Response to a major disease of poverty: the Global Partnership to Stop TB.

Abstract

In May 2000, the World Health Assembly called on international organizations, nongovemmental organizations (NGOs), donors, foundations, and the international community at large to participate in the Global Partnership to Stop TB. The Partnership's aim is to eliminate tuberculosis as a public health problem. The international standard treatment for TB, the directly observed treatment short-course (DOTS) is one of the most cost-effective public health interventions in existence, but in 2000, only a quarter of those with TB received DOTS (1). The Health Assembly's call for a new partnership was an appeal to use the opportunity that exists, and the response has been phenomenal. In October 2001 the Partnership with 200 members, together with representatives of the 22 countries that account for 80% of the world's TB burden, presented a comprehensive five-year global plan and budget to a meeting at the World Bank. Now the Partnership and high-burden countries have begun to carry out the plan. Countries and regions have established their own Stop TB partnerships, and the Partnership has quickly evolved from an initiative of international organizations into a global social movement. A major challenge will be to marshall the resources needed to implement the plan. The Partnership's flexible structure facilitates quick decision-making based on consensus and rapid implementation of programmes. The Partners' Forum, the general assembly of partners, meets every other year. A small secretariat hosted by WHO carries on the day-to-day work of the Partnership and manages the Global TB Drug Facility, an initiative that supplies the drugs needed for DOTS expansion. The secretariat is guided in this work by a Coordinating Board that reflects the Partnership's diverse constituencies. Six working groups cover the vital technical areas of the Partnership's activity: DOTS expansion; DOTS-Plus for multidrug-resistant TB (MDR-TB); TB and HIV; TB drugs research and development (RD TB diagnostics RD and TB vaccines R&D (TB Vaccine Development Coalition). A task force on advocacy and communications, and a sister body on financing support the secretariat and the working groups. As a major member of the Partnership, WHO coordinates the development of a global strategy and policy for TB control. The Organization is the driving force behind the DOTS Expansion Working Group, which guided all high-burden countries to make detailed national plans, and published the Global DOTS Expansion Plan in 2001. WHO also plays a major role in other working groups, including those engaged in developing new drugs, diagnostics and vaccines. The aim of the working group on DOTS-Plus for MDR-TB is to formulate a realistic response to the spread of MDR-TB in resource-poor settings. It has succeeded in reducing the price of second-line TB drugs by up to 94% through a competitive and pooled procurement system run by its Green Light Committee (GLC). The GLC serves to control global access to second-line drugs so that misuse does not cause further resistance. The working group on TB and HIV has designed a strategic framework to guide efforts to decrease the burden of TB and HIV co-infection. …