Communities of practice
TB deaths in South Asia: has there been a “cover-up”?
19 Jan 2011
Citation: Currey B, Quamruzzaman Q, Rahman M (2011). A millennial cover-up: tuberculosis deaths in South Asia. J R Soc Med; 104(1):2-4.
2011, The Royal Society of Medicine Press
Tuberculosis control programmes are concentrating on treatment in order to reduce the spread of the disease, when a more appropriate goal would be to focus on prevention which would achieve bigger reductions in mortality. This is the case made in an editorial, published in the Journal of the Royal Society of Medicine, written by three authors based at Dhaka Community Hospital in Bangladesh.
Focusing on the situation in South Asia, the authors go on to speak of a “cover-up” intended to suggest that progress towards the TB targets set in the millennium development goals (MDGs) has been greater than is actually the case. The UK’s Department for International Development (DFID) stands accused of bearing much of the responsibility.
The article acknowledges that the UK took the lead (at the conference of the G8 nations in Okinawa in 2000) in developing the G8 commitment to reducing TB deaths and prevalence by 50% by 2010 . This commitment was subsequently much watered down in the MDGs, where TB was considered along with other infectious for which the target was “to have halted and begun to reverse the spread” by 2015. “Prevalence” and “deaths” also became “prevalence rates” and “death rates”.
DFID, says the editorial, has emphasized the progress that has been made by national TB programmes in South Asia in improving case detection and treatment. The agency has also stated that TB death rates in the region can be regarded as “moderate”.
But the editorial points out that declines in mortality in the last two decades have been far short of the 50% Okinawa figure. For the region as a whole, the reduction has been only 11% (India 8%). Nearly half a million people (460,003 in 2007) are still dying as a result of TB in the region every year. The authors claim that the global TB programme is “under-funded and failing to eradicate, or root out, the scourge of poverty and the risks underpinning preventable tuberculosis”.
DFID has responded to the editorial. A spokesperson told the Guardian newspaper that: “The British government is totally committed to treating and preventing this deadly disease from spreading. That is why only last month the secretary of state announced treatment for an additional 56,000 people through the global fund. We will continue to help build better medical services in the poorest countries to ensure TB, like other major diseases, is effectively diagnosed and cured”.
TB is acknowledged to be an infectious disease of poverty and bringing it under control will require progress in poverty reduction. This includes improvements in living conditions, incomes and food security. Nevertheless, effective management of cases of the disease also remains crucial. DFID is right to back these efforts and to highlight progress when it is made.
But one shares the discomfort of the authors of this editorial over the description of half a million deaths as “moderate mortality”. We downplay the significance of such figures at our peril. TB control goals should be ambitious and the authors do well to speak up against the tendency to water down and defer the targets that have been set.
Note: The editorial is published in a journal that is not available with open access. To read it therefore a subscription to the Journal of the Royal Society of Medicine is required.
1. G8 Communiqué Okinawa 2000. Accessible on: http://www.g8.utoronto.ca/summit/2000okinawa/finalcom.htm
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