Partnerships Key in Fighting TB

World TB Day, March 24, commemorates the date in 1882 when Robert Koch, M.D., announced his discovery of the cause of tuberculosis (TB), the organism Mycobacterium tuberculosis. His work was hailed as a breakthrough by a world weary of TB. Eventually, the United States’ success in fighting TB allowed the country to shift its focus from TB control to TB elimination.

However, as evidenced by CDC’s Division of Tuberculosis Elimination’s (DTBE) recently released provisional data for 2007, the trends are sobering: the rate of decline is slowing, and racial/ethnic minorities and foreign-born persons continue to be affected by TB at disproportionate rates.

Despite much progress against this largely treatable and preventable disease, TB is still a serious health threat across the world. The World Health Organization (WHO) estimates that two billion people, equal to one third of the world’s population, are infected with M. tuberculosis, with 9.2 million new TB cases and 1.7 million deaths from TB occurring in 2006.

CDC recognizes that building and strengthening partnerships is key to TB prevention and control efforts. The country’s progress in eliminating TB will not be sustainable without strengthened collaborations with local, state, national, and international partners from all sectors of society.

Forging Global and National Partnerships to Stop TB

In 1991, the American Lung Association coordinated the establishment of the National Coalition for the Elimination of Tuberculosis (NCET) —recently renamed Stop TB USA. The new name better aligns and identifies the coalition with the Global Stop TB Partnership and other global Stop TB partners such as Stop TB Canada and Stop TB Mexico, and thus clarifies its role as a partner in a larger group rather than a stand-alone U.S. entity.

NCET/Stop TB USA represents 72 agencies, associations, and voluntary groups, and 43 state and local TB advisory committees. The coalition has grown over the years into an effective advocacy organization and works in close partnership with CDC in its campaign to educate the public, the medical community, and policymakers about the need to eliminate TB.

Over the years, NCET has proven invaluable in its ability to generate increased awareness and support for TB control efforts. The coalition is credited with playing a major role in bringing about a significant increase in federal support for TB control in the 1990s. Stop TB USA now hopes to expand its partnerships at the federal, state, and local levels, as well as with nontraditional partners, to accelerate TB elimination.

Global Partnerships to Stop TB

In 1993, WHO took the rare step of declaring TB a global emergency. Shortly afterward, WHO launched the DOTS strategy (for directly observed therapy, short course) in many countries. Despite these efforts, the increasing epidemic showed that the efforts of one or two groups were not enough. It would take the combined efforts of many partners in many countries.

Recognizing that real progress could only be made through collaboration with all stakeholders, in 1998, WHO established an international alliance to fight TB called the Stop TB Initiative. The alliance initially consisted of a “skeleton crew” of stakeholders from the American Lung Association, the American Thoracic Society, CDC, the International Union Against TB and Lung Disease, the Royal Netherlands TB Association (KNCV), and WHO.

The alliance noted several constraints to progress: a lack of or inadequate political will or commitment; financing; human resources; program-level management; TB drugs; and information systems. Based on these findings, the group proposed a variety of collaborative solutions.

By 2000, the alliance had evolved into a larger, more formal, and more powerful entity known as the Global Partnership to Stop TB (also called the Stop TB Partnership). Nowadays, the Stop TB Partnership includes over 500 organizations working together toward the elimination of TB.

The Global Fund to Fight AIDS, Malaria, and Tuberculosis was formed subsequent to the partnership meeting, greatly increasing the available funding for TB. As another direct result of the partnership’s recommendations, the Global Drug Facility was established, which provides free or affordable drugs to countries in need.

With the emergence of multidrug-resistant (MDR) TB, the DOTS-Plus Strategy and the Green Light Committee were developed to help endemic countries manage patients and obtain low-cost drugs for these patients. All of these, and more, resulted from WHO’s decision to enlist global partners to fight TB.

More Information

• Division of Tuberculosis Elimination (DTBE)
• Global Tuberculosis Control 2008: Surveillance, Planning, Financing*
• Stop TB Partnership*
• The Global Fund to Fight AIDS, Malaria, and Tuberculosis*
• World TB Day