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TB Notes 1, 2000
Where We've Been and Where We're Going: Perspectives from CDC's Partners in TB Control
Changes I've Seen
TB Control in New York City: A Recent History
Not by DOT Alone
Baltimore at the New Millennium
From Crickets to Condoms and Beyond
The Denver TB Program: Opportunity, Creativity, Persistence, and Luck
National Jewish: The 100-Year War Against TB
Earthquakes, Population Growth, and TB in Los Angeles County
TB in Alaska
CDC and the American Lung Association/ American Thoracic Society: an Enduring Public/Private Partnership
The Unusual Suspects
The Model TB Prevention and Control Centers: History and Purpose
My Perspective on TB Control over the Past Two to Three Decades
History of the IUATLD
Thoughts about the Future of TB Control in the United States
Where We've Been and Where We're Going: Perspectives from CDC
Early History of the CDC TB Division, 1944-1985
CDC Funding for TB Prevention and Control
Managed Care and TB Control - A New Era
Early Research Activities of the TB Control Division
The First TB Drug Clinical Trials
Current TB Drug Trials: The Tuberculosis Trials Consortium (TBTC)
TB Communications and Education
TB Control in the Information Age
Field Services Activities
TB's Public Health Heroes
Infection Control Issues
A Decade of Notable TB Outbreaks: A Selected Review
International Activities
The Role of CDC's Division of Quarantine in the Fight Against TB in the U.S.
The STOP TB Initiative, A Global Partnership
Seize the Moment - Personal Reflections
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This is an archived document. The links are no longer being updated.

TB Notes 1, 2000

History of the IUATLD

by Donald A Enarson, MD
and Annik Rouillon, MD
International Union Against TB and Lung Disease
68 boulevard Saint-Michel, 75006 Paris FRANCE

The International Union Against Tuberculosis and Lung Disease (known to its members as "the Union") is the only international voluntary organization dealing specifically with TB. It is very special in terms of its structure, membership, and diversity of activities.

Roots of the Union, 1867-1914

TB was presented as a communicable disease in the first international conference of medicine specialists convened in Paris in 1867. Conferences specifically addressing TB followed in Paris in 1888, 1891, 1892, and 1898. The 1899 conference took place in Berlin and, for the first time, official representatives from both governments and nongovernmental agencies were present. The independent developments of sanatoria (1854), the discovery of the bacillus (1882), the opening of TB dispensaries (1887), the development of the voluntary movement (1890), and the organization of periodic conferences called for a centralized agency for coordination and communication. The Central Bureau for Prevention of Tuberculosis was formalized in Berlin in 1902, and the double-barred cross was adopted then as its symbol. Periodic international conferences systematically addressing clinical, research, and sociological aspects of TB were held until the outbreak of the First World War in 1914.

Establishment of the Union, 1920-1939

In 1920, a conference on TB was convened in Paris in which 31 countries participated, including Australia, Bolivia, Brazil, Chile, China, Colombia, Cuba, Guatemala, Japan, Panama, Paraguay, Iran, and Thailand, in addition to those of Europe and North America. In an impressive procession, delegates one by one pledged "to agree on the means to fight TB, to make a consensus on the strategy, to jointly apply the most effective weapons to combat this common enemy," thus establishing the International Union Against Tuberculosis (IUAT) in its present form. It was conceived as a federation of national associations (130 by 1999). Ten international conferences followed until 1939.

In order to supplement the routine reports of the conferences, a regular publication was commenced in 1923. In this prewar period, the Bulletin included administrative reports and statistics (subsequently compiled by WHO) as well as information on the strategy and policies for the fight against TB and results of numerous surveys on specific aspects of the disease and the campaign. The Bulletin continued publication until mid-1940, the final editions containing the main reports to have been given at the 11th conference planned for Berlin in September 1939, the very month when the Second World War commenced.

Relaunching of the Union, 1946-1961

At the first reunion of the Executive Committee after the war in 1946, the IUAT recommended to the planners of the future World Health Organization "establishment of a strong Division of Tuberculosis." Official relations with the WHO were then established which continue to the present time.

The first postwar conference in 1950 in Copenhagen, with participation of 43 nations, was followed by a series of conferences, with the 29th world conference in Bangkok in 1998, when 105 countries participated. Conferences outside North America and Europe were held in Brazil in 1952, India in 1957, and Turkey in 1959. During this period a series of international symposia were also organized, generally in Paris, addressing a variety of topical issues such as TB in Africa, strain variation in BCG, radiography for TB, new drugs, and the role of voluntary agencies, among others.

In order to strengthen the administration of the growing agency, a post of full-time Executive Director was established in 1952. A system of quotas was devised for membership contributions. Over many years, the American Association has continually maintained a high quota share. Fees were also levied from individual members. In 1951, scientific committees were commenced and met annually for intensive discussion of the emerging strategy for the fight against TB. In 1953, regions were established in order to remain close to where the needs are. In 1958, the first international collaborative clinical trial for treatment of any disease was undertaken, with a total of 17,391 patients from 17 countries evaluated for drug resistance. This was followed by a collaborative controlled clinical trial starting in 1960, to evaluate the efficacy of chemotherapy in previously untreated patients. In this period, the IUAT contributed to annual international courses on TB control sponsored by WHO in Istanbul, Prague, Rome, and Caracas.

A global view 1961-1978

In 1961, at the suggestion of the Executive Director, Dr. Johannes Holm, the Mutual Assistance Program was launched to encourage transfer of technology, resources, and information from industrialized to newly independent countries, through the agency of national associations in the developing countries. This was followed by travelling seminars in Africa and in Eastern and Middle East regions, and by field projects in Mali, Sri Lanka, Peru, and India, among many others.

