Thank you. I am honored to be here with so many distinguished guests, friends and colleagues for the release of the World Health Organization's (WHO's) 2011 Global Tuberculosis Control Report. I want to recognize Dr Mario Raviglione, Dr. Anthony Fauci, Dr. Harold Jaffe, and Ms. Deborah von Zinkernagel.
As some of you might know, my background in clinical epidemiology led me to work on multi drug-resistant tuberculosis in New York City and at the World Health Organization not so many years ago, and later on the establishment of the Global Alliance for TB Drug Development (with NIH and others) and the Global TB Drug Facility at WHO.
TB has been killing people for more than 15,000 years and still plagues the world, especially the poor and most vulnerable populations in society. Artists from Rembrandt to Monet have depicted the impact of TB in their own lives in some of their most famous creations, as did Verdi in La Traviata.
This year's report is an important reminder that TB continues to be a major source of global morbidity and mortality, but it also demonstrates that significant progress in preventing, controlling, and curing people of the world's second biggest infectious killer can be made. It is heartening to see that mortality rates have fallen by more than a third since 1990, and that much of the world is on track to meet the UN Millennium Development Goal to halve TB prevalence and deaths by 2015.
USAID is proud to support the critical work of domestic and international partners against TB. We know that treating TB abroad saves lives, while also saving money here at home. We are also please to support the documentation and analysis of trends in diagnosis, treatment, and outcome. These data are essential to informing national programs and donor strategies.
It is particularly rewarding to see that the collaborative work of national governments and their domestic and international partners has resulted in the progress described by Dr. Raviglione. We must, however, "keep our eyes on the prize". We know from past experience that continued vigilance is essential to maintaining gains and reaching our goals; failing to do so is likely to result in major outbreaks of drug resistant TB, such as those seen in the Unites States in the late 80s, the former Soviet Republics in the early 90s, and Africa more recently.
While we strongly believe that the foundation of successful TB programs are through the implementation of quality DOTS programs, we believe that progress can be accelerated with the introduction and scale up of innovative technologies for development.
USAID is investing in the roll out of the new diagnostic Xpert, supporting the procurement of equipment and reagents, and the provision of technical assistance to countries. USAID also supports the work of The Global Alliance for TB Drug Development towards a shorter DOTS regime and more effective management of MDR TB.
As documented in this report and the WHO MDR TB report, the rates of multi-drug resistant (MDR) and extensively resistant (XDR) strains are alarming. Building on solid DOTS platforms, national programs need to improve their capacity to diagnose and treat MDR disease. USAID is leading the way in introducing and scaling-up MDR TB programs in countries with the highest burden.
The deadly overlap of TB and HIV is a challenge and opportunity, with co-infection rates over 80% in some African countries. USAID will continue to work closely with PEPFAR, the CDC and other partners to assist national governments in their efforts to address this challenge.
And from a broader developmental perspective, TB has an overall effect on the social and economic fabric of society:
- The links between TB and poverty are well documented, as the disease strikes the most economically productive segments of the population.
- Each year an estimated 3 million women develop TB, of whom 320,000 die. USAID is working to better understand gender variances in incidence, care and mortality.
- TB related deaths have left an estimated 9.7 million orphans globally. This is compared to 14 million orphans reported as a consequence of HIV-related deaths.
Because of TB's overall effect on society and the need for multi-sectoral approaches, USAID believes health systems strengthening is critical to the success of TB programs.
Through President Obama's Global Health Initiative (GHI), we are focusing on health systems that work for poor and vulnerable people leveraging our work in family planning, maternal and child health, HIV/AIDS and nutrition programs. GHI's call for country ownership and sustainability will mean greater capacity for mixed systems governance, health financing reform and smart integration of health services.
This means providing easier access at a single location for a broader set of medical and health interventions. It means making the shift from diseases to patients. As non-communicable diseases like heart disease and cancer emerge as new killers of poor people, we can leverage district platforms for tuberculosis or antenatal care to combat smoking and related behaviors.
GHI is acting as a catalyst for reform by improving collaboration across the US Government, smartly integrating USG investments, focusing on innovation, discovery and new partnerships, and strengthening a sense of shared accountability.
At USAID, Administrator Shah is reinvigorating our capacity for evaluation, research and innovation, reforming the way we award contracts and grants, and strengthening talent management.
Investments in global health underpin our common humanity. USAID was created 50 years ago by President Kennedy because life, liberty and the pursuit of happiness is more than just an American dream, it's a human right.
We stand together with national governments and other partners to save lives from TB and other diseases, and to develop healthier societies in the countries with the most need.
The WHO report is a guidepost in this path, and for the document and its leadership in global TB control we congratulate Mario and his colleagues in Geneva and around the world.
Note: Some of the famous artists that have painted about TB are the following:
"Saskia as Flora detail" - Rembrandt Van Rijn, 1634 Rembrandt Harmenszoon van Rijn (1606-1669) was considered one of the greatest painters in European art history. In 1634 he married Saskia van Uylenburg. She came from a good family. Her father had been a lawyer and burgemeester (Mayor) of Leeuwarden. Saskia died from tuberculosis (TB) in 1642 at the age of 29 soon after the birth of their fourth child Titus. Rembrandt's drawings of her when she was sick and on her death bed are among his most moving works.
The Dead Mother and Child by Edvard Munch (1897) Norway's most popular artist Edvard Munch was born in 1863. His mother died of Tuberculosis at the age of 30 when Munch was five. His sister Sophie died of Tuberculosis at the age of 15 when Munch was 14.
Facing Death by Eugeen van Mieghem (1875-1930) draws his dying muse. Contemporaries called the Antwerp-born Van Mieghem the 'artist of the people'. During his time at the Antwerp Academy, Van Mieghem met Augustine Pautre, the woman who was to become his wife. In December 1904 Augustine was diagnosed with tuberculosis, a disease that was still fatal at that time. She died in March 1905. Despite her physical decline, Van Mieghem continued to draw Augustine. His studies of her sunken face and her wasted body are the most impressive works he created. Rembrandt's poignant drawings and etchings of Saskia on her sickbed must have been an example and an inspiration to Van Mieghem.
Birth of Venus (detail) by Sandro Botticelli Simonetta Cattaneo de Vespucci (1453 - 1476), known as "la bella Simonetta", was renowned for being the greatest beauty of her age and she is believed to have been the model for Venus in Botticelli's The Birth of Venus as well as the model for several other women in his paintings. Simonetta died probably from pulmonary tuberculosis. She was only twenty-two at the time of her death. The entire city was reported to mourn at the death of "la bella Simonetta" and thousands followed her coffin to its burial. Botticelli finished painting The Birth of Venus in 1485, nine years later.
Camille on her Death Bed by Claude Monet Claude Monet, French painter (1840-1926) was one of the founders of French Impressionist painting. In fact the Impressionism term is derived from the title of his painting -Impression, Sunrise - which the harbor of Le Havre in France was the subject. Camille Doncieux (1847 -1879) was the first wife of Claude Monet. They were married in 1870. She modeled for her husband on several occasions. Camille became ill with tuberculosis in 1876 when she was pregnant with her second child. Although she eventually gave birth to their son, Michel, Camille's body was weak and she passed away on September 5, 1879 from tuberculosis at the age of 32. Monet painted Camille Monet, on her death bed, a last tribute to his wife. A heartbroken and depressed Monet began to create paintings, which were recognized as some of the best artworks of 19th century.
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Last updated: January 29, 2016