Beijing faces funding crisis for TB treatment

PUBLISHED : Saturday, 24 March, 2012, 12:00am
UPDATED : Saturday, 24 March, 2012, 12:00am


With a global health fund withdrawing, the mainland is scrambling to find the means to support its fight against tuberculosis, which the WHO estimates infects 1.3 million mainlanders every year.

With the world's second-highest number of tuberculosis (TB) infections, mainland China has treated 8.29 million TB patients in the past 10 years. About 900,000 cases of active TB were discovered and treated last year, including 423,000 infectious cases. But the Global Fund to Fight Aids, Tuberculosis and Malaria, which started to support Beijing's efforts to contain TB in 2003, will withdraw from mainland projects in June next year and will not grant any further financial help, citing China's growing economic might.

The group offered 150 million yuan (HK$184 million) in TB funding a year, accounting for 16 per cent of total spending, said Jiang Shiwen , a researcher with the TB prevention department of the Chinese Centre for Disease Control and Prevention.

Xiao Donglong, an inspector with the Ministry of Health, said: 'The ministries of health and finance are actively studying the issue of financial guarantees after the withdrawal of funding.'

On a visit to the CDC in December, Premier Wen Jiabao vowed the government would try to make up for the funding shortfall.

'The central government might further increase spending on prevention and control of TB to make up for the shortfall of funding for the parties that provide services,' Xiao said. 'There is also a shortage of funds for treating TB patients, which needs to be included in the basic medical insurance scheme.'

Xiao said state spending on fighting TB had grown from 20 million yuan a year in 2000 to 600 million yuan now, which ensured free diagnosis and treatment of non-drug-resistant TB.

But treatment for multiple-drug-resistant TB (MDR TB), which is far more expensive and takes longer, is not free. It takes 18 to 24 months to treat MDR TB, as opposed to six to eight months of antibiotic treatment for normal TB. It also costs 50,000 yuan to treat MDR TB, 100 times the cost of treating normal TB.

Drug-resistant TB emerges when patients fail to follow treatment regimes or stop treatment too early. When the TB bacteria is not fully eliminated, it can mutate, re-emerge later and become resistant to the small range of drugs that can fight the disease. People, who are infected with the MDR TB strain, and have never had TB can also see the drug resistant form of the bacteria develop.

Twelve provinces are running pilot schemes on the inclusion of MDR TB treatment in basic medical insurance, covering an average of 65 per cent of the fees.

Wen pledged in his annual government work report earlier this month that eight diseases, including MDR TB, will be included in the scheme nationally. But Chen Mingting , deputy director of the National Centre for Tuberculosis, said he was worried that it would still be a very slow process.

'This is the direction given by the state leader but it needs to be realised by the provincial governments,' Chen said. 'It involves multiple government agencies and needs local government to use their own fiscal spending. It is not that easy and has to be advanced step by step.'

Apart from the monetary problem, a proper regime needed to be set up around the country, Chen said.

Only 10 per cent of the 120,000 people on the mainland infected with MDR TB could receive proper treatment, Chen said. It involves taking four effective drugs together for 18 to 24 months.

'Most patients can be treated in time, but only 10 per cent can be treated properly, which requires a regime of the CDC working closely with hospitals,' Chen said.

In theory, the CDC should take charge of tracking patients and ensuring they are taking medication, but only 51 cities out of more than 300 have such a regime. A national five-year plan on preventing and controlling MDR TB aims to have half of cities establish such a regime by 2015.

Some patients stop taking medicine after one or two months of treatment, when the cough stops and the symptoms are gone, but the bacteria is not eliminated and the symptoms will come back. They will then start treatment again. This will eventually lead to patients developing extensive-drug-resistant TB (XDR TB), which is difficult to treat and sometimes fatal. Some 9,000 people on the mainland develop XDR TB each year.

What makes TB, once known as the white plague and disease of poverty, so difficult to eliminate on the mainland is a shortage of staff, resources and funding.

Chen said an extra 300 million yuan was needed a year.

TB has also become a global problem after a resurgence in the 1990s, even in the West. There is no effective vaccine for adults. A BCG vaccine protects children from cerebral TB, but not from pulmonary TB.