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TB Notes 1, 2000
The STOP TB Initiative, A Global Partnership
by Bess Miller, MD, MSc
Associate Director for Science, DTBE
Image 1: Logo of the "Stop TB" initiative
Over the past few decades, when we have looked at the agendas of
international health agencies, major donors to the health sector,
government health ministries, academia, and civil society, we have
wondered, Where is TB? Why is TB on the back burner? The STOP TB
Initiative is a global campaign to move TB to the FRONT BURNER.
With the arrival last year of the new Director General of the World
Health Organization (WHO), Dr. Gro Brundtland, there has been an
interest in intensifying the relationship between WHO and its global
partners. For a number of diseases, but especially for malaria and
TB, WHO has initiated campaigns to join forces with other agencies
and donors in the public and private sectors to achieve global health
Additional factors have added fuel to the sparks of this new campaign.
Over the past several years the World Bank has given an unprecedented
number of loans to developing countries to strengthen TB control
efforts and has established TB as one of its top priority diseases.
There has been renewed interest in TB research in the areas of vaccine
development, new drug development, and new diagnostics. Large donors
such as the Soros and Gates Foundations have shown an interest and
commitment to TB control and TB research. The stars are aligned.
In November 1998, at the annual meeting of the International Union
Against Tuberculosis and Lung Disease held in Bangkok, Thailand,
Dr. Brundtland launched the STOP TB Initiative, a WHO-led global
partnership whose mission is to put TB higher on the international
public health agenda and to substantially increase the investment
in TB worldwide. It aims to increase involvement of international
players at all levels, including international health agencies,
donor agencies, governments, nongovernmental organizations, professional
societies, and community organizations involved in TB at the country
level. The focus of the initiative is on the 22 so-called "high-burden"
countries which WHO has identified as responsible for approximately
80% of all reported cases of TB in the world. These include India,
China, Indonesia, Bangladesh, Pakistan, Nigeria, Philippines, South
Africa, Ethiopia (Fed. Democratic Republic of), Viet Nam, Russian
Federation, Congo (Democratic Republic), Brazil, Tanzania (United
Republic of), Kenya, Thailand, Myanmar, Afghanistan, Uganda, Peru,
Zimbabwe, and Cambodia. In addition, countries with extremely high
rates of TB, especially those impacted by the HIV epidemic, will
The STOP TB Initiative will focus attention on addressing the specific
constraints to action on TB identified at the London Ad Hoc Committee
Meeting on the Global TB Epidemic held in March 1998. The needs
identified at this meeting include political will and commitment,
human resource development, a secure supply of quality anti-TB drugs,
research, financing, organization and management, information systems,
and health sector reform.
The founding partners of the STOP TB Initiative are the WHO, the
Royal Netherlands TB Association (KNCV), the International Union
Against TB and Lung Disease, the World Bank, the American Lung Association,
the American Thoracic Society, and the Centers for Disease Control
and Prevention. New partners include UNICEF, UNAIDS, the National
Institutes of Health, the Japan Anti-TB Association, the Norwegian
Heart and Lung Association, the Canadian International Development
Agency, the Soros Foundation, and the Rockefeller Foundation. Many,
many others are joining. The tremendous energy and inspiration these
new partners bring to the Initiative cannot be overstated.
Current efforts of the STOP TB Initiative are directed at the following
This conference brought together the ministers of health as well as
of finance, development, and planning from the highest burden countries
to set the stage for expanded country action against TB across sectors
of government and society.
- the creation of a global drug supply facility to provide universal
availability of quality TB drugs;
- the development of a global partnership agreement to catalyze
and secure public agreements among donor agencies and high-burden
countries on specific steps to be taken to control TB;
- the co-sponsorship of an initiative to develop new drugs for
- the co-sponsorship with the Government of the Netherlands of
a Ministerial Conference in March 2000.
While many efforts are underway at the "global" level,
TB control efforts take place at the local level, and it is at this
level that we will concentrate future efforts. This past summer,
the Initiative sponsored a series of regional workshops with the
highest burden countries to identify constraints to TB control at
the country level. Suggestions for the STOP TB Initiative made at
these workshops included the following activities:
- expand beyond traditional partners for TB control;
- strengthen advocacy;
- develop a social mobilization campaign; and
- increasem operations research in affected countries.
CDC is actively participating in the STOP TB Initiative and is
represented on the Steering Committee (Bess Miller, Associate Director
for Science and Carl Schieffelbein, Deputy Director for Special
Projects, DTBE), as well as the Secretariat in Geneva (Mark Fussell,
Public Health Advisor, DTBE).
Yes, TB is on the front burner at last, and we plan to keep it