The Second Stop TB The Second Stop TB

Partners’ ForumPartners’ Forum

Keynote address: Marcos EspinalKeynote address: Marcos EspinalExecutive SecretaryExecutive Secretary

24 March 2004 – New Delhi, India24 March 2004 – New Delhi, India

24 March 24 March

20042004

OverviewOverview

I.I. Progress: Fulfilling Amsterdam Progress: Fulfilling Amsterdam and Washingtonand Washington

II.II. Preview: Plotting the way Preview: Plotting the way forward forward

III.III. Partners: Everyone is Partners: Everyone is necessarynecessary

24 March 24 March

20042004

““The Global Stop TB Partnership is working”The Global Stop TB Partnership is working”

Grown 50 fold: Grown 50 fold: 280 members280 members

Accelerated TB control Accelerated TB control progress and fundingprogress and funding

Become a model for Become a model for international public health international public health partnershipspartnerships

Reach out to new partners—Reach out to new partners—e.g. the private sector and civil e.g. the private sector and civil societysociety

50%

25%

4%

11%

3%7%

NGO Government Internat.OrgAcademic For Profit Other

Review progress Review progress through 2003 through 2003

24 March 24 March

20042004

Achievements & Achievements & Aims Aims 2001–2005 2001–2005

““Global Firsts”Global Firsts”

The Global Plan to Stop TB, the Global DOTS The Global Plan to Stop TB, the Global DOTS Expansion Plan, the Global Drug Facility (GDF), the Expansion Plan, the Global Drug Facility (GDF), the Green Light Committee (GLC) and the link with the Green Light Committee (GLC) and the link with the Global Fund to Fight AIDS, TB and Malaria (GFATM)Global Fund to Fight AIDS, TB and Malaria (GFATM)

By 2001: By 2001: National plans and increased commitments National plans and increased commitments By 2002:By 2002: NIACCs, accelerating detection rates to NIACCs, accelerating detection rates to

37%, and a fully operational GDF37%, and a fully operational GDF By 2005:By 2005: 70/85 TB control targets 70/85 TB control targets

24 March 24 March

20042004

Working Group on DOTS Working Group on DOTS ExpansionExpansion

– 180 countries 180 countries implementing DOTSimplementing DOTS

Working Group on Working Group on TB/HIVTB/HIV

– Policy for TB/HIV Policy for TB/HIV collaborative activiescollaborative activies

Working Group on DOTS-Working Group on DOTS-Plus for MDR-TBPlus for MDR-TB

– Treatment for MDR-TB in Treatment for MDR-TB in more than 10 countriesmore than 10 countries

The Global Plan to The Global Plan to Stop TB Stop TB

Working Group on New Working Group on New DiagnosticsDiagnostics

– Enabling environment for Enabling environment for commercial tool developmentcommercial tool development

Working Group on New TB Working Group on New TB DrugsDrugs

– Pipeline of promising Pipeline of promising compoundscompounds

Working Group on New Working Group on New VaccinesVaccines

– Two vaccine candidates Two vaccine candidates entering phase I clinical trialsentering phase I clinical trials

24 March 24 March

20042004

Progress Progress DOTS in 180 countriesDOTS in 180 countries

> 90% pop

low incidence, non-DOTS

< 10% pop

10 - 90% pop

No report

non-DOTS

DOTS coverage

24 March 24 March

20042004

70

80

85

100

50 60 70 80 90 100 110 120

DOTS detection rate (%)DOTS detection rate (%)

Tre

atm

ent

succ

ess

(%)

Tre

atm

ent

succ

ess

(%)

Cambodia

Oman

Sri Lanka

Guatemala

Peru

Morocco

Maldives

Viet Nam Cuba

Slovenia

Solomon Is

UruguayQatar

Mongolia

USA

Morocco

Tanzania

Venezuela

Djibouti

ChileNicaragua

TARGET ZONE

Bosnia & Hezegovina

Hong Kong

DR Congo

El Salvador

Fiji

French Polynesia

Italy

Kazakhstan

Kenya

Kyrgyzstan

Latvia Lebanon

Malta

Marshall Is

Portugal

St Lucia

Samoa

South Africa

Tonga

Tunisia

Turks & Caicos Is

It can be done—It can be done—Achieved and sustained in Achieved and sustained in

6 countries for four years!6 countries for four years!

