I too responded in the same way. We were given the envelopes and we opened our own envelopes. I was HIV positive and she was HIV negative. She hugged me and sat down with me for a while. She said that she loves her husband and don't want him to die. She said she will encourage him to take care of his health and go for the treatment. She continued loving me" says Chrispin.



"The counselor said that we are a very unique couple - and she was earlier counseling a different couple in a similar situation (HIV sero-discordant couple), but they were fighting and blaming... instead my wife was so supportive, understanding and loving" said Chrispin.



"Anti-retroviral therapy (ART) clinics in Lusaka (Zambia) were very few in those times, so we selected a clinic which was very far from my community because I was afraid of people from my community seeing me going to an ART clinic" says Chrispin. He began taking ART in January 2006.



"At every clinic visit, my wife was with me. My wife never lost hope and she was there on my side. I withdrew myself from the community, and I wasn't seeing anyone. Now I understand the high-levels of HIV-related stigma I was confronted with, particularly self-stigma" says Chrispin.



One day on a TV, I saw a news about a conference on HIV/AIDS being organized in Lusaka. I thought I need to attend this conference. When I went there the conference registration was already closed but one lady directed me to a room where people living with HIV (PLHIV) were meeting" shares Chrispin.



"This room was fully packed - later I understood this is where I belong. I came to know about Treatment Advocacy & Literacy Campaign (TALC). Later I discussed forming support groups for PLHIV with my wife, and a lady from our local church helped me come up with a list of six members who were in a similar situation" says Chrispin.



"Later at TALC, a journalist came from local radio and TV station to interview four PLHIV on stigma and discrimination and I was one of the four selected. Many months passed by and I had nearly forgotten about this interview" says Chrispin.



"This programme was aired. My four children were told by their friends that your daddy is on TV and my children went to the neighbourhood and saw the TV show where I was revealing my HIV status. My children's friends said they are sorry to hear that their father is HIV positive" shares Chrispin.



"My children later said to me that they also have a right to be consulted before my going public about HIV status" says Chrispin.



Chrispin and his wife have four lovely children.



"I sat down with my children to have a discussion later that evening. My eldest son said that he wasn't aware of my HIV status and they are worried about my health. He was concerned about my health and my going public regarding my HIV status without consulting my own children. I was too touched. I apologized to my children and said that peer influence led me to do this on TV, and pleaded forgiveness if possible. Children said that they love me as their father just as before, and my going public will help them in schools as they will get information" shares Chrispin.



"My eldest son went for HIV test to support me, and get more information related to HIV. My youngest son is in grade 6, and found some information about HIV from school, and brought it back to me" shares Chrispin the inspiring story of a family united together in Zambia.



Chrispin always consistently uses condoms in every sexual act with his wife, because they love each other and want to take good care of each other. "Condoms are always available in our bedroom, we take care of ourselves of using condoms and have protected sex always - because we truly love each other and want to take care of each other and our children" says Chrispin.



Many health providers assume that people with HIV or HIV sero-discordant couples do not have sex and fail to provide them with the information they need to prevent further transmission. The healthcare services to meet sexual and reproductive healthcare needs of PLHIV and sero-discordant couples need to be available as well.



Chrispin's experiences from his own life on how they as a family are unitedly dealing with HIV and tuberculosis are undoubtedly an inspiring testimony of how affected communities can demonstrate leadership in coming up with best solutions to their own problems.



Health-care workers need to recognise the specific sexual and reproductive needs of PLHIV in order to help them protect their own health and the health of their families.

- Bobby Ramakant

Bloomberg Award for Thailand's pictorial warnings on tobacco products

Bloomberg Award for Thailand's pictorial warnings on tobacco products
Jittima Jantanamalaka

The first Bloomberg Award for Global Tobacco Control (2009) was conferred to Dr Prakit Vathisathokit, Executive Secretary of Action on Smoking and Health (ASH), Thailand.

Dr Prakit was awarded for his leadership to implement the pictorial health warning labels on tobacco products effectively in Thailand.

Talking about his campaign at ASH, he contributed extensively in raising awareness in society about tobacco-related health hazards. Working closely with the Ministry of Health in Thailand, Dr Prakit was part of the team which drafted a number of warnings for tobacco products. Thailand was the fourth country in the world after Canada, Brazil and Singapore, to print effective pictorial health warning labels on tobacco products. Thailand has nine photographs of people with tobacco-related life-threatening diseases which it uses on rotational basis for pictorial health warning labels on tobacco products.

