TB Monitor International-TB Monitor International-G-8 vows to help reduce three 'diseases of poverty'
Japan pledges billions in funding, others follow
Leaders at the Group of Eight summit, which met in July in Nago, Japan, gave every appearance of wanting to do the right thing. At times, the whole summit seemed like a series of promises to pay more attention to TB, malaria, and HIV/AIDS, the three "diseases of poverty," as G-8 press releases called them.
By the time they went home, G-8 leaders had vowed that within 10 years, they would cut in half the deaths from TB and malaria, as well as trim deaths due to HIV/AIDS by a fourth. Japan pledged $3 billion during the next three years to help pull off the job, stirring the 14-member European Union to make noises about adding money of its own. (Rumor has it the European Union is thinking about throwing in another billion.)
Here at home, the U.S. Congress seems likely to approve a more modest sum.
Around the globe, TB experts and public health policy-makers have greeted the promises to help with qualified praise.
"The devil's in the details," says James Orbinski, MD, head of Medecins Sans Frontieres International (MSF). "The real issue here is who gets the money, and when, and what will be done with it. If this is just a way to fund drug purchases from big pharmaceutical companies, then the whole thing is a colossal waste of time."
Bank loans to help buy drugs
To be fair, Orbinski may be recalling an especially ill-timed announcement from the U.S. Export-Import Bank, which greeted the G-8 summit with the news that it stood ready to lend debt-burdened, AIDS-ravaged countries in Africa a billion dollars at near-commercial interest rates so they could buy drugs from American pharmaceutical firms.
"Tacky," sniffs one MSF spokesperson in New York.
Other public health experts warn that G-8 leaders had better move fast if they hope to have any effect. "The window of opportunity is very narrow, both for HIV and TB," says Jim Yong Kim, MD, PhD, director of Harvard Medical School's program in infectious diseases and social change.
"We're seeing fundamental demographic shifts in Africa right now as a result of HIV. It's time for the TB community to move swiftly, and hold [G-8 leaders] to their word," he explains.
Other international TB strategists agree, among them Ariel Pablos-Mendez, PhD, scientific director for the Rockefeller Foundation in New York City, which kick-started the newly formed Global Alliance for TB Drug Development.
"The mood has changed dramatically over the past year, and I think the inertia will continue," Pablos-Mendez says. "The question now is how the money will be spent, and by whom."
Mario Raviglione, MD, coordinator for epidemiology and operational research for the World Health Organization's (WHO) infectious disease unit, says he and others at the organization will stand ready to hold feet to the fire when G-8 leaders reconvene in Tokyo this December. To do that, WHO will arrive with a detailed plan of action in hand, Raviglione adds.
"Just today we met about forming a task force to generate comprehensive recommendations for G-8," he says. "At the very highest levels, WHO is taking these commitments extremely seriously. This is a crucial phase in the life of the TB control community, and I can assure you that things won't fall apart at our end."
One thing Raviglione wants ready by the time December rolls around is a system that will pair each of the 22 highest-burden countries with a rich-country "sponsor" willing to provide technical assistance to get TB control programs up and running.
System for poor nations
"For example, perhaps the Netherlands, which has worked with Kenya before, says it will take Kenya," Raviglione says. "Maybe Italy takes Afghanistan, and the WHO helps China, and so on. That way," he concludes, "we have everyone covered from the technical perspective. Then we decide how much money we need to close the remaining gaps, go to the donors, and tell them."
Back in the United States, awash in budget surpluses, dollars seem likely to start flowing. The Stop TB Now Act, which is sponsored by Rep. Sherrod Brown (D-OH), requests $100 million for TB in developing countries and should wind up with at least $50 million, perhaps even more, Capitol Hill-watchers say.
"We're writing programs for anywhere from $30 million to $100 million," says Amy Bloom, MD, USAID liaison to the federal Advisory Council for the Elimination of Tuberculosis. "All we know for sure is that we'll be getting more money."
In addition, Sen. Bill Frist (R-TN), a heart-and-lung transplant surgeon who spent part of this past July in Africa as a medical missionary for an organization called Samaritan's Purse, has been drumming up support for an aid package to provide a billion dollars in benefits for African AIDS victims. Frist's bill, already authorized in the Senate, would supply $120 million during the next two years to fight TB.
The two bills shouldn't interfere with each other, says an aide in Brown's office. Indeed, they're more likely to generate synergy by showing that support for the 'Big Three' infectious diseases is not only bipartisan, but bicameral as well.
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