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WHO Calls For Urgent Action Against Multi-Drug Resistant TB in Asia-Pacific

About two million people in the Western Pacific region develop tuberculosis each year. Poverty, an aging population and rising HIV infections are helping spread the respiratory disease. On World Tuberculosis Day, health experts in Asia stress the urgency of controlling a much bigger medical threat: drug resistant tuberculosis. VOA's Heda Bayron has more on the story from our Asia News Center in Hong Kong.

The World Health Organization says more than a quarter of the world's multi-drug resistant tuberculosis (MDR-TB) cases are found in the Western Pacific. A majority of them - around 140,000 cases - are concentrated in China.

This World Tuberculosis Day, the WHO is urging governments in Asia to invest in immediate action - saying stopping more virulent strains of the disease is costlier and more complex.

Unlike ordinary TB - which can be cured by antibiotics within six to eight months - MDR-TB requires more powerful and expensive drugs taken for more than two years, often with severe side effects.

Dr. Pieter van Maaren - head of the Stop TB department of the WHO in the Western Pacific - says the emergence of MDR-TB can be blamed on a failure to implement the standard treatment strategy known as DOTS.

"It's a man-made problem," said Pieter van Maaren. "What you see in China for example is, in the past, the TB control program was not very strong and they have not managed TB patients according to the DOTS strategy. But it was only in 2002, 2003 that the entire country had access to DOTS strategy - the best way of managing TB. That is why we see at this point in time the problem of drug resistant TB in China emerging."

Incorrect or incomplete medication leads to drug resistance. DOTS - direct observed treatment short-course - combats the problem by requiring patients to come to clinics daily or several times a week to take their medicines. There, health workers closely monitor correct dosage and duration of treatment.

In Hong Kong - where the fight against TB and drug resistance has been successful - anti-TB drugs are given free in public clinics. Because of the city's small size, patients have easy access to them. In the past 50 years - Hong Kong has reduced the incidence of TB by almost 98 percent.

But Dr. S.L. Chan, a tuberculosis expert at the Hong Kong Tuberculosis, Chest and Heart Disease Association, says getting patients to stay on course with DOTS is a multi-faceted challenge.

"In the past you can say, 'You must have treatment' under supervision and they have no choice," said Dr. Chan. "But now because of human rights if you tell them, 'You must have DOTS' they will say 'I can't'. You can't force them… Another thing, [in Hong Kong] there is still a large proportion of the population suffering from tuberculosis in the age between 20-49. They are the working group. How can you imagine they come to the clinic for supervised treatment?

Other challenges include funding and reaching people in remote areas or places with overtaxed health facilities.

The WHO is targeting its fight against TB in the world's most populous nation, China. Mario Raviglione is the global head of the WHO's Stop TB department.

"We are now pretty confident that the Chinese are going to do the right thing, what needs to be done to save the situation," said Mario Raviglione. "Clearly there is a lot of work ahead."

The Western Pacific sees two million TB cases develop each year and more than 800 people die from the respiratory illness every day.

The WHO has set an ambitious goal for the whole region and that is to cut by half TB prevalence and mortality within three years.

Doctors say the region's rising HIV/AIDS epidemic, persistent poverty and dismal public health funding are the main obstacles to these goals.

The WHO says the region has only earmarked less than 10 percent of the nearly $1 billion it needs to combat the disease in the next five years. More than $200 million of it would be needed to contain multi-drug resistant TB.

TB is spread through coughing and sneezing. In Asia, it is most prevalent in Cambodia, China, Laos, Mongolia, Papua New Guinea, the Philippines and Vietnam.