Some other countries took these photographs from Thailand to use it as pictorial health warning labels in their own countries, including: Malaysia, Brunei Darussalam, Singapore, Viet Nam, Philippines and Caribbean countries.

The level of awareness about tobacco-related health hazards has certainly gone up, tobacco users are more inclined to quit and children and young people felt de-motivated to use tobacco as a result of strong and effective pictorial health warning labels on tobacco products, said Dr Prakit.

This wasn't an easy task. Tobacco industry tried to threaten and thwart efforts of Dr Prakit, but unsuccessfully. "At that time there were not many countries that had strong and effective pictorial health warning labels on tobacco products. That is why tobacco industry was trying to threaten us. The tobacco industry said that the pictorial health warning labels were breaking the International Trademark law, and they will take legal action against us" said Dr Prakit. "But there were no legal action, just threats."

"Even if the tobacco industry had gone to the court, they would have lost the case because the World Trade Organization (WTO) marks tobacco and cigarette as a special good, which is dangerous to the consumer" said Dr Prakit.

Thailand has signed and ratified the global tobacco treaty - World Health Organization Framework of Convention Tobacco Control (WHO FCTC) - which is a legally binding instrument. The FCTC strongly supports the pictorial health warning label provision, and Thailand is obligated to follow it. Also the WHO has recommended these warnings as they are cost-effective ways to control tobacco. The tobacco industry would have certainly lost in court, says Dr Prakit.

Presently there are 163 countries that have signed on the FCTC and all of them have to implement pictorial health warning labels on tobacco products within 3 years. "To prepare the photographs is not difficult but to handle the tobacco industry which tries to block and interfere with the health policies is most difficult" says Dr Prakit.

Tobacco is very addictive, as addictive as heroin, says Dr Prakit, which is why even many tobacco users are not easily able to quit even if they want to do so.

Due to strong and consistent tobacco control campaign in Thailand over the past 20 years, the number of smokers and sale of cigarettes are still the same - 10 million. If we didn't have a strong campaign and policy framework, estimated number of tobacco users in Thailand would have reached 14 million.

There is a lot more to be done in Thailand on tobacco control. We need to effectively enforce the smoke-free laws in Thailand, ban cross-border advertising and raise taxes on tobacco products so that tobacco cessation services can be scaled up, feels Dr Prakit.

[Audio podcast is available here]

Jittima Jantanamalaka - Citizen News Service (CNS)

Bloomberg Award for Thailand's pictorial warnings on tobacco products

Bloomberg Award for Thailand's pictorial warnings on tobacco products
Jittima Jantanamalaka

The first Bloomberg Award for Global Tobacco Control (2009) was conferred to Dr Prakit Vathisathokit, Executive Secretary of Action on Smoking and Health (ASH), Thailand.

Dr Prakit was awarded for his leadership to implement the pictorial health warning labels on tobacco products effectively in Thailand.

Talking about his campaign at ASH, he contributed extensively in raising awareness in society about tobacco-related health hazards. Working closely with the Ministry of Health in Thailand, Dr Prakit was part of the team which drafted a number of warnings for tobacco products. Thailand was the fourth country in the world after Canada, Brazil and Singapore, to print effective pictorial health warning labels on tobacco products. Thailand has nine photographs of people with tobacco-related life-threatening diseases which it uses on rotational basis for pictorial health warning labels on tobacco products.

Some other countries took these photographs from Thailand to use it as pictorial health warning labels in their own countries, including: Malaysia, Brunei Darussalam, Singapore, Viet Nam, Philippines and Caribbean countries.

The level of awareness about tobacco-related health hazards has certainly gone up, tobacco users are more inclined to quit and children and young people felt de-motivated to use tobacco as a result of strong and effective pictorial health warning labels on tobacco products, said Dr Prakit.

This wasn't an easy task. Tobacco industry tried to threaten and thwart efforts of Dr Prakit, but unsuccessfully. "At that time there were not many countries that had strong and effective pictorial health warning labels on tobacco products. That is why tobacco industry was trying to threaten us. The tobacco industry said that the pictorial health warning labels were breaking the International Trademark law, and they will take legal action against us" said Dr Prakit. "But there were no legal action, just threats."

"Even if the tobacco industry had gone to the court, they would have lost the case because the World Trade Organization (WTO) marks tobacco and cigarette as a special good, which is dangerous to the consumer" said Dr Prakit.

Thailand has signed and ratified the global tobacco treaty - World Health Organization Framework of Convention Tobacco Control (WHO FCTC) - which is a legally binding instrument. The FCTC strongly supports the pictorial health warning label provision, and Thailand is obligated to follow it. Also the WHO has recommended these warnings as they are cost-effective ways to control tobacco. The tobacco industry would have certainly lost in court, says Dr Prakit.