24 March 24 March

20042004

70

80

90

100

50 60 70 80 90 100 110 120

DOTS detection rate (%)

Tre

atm

ent

succ

ess

(%)

It can be doneIt can be donein in youryour country country

40

50

60

70

80

90

100

0 10 20 30 40 50 60 70 80 90 100

DOTS detection rate (%)

Tre

atm

en

t s

uc

ce

ss

(%

)

Uganda

DRCongo

KenyaTanzania

Viet Nam

MyanmarBangladesh

India PhilippinesIndonesia

China

Ethiopia

Nigeria

RussiaSouth Africa

Thailand

Cambodia

Pakistan

Afghanistan

Brazil

Zimbabwe

Mozambique

Peru

TARGET ZONE

85 %

70 %

24 March 24 March

20042004

Global Drug FacilityGlobal Drug Facility(GDF)(GDF)

Supplied TB drugs to 1.7 million DOTS patients Supplied TB drugs to 1.7 million DOTS patients

Committed drugs – Committed drugs – 2.8 million patients in 58 countries2.8 million patients in 58 countries

Raised and committed Raised and committed US$ 30 millionUS$ 30 million in grants in grants

Increased delivery-efficiency, slashed drug prices Increased delivery-efficiency, slashed drug prices

Advanced combination treatmentsAdvanced combination treatments

Established direct procurement service and White List Established direct procurement service and White List of suppliersof suppliers

Signed an agreement with Novartis through WHO to Signed an agreement with Novartis through WHO to provide free TB drugs for 500 000 patients over the provide free TB drugs for 500 000 patients over the next 5 yearsnext 5 years

Creating a “model,” since 2001 it has:Creating a “model,” since 2001 it has:

24 March 24 March

20042004

The Partnership’s The Partnership’s “Report Card” “Report Card”

First independent external evaluation:First independent external evaluation:– Scored “extremely high” marksScored “extremely high” marks– Added value, new initiatives, increased funding Added value, new initiatives, increased funding – Made progress against TB Made progress against TB – Supported new diagnostics, drugs and vaccinesSupported new diagnostics, drugs and vaccines– Operationalized GDF and GLC Operationalized GDF and GLC – Increased political commitment to the Global PlanIncreased political commitment to the Global Plan

We‘ve made a great start but ...We‘ve made a great start but ...

24 March 24 March

20042004

The clock is ticking …The clock is ticking …This is no time for This is no time for complacencycomplacency

II. The WayForward

0

10

20

30

40

50

60

70

80

1990 1995 2000 2005 2010 2015

Year

Ca

se

de

tec

tio

n r

ate

, sm

ea

r-p

os

itiv

e c

as

es

(%

)

average rate of progress 1994-2000

accelerated progress:target 2005

WHO target 70%

DOTS begins

24 March 24 March

20042004

II. II. Preview of the Preview of the futurefuture

Plotting the way forwardPlotting the way forward

2005 (Global Targets: 70/85)2005 (Global Targets: 70/85)

2015 (Millennium Development Goals: 2015 (Millennium Development Goals: halving prevalence and mortality)halving prevalence and mortality)

24 March 24 March

20042004

Accelerate progressAccelerate progress 20052005

Win the “case race”Win the “case race”

ONE MILLION TB PATIENTS EXTRA ONE MILLION TB PATIENTS EXTRA EVERY YEAREVERY YEAR

24 March 24 March

20042004

Accelerate progress Accelerate progress 20052005

Win the “case race”Win the “case race” Double DOTS detection from 37% to 70% by:Double DOTS detection from 37% to 70% by:

– ensuring diagnosis and cure of known TB cases according to ensuring diagnosis and cure of known TB cases according to DOTS standardsDOTS standards

– recruiting patients from non-DOTS participating clinics and recruiting patients from non-DOTS participating clinics and hospitals and from beyond the public health systems;hospitals and from beyond the public health systems;

Inch up treatment cure rates from 82% to 85%Inch up treatment cure rates from 82% to 85% Strengthen focus on countries and communities Strengthen focus on countries and communities Focus on TB’s human face Focus on TB’s human face

24 March 24 March

20042004

Intensify action Intensify action 20052005

Bold initiatives:Bold initiatives:

ISAC:ISAC: Emergency ‘Intensified Support & Action Emergency ‘Intensified Support & Action Countries’ acceleratesCountries’ accelerates efforts in lagging HBCsefforts in lagging HBCs

