Stop TB Partnership's

MDR-TB Working Group Meeting 2007

Glenn ThomasCommunications officer, Stop TB Department

Tbilisi, Georgia, 21 September 2007

MDR-TB AND XDR-TBUNDER THE MEDIA SPOTLIGHT

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WHO 2005. A

ll rights re

served

Ecuador

Georgia

Argentina

Bangladesh

Germany

Republic of Korea

Armenia

Russian Federation

South Africa

Portugal

Latvia

Mexico

Peru

USA

Brazil

UK

Sweden

Thailand

Chile

Based on information provided to WHO Stop TB Department 13 September 2007

SpainIslamic Republic of Iran

China, Hong Kong SAR

France

Japan

NorwayCanada

Italy

Netherlands

Estonia

Lithuania

Ireland

Romania

Israel

Azerbaijan

Poland

Slovenia

India

Australia

Mozambique

Vietnam

September 2007Countries with confirmed XDR-TB cases

10 000

20 000

30 000

40 000

50 000

60 000

70 000

Sept 02-03 Sept 03-04 Sept 04-05 Sept 05-06 Sept 06-07

Ref: Google news archive

'TB' newspages, English language

TB news coverage

news

page

s

WHO XDR-TB Communications

"Priority for the immediate strengthening of basic TB control in countries"

– key Global Task Force recommendation

Strengthen global response and global resources,

e.g. Global MDR-TB and XDR-TB Response Plan

Inform technical and non-technical audiences through

updated WHO publications, FAQs, Newsletters, etc.

Respond to XDR-TB headlines stories and provide

relevant information e.g. involuntary detention, air travel

Identify short, medium and long term responses

to prevent, treat and control XDR-TB

March 2006First published reference to XDR-TB

XDR = Resistance to at least INH and

RIF (MDR) PLUS resistance to

fluoroquinolones, AND one of the

second-line injectable drugs (amikacin,

kanamycin, or capreomycin)

Of 17,690 isolates from 49 countries

during 2000-2004 20% were MDR

and 2% were XDR

XDR found in:

USA: 4% of MDR

Latvia: 19% of MDR

S Korea: 15% of MDR

September 2006Emergence of XDR-TB threat

5 SEPTEMBER 2006 | GENEVA –

The World Health Organization has expressed concern over the emergence of virulent

drug-resistant strains of tuberculosis and is calling for measures to be strengthened and

implemented to prevent the global spread of the deadly TB strains.

This follows research showing the extent of XDR-TB, a newly identified TB threat

which leaves patients (including many people living with HIV) virtually untreatable

using currently available anti-TB drugs.

What is the current evidence of XDR-TB?

What action is required to prevent XDR-TB?

‘Note to the Media’ highlighted:

What is XDR-TB?

October 2006XDR-TB Global Task Force

1. What is XDR-TB?

2. What is the medical definition of MDR-TB and XDR-TB?

3. How do people become infected with XDR-TB?

4. How easily is XDR-TB spread?

5. Can XDR-TB be cured or treated?

6. How common is XDR-TB?

7. What are the risks of being infected with XDR-TB?

8. How can a person who already has 'ordinary' TB i.edrug-sensitive TB, avoid getting XDR-TB?

9. Why have we never heard of XDR-TB before?

10. How do countries prevent XDR-TB?

11. Can the TB vaccine, known as the BCG vaccine, prevent XDR-TB?

12. What is the link between XDR-TB and HIV/AIDS? Why in some places is XDR-TB so highly linked with or associated with HIV? Are most people with HIV-TB now infected with MDR-TB and XDR-TB?

13. How do I know if I have TB or XDR-TB?

14. Is it safe to travel to places where XDR-TB has been identified?

15. What should be done if a person has been in contact with a known or suspect case of XDR-TB?

16. What risks do health-care workers face with XDR-TB, particularly those who may be HIV-positive themselves?

17. How quickly can XDR-TB be diagnosed?

18. What is WHO doing to combat XDR-TB?

The FAQs on XDR-TB

November 2006Funding call for emergency response

1 NOVEMBER 2006 | PARIS –

Global TB leaders at the Union World Conference on Lung Health announced today that

$95 million will be required to address the threat of XDR-TB in 2007.

Dr Mario Raviglione, Director of the Stop TB Department of WHO, and other TB and HIV

leaders called on governments and funding agencies to provide the resources urgently needed

to prevent further occurrence of XDR-TB.

The key to prevention, treatment and control of XDR-TB is to strengthen basic TB control

everywhere.

December 2006World AIDS Day

The recent identification of XDR-TB, and its devastating impact

amongst those with HIV, demonstrates the deadly synergy between

these two diseases. It demands massive new investment.

Jorge Sampaio UN Special Envoy to Stop TB

Another key element in the (HIV/AIDS) epidemic -TB - has recently

drawn increased attention with the development of an extremely

drug-resistant form that signals the urgent need for TB control.

Anders Nordström, Acting Director-General, WHO

MDR-TB and XDR-TB highlight new challenges in our collective

response to HIV/AIDS.

Peter Piot, Executive Director, UNAIDS

January 2007XDR-TB & Human Rights

January 22, 2007 -

"XDR-TB represents a

major threat to public

health. If the only way to

manage it is to forcibly

confine then it needs to

be done,'' said Jerome

Singh, study co-author

and lawyer at Durban's

Center for the AIDS

Program of Research in

South Africa.

