Doctor urges stronger TB fight

Tuberculosis, which kills more than 2 million people a year, is a growing global health problem that can be cured and ultimately eliminated, but only if it is taken seriously, said Dr. Marcos Espinal, the head of the World Health Organization's "Stop TB" program.

"If he has vision, President Bush could go down in history [as the man who ended [R]tuberculosis]," said Dr. Espinal, a pediatrician from the Dominican Republic who has spent his career working on the disease. "There is a cure. There is a cost-effective strategy. There is a best return for value, and there are ways to invest more."

He said the United States gives about $85 million a year to TB mitigation through the U.S. Agency for International Development. More is spent by the Centers for Disease Control and Prevention and nongovernmental partners such as the Bill and Melinda Gates Foundation. He said if the United States would spend about $200 million a year, "we could watch the number of cases go down."

Dr. Espinal, who is in the United States to lobby Congress and world leaders at the United Nations this week, said about 2 billion people in the world carry the TB bacillus.

Of those, 5 percent to 10 percent will develop active tuberculosis. The disease can be cured with an $11 treatment of four pills a day for six months in what is known as "directly observed therapy."

Dr. Espinal said the Stop TB program has brought down the cost of the drugs, created a simpler pill regime and cured 3.2 million people in the past three years.

By curing the disease and slowing its transmission, the TB prevalence rate is declining 6 percent a year in Peru, he said. "In China, it has come down 30 percent," he added.

About 9 million people develop full-blown TB every year, and more than 2 million die from it. TB is the leading killer among people infected with HIV/AIDS.

Dr. Espinal said about 3 percent of TB patients suffer from a variety of the disease that is resistant to multiple drugs. In the developed world, it would take two years of consistent treatment and $60,000 to $180,000 in drugs and hospital stays to cure this variety.

He said that even though TB is found mainly in the developing world, it is a threat to the United States. New York City, which was cutting funds and shutting down TB clinics in the 1970s, was struck with a multidrug-resistant TB outbreak, which cost the city $1 billion to control.

"Sixty percent of U.S. TB cases are foreign-born, which means the United States will always have a TB problem, unless it is cured in the developing world," he said.

"We have a vision of the world that is free of TB by 2050," Dr. Espinal said. "It can be done. But it will take more money."