- The Washington Times - Saturday, October 20, 2001

World Health Organization officials fear a tuberculosis catastrophe may soon grip south-central Asia in the wake of the U.S.-led anti-terror campaign against Osama bin Laden.

"The situation is pretty bad," said Mario Raviglione, WHO's coordinator for TB Strategy and Operations, based in Geneva. "Without sufficient medicine and in conditions of increasing poverty, we would certainly expect that TB will become even worse than it was already without war. Fifty-six percent of people who are infected will die."

WHO estimates Pakistan had 269,000 cases of TB in 1999 and ranks as the sixth-highest-incidence country; it estimates Afghanistan had 71,000 cases, which gives it the 20th-highest-incidence rate.

On Monday, representatives from the top 22 TB high-incidence countries will convene at the First Stop TB Partners' Forum in Washington. The two-day conference is to be attended by WHO Director-General Dr. Gro Harlem Brundtland, World Bank President James D. Wolfensohn and international financier and philanthropist George Soros. Its aim will be to detect 75 percent of all TB cases worldwide by 2005 and cure 85 percent of those cases. The 22 nations being represented at the conference are responsible for 80 percent of all TB cases.

Events in Central Asia, and how instability there might contribute to the spread of TB, are sure to dominate discussions at the conference. Health officials note that during war, the mortality rate from TB typically increases dramatically. Mr. Raviglione said the mortality rate from the disease increased seven-fold during World War II, killing nearly half of those infected.

The projected TB crisis is in addition to the health risks heightened by the Crimean-Congo hemorrhagic fever, which is endemic in Pakistan and Afghanistan and which causes severe internal bleeding. About 35 percent of those infected die from the fever. Four cases of the fever were reported in Pakistan near the Afghan border.

Mr. Reichman, whose book "TB Time Bomb" was published this week, fears that a multidrug-resistant TB may be spreading throughout Afghanistan and Pakistan, where the four drugs needed to treat TB in the crucial first two months are not available.

"An epidemic occurs in areas with a poor TB-control program," he said. "Here you have an unprecedented conference where all these people are getting together to stop TB globally, which is something we can do, and at the same time, these world events are accelerating the TB problem globally."

Some observers note that the physical strain on refugees and the cramped conditions at refugee camps will aid the spread of the disease. "Afghan refugees are presumably living together in very close proximity; they are probably not getting good diets and not getting enough exercise none of these things promote good health," said Lee B. Reichman, director of New Jersey Medical School National Tuberculosis Center in Newark.

For effectively controlling TB, officials say WHO needs an additional $1.3 billion a year to augment its Directly Observed Therapy Short Course, or DOTS, program, which tries to avert the outbreak by wide distribution of drugs and health care infrastructure.

Diana Weil, World Bank senior public health specialist, said the key is the strong collaboration of Pakistan and Afghanistan with donor nations such as Britain, Italy and Japan, as well as the World Bank. With increased efforts, Pakistan strengthened its TB program last year, she said.

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