Image 1: A picture of the 1982 stamp from Benin marking the centennial of the discovery of the tubercle bacillus by Dr. Robert Koch.

In this period, the scientific committees continued to focus on the strategy for TB control. Some examples of the activities follow. In 1961, two international collaborative studies evaluated the test characteristics of 1,099 films read by 90 readers from 7 countries and WHO. A subsequent study evaluated sputum smear microscopy. Starting in 1965, an international collaborative study on tuberculin skin testing evaluated 75,000 children in 21 countries. Further controlled clinical trials addressed the issue of previously treated patients and daily self-administered versus intermittent supervised regimens. In 1968, a survey evaluated adverse reactions to BCG vaccination, with over 10,000 events analyzed. Also in 1968, A Technical Guide for Sputum Smear Microscopy was published; the 5th edition of this guide was published in 1999.

In 1965, the Tuberculosis Surveillance Research Unit was established under Dr. Karel Styblo. It developed an index to evaluate infection and its trends, clarified the natural history of the disease (including transmission probabilities and risk factors), and estimated the impact of control measures. In 1969, in collaboration with the then–Communicable Disease Center of the United States and seven member countries in Eastern Europe, an international trial of preventive chemotherapy for fibrotic lesions of the lung in 25,000 individuals was commenced and was evaluated over 5 years of follow-up. In 1973, it was proposed that the mandate of the IUAT be extended to include other lung diseases. However, the name of the organization was not changed to reflect this extension until 13 years later.

In 1975, Dr. Halfdan Mahler, Director General of WHO, publicly acknowledged the crucial role played by the IUAT in the fight against TB. In early 1976, 18 NGOs (nongovernmental organizations) responded to IUAT's invitation to consider jointly the role which NGOs may and should play in primary health care (PHC) programs. The resulting position paper was presented at the joint UNICEF/WHO International Conference on PHC in Alma Ata in 1978.

Image 2: Picture of a stamp from Burundi commemorating the fight against TB.

Image 3: Picture of a stamp from the Republic of Korea depicting a community x-ray campaign for TB.

Modeling the global fight against TB, 1978-1991

In 1978, in response to a request from the Minister of Health of Tanzania, the IUAT proposed the establishment of a National TB Program under the direction of the government and with support and coordination of the IUAT. This proposal was the basis of a new program of Technical Assistance of the IUAT and became the basis in 1979 for the first edition of the TB Guide. Such assistance eventually extended to nine low-income countries and became the basis of the current DOTS Strategy of the WHO.

In 1981, the IUAT became the first organization to adopt a policy that its meetings be designated "non-smoking" conferences. In 1982, the Koch centenary was celebrated at the 25th conference in Buenos Aires, where the Koch Medal of the IUAT was awarded to Drs. Johannes Holm and Wallace Fox. That same year saw the establishment of World TB Day on March 24 each year, following a proposal by the Mali Association. In 1984 the IUAT was officially registered with USAID, a very rare privilege for a non-US agency. The IUAT officially changed its name in 1986 to the IUATLD to reflect the inclusion of other lung diseases in its mandate. In 1987, a delegation from the IUATLD visited WHO to encourage it to consider the problem posed for TB by the emergence and spread of HIV infection that had been noted in the collaborative projects.

In 1989, the Burden of Health Study carried out by Harvard University was pivotal in demonstrating the cost-effectiveness of the IUATLD model, which was instrumental in convincing planners and policymakers to adopt the strategy as a part of the general health services.

A global fight, 1991-present

The principles of the model National TB Program, outlined on the occasion of the retirement of Dr. Styblo in 1991, were subsequently enumerated as the "DOTS" Strategy, promoted as the official policy of the WHO. In that year, the international TB training course of the IUATLD was first held in Arusha, Tanzania, to illustrate the principles of the model program. From 1993 to 1996, the training and technical support activities of the IUATLD were extended from a largely African base to represent every region of the world. In 1996, the IUATLD entered into a formal agreement to provide training fellowships with support from the International Fogarty Foundation.

By 1998, field activities involved 10 countries in the Eastern Region, 5 in the Middle East, 10 in Africa, 15 in Europe, 8 in Latin America, and 2 in North America. The network of courses in management included Tanzania, Benin, Nicaragua, and Viet Nam, and the courses on research methods included Turkey, Kenya, South Africa, Mexico, Chile, Argentina, Brazil, Peru, Malaysia, and China. During this period, more than 1 million patients with TB were cared for in the context of the collaborative programs of the IUATLD. In 1998, the IUATLD joined with the WHO and other international partners to form the "Stop TB" Initiative in the hopes of extending the model to all countries of the world.

These activities were made possible thanks to funds entrusted to the Union from richer associations and by governments of a number of affluent countries.

Characteristics of the IUATLD

The distinguishing qualities of the IUATLD, besides its universality, its spirit of solidarity, and its tolerance, are its continual striving for quality and its independence. Thanks to these, it provides the international community with an invaluable asset, namely, its pioneering role in devising and encouraging or testing innovations. It provides a neutral platform for international collaboration, exchange of information, friendship, mutual esteem and education, and a reduction of prejudice. It maintains not only a program of scientific conferences and publications but also a program of action for health in the community, comprising technical assistance, education, and research. Dr. Gro Harlem Brundtland outlined the future in the following statement to the 51st session of the World Health Assembly in Geneva in 1998: "We must reach out to the NGO community. Their reach often goes beyond that of any official body. Where would the battle against leprosy, TB, or blindness have been without the NGOs?"


Released October 2008
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