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President Obama's ambitious Global Health Initiative — announced to a receptive international community in 2009 — is faltering as budget constraints and shaky implementation limit the impact of the multibillion-dollar program.

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Annika Negin, 22, of Tallinn, Estonia, learned nine months ago she had multi-drug resistant tuberculosis. Doctors said she likely contracted the illness from her father. Negin is committed to taking drugs for another nine to 15 months, and represents part of Estonia's successful approach to fighting TB: persuading patients to take their medication. (John Donnelly /Courtesy)

Deadly tuberculosis a specter on Europe

Belarus, with highest rate ever recorded for MDR-TB, asks for help

GENEVA, Switzerland – On the sidelines of a conference in Baku, Azerbaijan, just three months ago, a senior health official from Belarus met privately with Mario Raviglione, whose job here at the World Health Organization’s headquarters is to control the spread of tuberculosis around the world.

Belarus needed help. It had just confirmed a study that found 35 percent of all TB cases in the capital of Minsk were multi-drug resistant TB (MDR-TB) – the highest rate in the world ever recorded for the deadly disease, which takes up to two years to treat and is cured in Western Europe only one third of the time.

“It’s a real tragic situation,” Raviglione, director of WHO’s Stop TB Department, said, looking back at that moment with the Belarus official. “But they came out openly about this and they wanted help, which is very positive. For a long time, several countries have been hiding their realities about multi-drug resistant TB.”

The WHO's Regional Office for Europe recently released a report that warned about the spread of the hard-to-treat MDR-TB into all of Europe, making the case that the relatively wealthy capitals of the West faced the grave danger of a much higher number of cases if the entire region did not move quickly to put in place effective control measures.

The report, which was released in September and which now poses a great challenge to global-health experts in Europe, concluded that “MDR-TB is spreading at an alarming rate” in Europe and Central Asia, a region that includes the top nine countries in the world in rates of drug-resistant TB among newly diagnosed patients. TB, a global pandemic which kills an estimated 1.4 million people a year, already has made dangerous inroads in Western Europe, notably the urban center of London, which has the highest TB rate of any capital city in the region. London records nearly 3,500 cases annually, an increase of about 30 percent in the last decade.

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The spread of MDR-TB presents a particularly grim specter for Europe because of its lack of formal borders and the relative ease with which the populations travel in and out of European countries. In addition, since TB is transported globally, the Obama administration’s Global Health Initiative (GHI) and the Global Fund to Fight AIDS, Tuberculosis and Malaria also includes funding and strategies to fight the disease also largely in Asia and Africa, the latter of which has a volatile HIV-TB co-infection rate that remains a major cause of deaths.

For people advocating for more anti-TB funding, both the GHI and the Global Fund have come under attack because of relatively lower levels of support, especially when compared to the fight against AIDS. GHI officials counter that its more holistic approach, including using AIDS funds to treat other diseases and conditions, will better address the TB pandemic, but critics aren’t convinced. They look even at the difficulties in Europe as a barometer overall on the lack of a concerted effort by countries to control the contagious disease.

“What’s missing is that too few countries show the political will to fight TB,” said Lee Reichman, the founding executive director of the New Jersey Medical School’s Global Tuberculosis Institute. “What’s the number one point in the Stop TB Partnership? It’s political will.”

In Europe, Raviglione said countries need to do much more. “The real story about MDR-TB in Europe is that the vast majority of countries are facing a major problem, with the exception of the Baltic countries dealing with it effectively,” he said. “The problem is derived from a bunch of issues, including poor treatment regimens in the past, poor quality of some drugs, lack of reserve drugs to treat those with resistance, and not having the latest diagnostic tools.”

But Raviglione said the situation could be markedly improved if countries seek outside support, such as the case of Belarus, and follow certain procedures. He pointed to the examples of Estonia and Latvia in the Baltic region, which have dramatically cut numbers of TB cases in the last 15 years. The main reason for their success, according to several experts, is that both countries had a strong political will to fight TB that included targeting funds