EXTRACT OF SPEECH GIVEN BY DR JAMES ORBINSKI  At Amsterdam - STOP TB - Ministerial Conference,
On March 24, 2000 - WORLD TB DAY

GOVERNMENT INTERVENTION IS NEEDED ON TB RESEARCH THE MARKET HAS FAILED.

Smallpox has been eradicated, polio could follow suit shortly. The world can justifiably be proud of such far-reaching public health achievements.

Today is World TB Day. Most people in the industrialised world think of tuberculosis as a disease of the 19th Century that disappeared along with smallpox. Not so. This year, 3 million will die of TB, and eight million people will develop the disease, almost all in poor countries.

Today in Amsterdam, health and development officials from the United States and European Union are meeting ministers from the 22 countries worst affected by the disease. The World Health Organisation estimates that if left unchecked, TB could kill more than 70 million people world- wide in the next 20 years, and infect nearly one billion more, most of whom will go untreated.

TB represents the tragic failure to use medical advances for the wider benefit of humankind. Despite the explosion of scientific knowledge and techniques over the past two decades, the last novel drug was developed over 30 years ago. The vaccine we use today was developed in 1923.

There is an urgent and immediate need for short and simple treatments. Current treatments are long and cumbersome, with enormous labour costs for governments. The treatment lasts 6-8 months, but patients start to feel better quite early on in the process and drop out early because of the heavy social and economic cost of treatment. Uncured, they pass the disease on to others. This also leads to the development of drug- resistance, making old drugs redundant and subsequent treatment prohibitively expensive ($US 5-8,ooo per patient).

However, none of this concerns the multinational pharmaceutical industry. Eager for a share of the lucrative Western markets, all efforts are concentrated on finding yet another drug for impotence or baldness. Unfortunately for the millions who die every year, TB is not a lucrative market.

We cannot wait for the multinational pharmaceutical industry to respond spontaneously to this global crisis. We must move beyond debates about 'market forces' and 'commercial incentives'. We are facing a global public health challenge, and governments must either intervene in the market, or establish their own capacity to promote research and development for new, affordable, effective drugs and vaccines. Governments should lead the way, and develop a system for sharing the burden. TB is not just a medical crisis - it is a political and social problem that could have incalculable consequences for generations to come.

Dr James Orbinski is President of Medecins sans Frontieres International Council.
Medecins Sans Frontieres (MSF) was awarded the 1999 Nobel Peace Prize.
MSF is currently supporting more than 20 TB programmes world-wide. MSF
is campaigning for access to essential medicines.