Speaking at the end of the 38th Union World Conference on Lung Health in the Cape Town yesterday Billo said it was a scandal that there had not been more support in the past to find new and better and drugs and diagnostics.

‘€œWe had the medication for AIDS in six years. It’€™s a scandal,’€ said Billo. No new drug has been developed for TB for over 40 years with two drugs showing promise, but expectations are that this will only be available by 2011.

Moxifloxacin has entered Phase III trials, but this is only due to massive investment from the Bill and Melinda Gates Foundation.

Gates is also driving the search for new diagnostics and a vaccine.

Held for the first time in Africa, the conference attracted 3 000 delegates from 120 countries, but there was the stark reality that 27 000 people died of TB during the six days of the conference ‘€“ almost all in the developing world.

Delegates have seen a renewed push to find better solutions to confront the TB epidemic, but it is mainly due to its link to the HIV epidemic. TB is the number one killer of people living with HIV, despite the fact that it is curable.

However, poor TB control programmes in many countries, including South Africa, have neglected simple preventative measures such as infection control in clinics and hospitals and making sure that people are cured of TB first time around.

Dr Donald Enarson of The Union questioned what the reaction of AIDS activists would have been if they had been told drugs would only be available by 2012. ‘€œYou know why it’€™s only by 2012? They will tell you it’€™s because of technical problems. And those technical problems are that they need more money. They need double, triple the amount they have. Activists need to be demanding more investment, we can’€™t wait that long,’€ he said.

At present 96 percent of TB cases are treatable and curable by current methods. Globally, four percent of TB cases are MDR, although there are hotspots where it is much higher.

Experts agreed that the best way to control MDR TB was to cure TB and that the high number of MDR cases were a reflection of a failing TB control programme.

However, health minister Dr Manto Tshabalala-Msimang differed with scientists last week when she urged them to ‘€œseparate fact from fiction’€. The South African government pulled out all the stops at the conference to try and convince the world that all was well, launching a TB Programme for the next five years.

Current thinking is that most MDR TB patients can be treated in their communities if infection control measures are coupled with education, information and support from the health institution and community health workers.

However, Director-General in the health department Thami Mseleku was adamant that MDR TB patients need to be treated in TB hospitals for six months. He said that more beds would be made available. KwaZulu-Natal and the Western Cape are struggling to cope with the rising number of MDR TB patients, with many people placed on waiting lists for beds.

Others are not prepared to be separated from their families for six months and remain undiagnosed in the community.

Billo cautioned against spending too much energy on trying to decide how to treat MDR TB patients, urging governments to spend time implementing good infection control methods and a basic TB control program at community level.

Enarson used Chris Hani Baragwanath Hospital as one good example of failure to implement infection control programmes. ‘€œPatients lie side by side on gurneys, waiting to be seen. Many are coughing and we know that one third of people going to health services are going because of chest infections. If you consider that there are also many people going to hospital for HIV-related issues, you have a problem. It is the easiest thing for someone to stand by the door and separate those who cough and those who don’€™t,’€ said Enarson.

Billo said Tugela Ferry was a critical reminder of the importance of infection control. There is now acceptance that the extensively resistant TB strain identified at the KwaZulu-Natal hospital was linked to a lack of infection control. None of the 53 patients who were infected in the initial outbreak had a prior history of TB.

They were all infected in the hospital when admitted for HIV treatment ‘€“ 52 died.

Billo also revealed that 4-million children died each year from pneumonia that can be treated with antibiotics while there were now more than 300-million people living with asthma. ‘€“ Health-e News Service