PPM DOTS:PPM DOTS: The public-private and public-public The public-private and public-public Mix DOTS casts the health care net widerMix DOTS casts the health care net wider

Global Plan Phase IGlobal Plan Phase I: Finalize and secure : Finalize and secure fundingfunding

24 March 24 March

20042004

Fill the resource gapFill the resource gapin the Global Plan in the Global Plan

Funding and gaps for partnership activities, 2001–2005

Current-National

Current-External

Gap

Total gap:US$ 3.8 billion41% of global plan cost

0

2

4

6

8

10

DOTS Expansion

Adapting DOTS R & D Partnership Total

US$ billions

24 March 24 March

20042004

Why long-term Why long-term goals mattergoals matter TB will not go away tomorrowTB will not go away tomorrow

TB is still a disease of the poorTB is still a disease of the poor

Ill health and poverty are a vicious circleIll health and poverty are a vicious circle

Effective interventions exist; need to reach more Effective interventions exist; need to reach more people people

Improve national TB control policies, institutions, Improve national TB control policies, institutions, investmentinvestment

Coordinate partner-donor efforts Coordinate partner-donor efforts

The LIVES and CASES prevented are the bottom lineThe LIVES and CASES prevented are the bottom line

24 March 24 March

20042004

Long-term goalsLong-term goals2015 2015 2nd Ad Hoc Committee recommendations :2nd Ad Hoc Committee recommendations : Consolidate, sustain, advance achievements to dateConsolidate, sustain, advance achievements to date Enhance political commitmentEnhance political commitment Address the health workforce crisisAddress the health workforce crisis Strengthen health systems, especially PHC deliveryStrengthen health systems, especially PHC delivery Accelerate responses to the TB-HIV/AIDS emergencyAccelerate responses to the TB-HIV/AIDS emergency Mobilize communities and the private sector Mobilize communities and the private sector Invest in R&D to shape the futureInvest in R&D to shape the future

24 March 24 March

20042004

Long-term goalsLong-term goals2015 2015

Global Plan To Stop TB IIGlobal Plan To Stop TB II

Poverty Reduction Strategy PapersPoverty Reduction Strategy Papers

Investments plans based on well-documented Investments plans based on well-documented needs and costing scenarios needs and costing scenarios

24 March 24 March

20042004

Energize partnershipsEnergize partnerships

Partnerships play a strong role:Partnerships play a strong role: Countries: Strengthen / building partnershipsCountries: Strengthen / building partnerships

HIV/AIDS community: Make TB a major issue HIV/AIDS community: Make TB a major issue

Diverse partners: Define complementary roles Diverse partners: Define complementary roles

Donors: Cultivate investments, expand the baseDonors: Cultivate investments, expand the base

Media: Raise awareness, increase advocacy & networks Media: Raise awareness, increase advocacy & networks

Stakeholders: Broaden the rangeStakeholders: Broaden the range

24 March 24 March

20042004

Develop new toolsDevelop new tools

To defeat the mutable TB microbe, To defeat the mutable TB microbe, we must upscale efforts to develop:we must upscale efforts to develop:

New diagnostics: FIND, TDR,New diagnostics: FIND, TDR,

New TB drugs: Global Alliance, Novartis New TB drugs: Global Alliance, Novartis Institute, Glaxo Welcome Institute, Glaxo Welcome

New vaccines: AerasNew vaccines: Aeras

24 March 24 March

20042004

III. Partners: III. Partners:

To evolve dynamically and fulfilTo evolve dynamically and fulfil the Amsterdam Declaration andthe Amsterdam Declaration and the Washington Commitmentthe Washington Commitment

All of us here today must keep the New All of us here today must keep the New Delhi PledgesDelhi Pledges

24 March 24 March

20042004

Let us not failLet us not fail

““We don’t need more We don’t need more promises; we need to promises; we need to deliver on those already deliver on those already made.”made.”

- MDGs High-Level Forum, - MDGs High-Level Forum, January 2004January 2004

24 March 24 March

20042004

Keep the pledgesKeep the pledges

The reward will be found most meaningfully The reward will be found most meaningfully

in the faces of those whose lives have been saved in the faces of those whose lives have been saved

and health restored through our unremitting efforts.and health restored through our unremitting efforts.