TB on the mainland everyone's problem

PUBLISHED : Saturday, 24 March, 2007, 12:00am
UPDATED : Saturday, 24 March, 2007, 12:00am

One disease, two prognoses. When it comes to tuberculosis, the situations in Hong Kong and the mainland cannot be more different. As we mark World Tuberculosis Day today, there is an urgent need to reflect on this disparity, on which the health of a nation and perhaps that of the world now hangs.

The Hong Kong health authorities' battle against the disease is one of this city's great success stories of the post-war era. Though our incidence rate is still high compared with that of many developed countries, it's a far cry from the staggering 10,000-plus new cases a year in the 1950s and 1960s.

In contrast, the mainland has the world's second-largest TB patient population. Each year, there are 1.5 million new cases and 270,000 deaths. The World Health Organisation estimates that the mainland accounts for almost 17 per cent of the world's total TB population.

The WHO said the percentage of the world's population struck by TB peaked in 2004 and has held steady since 2005 for the first time since it declared the TB epidemic a public health emergency in the early 1990s. Yet the pool of TB sufferers on the mainland is growing.

A crumbling public health system, lack of trained medical personnel, wrong or inadequate drug regimes - all these problems exist not only in mainland cities but are much worse in the countryside, where the bulk of the TB patients live. The rise of the Chinese economy has created great disparity in wealth between cities and countryside. More rural migrants are moving into the cities in search of a better life and inadvertently spreading the disease. Many are poor and cannot find jobs; they have no money to seek medical treatment, thereby perpetuating a vicious cycle.

The ability of the central government to address this growing health crisis is not only a national but a global concern. Chief among this is the alarming rise of super-strains found to be resistant to conventional drugs, prolonging treatment and necessitating the use of more expensive drugs that most mainland patients can ill afford. New hot spots of drug-resistant TB are appearing around the world, but China has the largest share of them.

In the age of globalisation, diseases, like commodities, are easily transported. Drug-resistant TB may be another made-in-China export. This is because the disease, while eminently curable, requires a long and rigorous treatment lasting six months. Patients need to take more than a dozen pills every one or two days. This means most patients fail to follow through without the closest medical supervision.

The Health Department in Hong Kong estimates only about one in five patients manages to adhere to the regime on their own. The WHO therefore recommends the Directly Observed Therapy, Short-Course (Dots), which requires the presence of medically qualified personnel each time a patient takes the pills.

Hong Kong, a relatively small city, has the resources for Dots. How the mainland can meet this standard - which requires a sufficient level of drug supply, drug-production quality assurance and a constant pool of medical professionals - is an entirely different matter. Coupled with these obstacles is the fast-spreading epidemic of HIV and Aids. The HIV virus is a co-infecting agent found in many full-blown TB sufferers on the mainland, but the situation is more dire in the countryside.

So, while TB may not be a taboo disease on its own, it does exist in the shadow of one. Each disease worsens the condition of the other, while a vicious cycle is formed between the socio-economic reality of medical service availability and the epidemiology of the disease.

The central government has the will and inclination to stop the spread of TB, but the question is whether it has the means to carry out its policy and directives in the face of what appear to be insurmountable obstacles. For the sake of the health of the Chinese population and that of the world, however, it is imperative that Beijing make determined efforts to overcome those hurdles.



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