Presently there are 163 countries that have signed on the FCTC and all of them have to implement pictorial health warning labels on tobacco products within 3 years. "To prepare the photographs is not difficult but to handle the tobacco industry which tries to block and interfere with the health policies is most difficult" says Dr Prakit.

Tobacco is very addictive, as addictive as heroin, says Dr Prakit, which is why even many tobacco users are not easily able to quit even if they want to do so.

Due to strong and consistent tobacco control campaign in Thailand over the past 20 years, the number of smokers and sale of cigarettes are still the same - 10 million. If we didn't have a strong campaign and policy framework, estimated number of tobacco users in Thailand would have reached 14 million.

There is a lot more to be done in Thailand on tobacco control. We need to effectively enforce the smoke-free laws in Thailand, ban cross-border advertising and raise taxes on tobacco products so that tobacco cessation services can be scaled up, feels Dr Prakit.

[Audio podcast is available here]

Jittima Jantanamalaka - Citizen News Service (CNS)

Call in Africa to fund the gap in the fight against TB

Call in Africa to fund the gap in the fight against TB

Despite of African governments declaring tuberculosis (TB) as an emergency, Africa as a region, faces the largest funding gap of USD 10.7 billion to fully implement the Global Plan to Stop TB by 2015. This fact came in spotlight when the TB funding in Africa required to meet the TB-related targets of millennium development goals (MDG) by 2015 was analyzed, said Kenyan activist Lucy Chesire at the 3rd Stop TB Partners' Forum in Rio de Janeiro, Brazil (23-25 March 2009).

"The Ministers of health had recognized that TB is an emergency, but they don't act to mobilize resources to respond urgently to control TB and fully implement the Global Plan to Stop TB" stressed Lucy.

The countries in Africa had achieved a milestone by endorsing the African Union Abuja pledge of allocating 15% of national budgets to health, which was also reiterated at the 2008 African Union Summit in Egypt, the 2008 Conference of African Finance Ministers, and 2008 Special Conference of African Health Ministers. But they have failed to act on this pledge, said the activists. Only Botswana has kept the promise of allocating 15% of the national budget to health, the rest of the countries in Africa need to keep their promises.

To put pressure on these countries to fund the gap in TB control, the Africa Public Health Alliance had launched an 'African TB Partners Call on African Heads of State, Health and Finance Ministers to fund the gap in the fight against TB' at the 3rd Stop TB Partners' Forum.

Activists expressed their concern that 4.2 million Africans are currently living with TB and of these 2.8 million are new TB cases, making TB arguably Africa's biggest public health concern. An estimated 639,089 African lives are lost to TB annually.

"The current global economic crisis is all the more reason why high burden TB countries in Africa should invest in TB control. As per a report of World Bank and Stop TB Partnership (December 2007), high-burden TB countries are likely to recover 9-15 times of their investment in TB control" said Mayowa Joel of Nigeria. This report indicates that the economic cost of not treating TB to Africa between 2006 and 2015 would be USD 519 billion while TB can be controlled with USD 20 billion in the same period.

Even though Africa makes up only 11.7% of the global population, Africa alone contributes 27 of the 50 countries globally with the highest numbers of people living with TB, and also 26 of the 50 countries with the highest number of TB-related deaths globally.

Furthermore nine of the world's 22 high-burden TB countries are in Africa: Democratic Republic of Congo (DRC), Ethiopia, Mozambique, Nigeria, South Africa, Uganda, Kenya, United Republic of Tanzania and Zimbabwe.

The outbreaks of extensively drug-resistant TB (XDR-TB) and multi-drug resistant TB (MDR-TB) now threaten to further complicate the TB epidemic.

TB continues to be the leading killer of people living with HIV (PLHIV). The need for collaborative TB and HIV activities to respond to rising challenge of TB and HIV co-infection, is compelling. 22 high HIV prevalence countries with an estimated adult HIV prevalence rate equal to or greater than 4% are in Africa.

Five of the TB most affected countries: Nigeria, Ethiopia, South Africa, DRC and Kenya are all also amongst Africa's most highly populated countries, are all regional hubs or countries with the most number of common borders with other countries, says the activists.

Many organizations have signed on this call and those interested in signing on the call to Africa to fund the gap in TB control, can email Lucy Chesire at lucy_chesire@yahoo.com or Mayowa Joel at mayowajoel@yahoo.com

This call will be delivered to the Heads of State, ministers of Health and Finance at the forthcoming African Union summit in 2009.