``Ultimately in such

crises, the interests of

public health must

prevail over the rights of

the individual.''

Website -WHO Guidance on human rights and

involuntary detention for XDR-TB control

United Nations,

Economic and Social Council

SiracusaSiracusaSiracusaSiracusa Principles on the Limitation and Principles on the Limitation and Principles on the Limitation and Principles on the Limitation and

Derogation Provisions in the International Covenant Derogation Provisions in the International Covenant Derogation Provisions in the International Covenant Derogation Provisions in the International Covenant

on Civil and Political Rights on Civil and Political Rights on Civil and Political Rights on Civil and Political Rights

...In this regard, if a patient wilfully refuses treatment and, as

a result, is a danger to the public, the serious threat posed by

XDR-TB means that limiting that individual's human rights

may be necessary to protect the wider public.

This must be viewed as a last resort, and justified only after

all voluntary measures to isolate such a patient have failed.

1. carried out in accordance with the law2. in the interest of a legitimate objective of

general interest 3. strictly necessary in a democratic society to

achieve the objective 4. no less intrusive and restrictive means available

to reach the same objective 5. based on scientific evidence and not drafted or

imposed arbitrarily

March 2007World TB Day

WHO PRESS RELEASE

22 MARCH 2007

Global epidemic levelling off

- XDR-TB, HIV/AIDS and other

obstacles still thwarting progress.

Committee of Foreign Affairs - U.S. House of Representatives

21 March 2007 – Presentation by Dr Mario Raviglione, WHO

"The Global Plan and MDR and XDR-TB response plans

require that all partners expand their support substantially. We

therefore encourage the U.S. Government to consider

significantly increased financing through all of its institutions

currently engaged in TB control".

May 2007World Health Assembly

World Health Assembly

endorses TB resolution

The resolution reminds Member

States that the Stop TB Strategy needs

to be fully implemented, beginning

with a solid and high quality DOTS

programme, complemented by other

measures, including controlling

MDR-TB, and to provide access to

proper diagnosis and treatment to TB

patients.

It also calls for affected countries to

consider XDR-TB as the highest

health priority, and to declare TB as

an emergency where appropriate.

Interventions from Member States

underlined the need to address

MDR-TB and XDR-TB as a priority.

May 2007Air Travel and XDR-TB

Why has a health advisory been issued?

What are the specific factors that should be taken into account?

Is there a risk of TB infection during air travel?

What advice should be given to patients who fear that they may have been infected?

Website – WHO, 30 May 2007

( June 15 2007)

WHO strategy to stop drug-resistant TB

Global TB plan "may save thousands"

WHO seeks funds for drug-resistant TB plan

WHO seeks funding for TB fight

WHO's $2.15bn plan to contain drug-resistant TB

WHO launches global TB plan

WHO seeks more than $2bn to tackle drug-resistant TB

Warning over drug resistant TB

Health officials seek fourfold rise in global TB funds

WHO launches drive to halt rise of drug-resistant TB

La OMS lanza un plan de 1.800 milliones para combatir la TB resistanente

New UN plan commits $2.15b to fight drug-resistant TB

WHO: Aktionsplan gegen resistente tuberkuloseformen

WHO has plan how to stop drug-resistant TB

WHO seeks over $2bn to tackle drug resistant TB

OMS apresenta plano para deter formas resistentes de tuberculose

June 2007Launch of Global Response Plan

Outbreak Communications

1 TRUST

2 ANNOUNCING EARLY

3 TRANSPARENCY

4 THE PUBLIC

5 PLANNING

Overriding goal – to build, maintain or restore trust

First official announcement establishes trust

Helps maintain trust

Impossible to design successful messages without

knowing what the public thinks

The decisions and actions of public health officials

have more effect on trust than communication

Ref: WHO handbook, Effective Media Communication during Public Health Emergencies

Outbreak Communications

1 TRUST Overriding goal – to build, maintain or restore trust

Ref: WHO handbook, Effective Media Communication during Public Health Emergencies

Evidence shows that public panic is rare, and most rare when people have been candidly informed

- What are the challenges to trust?

Outbreak Communications

2 ANNOUNCING EARLY

First official announcement establishes trust

Ref: WHO handbook, Effective Media Communication during Public Health Emergencies

In today's world, information about outbreaks is almost impossible to keep hidden from the public

- Are the International Health Regulations enough?

Outbreak Communications

3 TRANSPARENCY Helps maintain trust

Ref: WHO handbook, Effective Media Communication during Public Health Emergencies

Outbreaks require communication that is candid, easily understood by the public, complete and factually accurate

- Greater transparency results in greater trust. But information gaps exist

Outbreak Communications

4 THE PUBLIC Impossible to design successful messages without

knowing what the public thinks

Ref: WHO handbook, Effective Media Communication during Public Health Emergencies

Risk communication messages should include information about what the public can do to make themselves safer

- Stop TB Strategy Component 5 - Empower people with TB, and Communities

Outbreak Communications

5 PLANNING The decisions and actions of public health officials

have more effect on trust than communication

Ref: WHO handbook, Effective Media Communication during Public Health Emergencies

Risk communication is most effective when it is integrated and incorporated into all aspects of an outbreak response

- Are you ready to communicate?

But…

OUTBREAK v EPIDEMIC

XDR-TB is a "slow burn"…