WRITTEN QUESTION E-3004/00

by Elspeth Attwooll (ELDR) to the Commission

(26 September 2000)

Subject: Tuberculosis control

The TB control strategy known as DOTS (Directly Observed Treatment, Short-course) has proven to be the most effective strategy available for controlling the TB epidemic.

Can the Commission outline what efforts it is making to promote DOTS as a method of tackling the tuberculosis epidemic, particularly in Africa and Asia?

Answer given by Mr Nielson on behalf of the Commission

(19 October 2000)

Tuberculosis (TB) is in most cases curable if the drugs are taken continually for the full duration of the course. Problems arise when there are interruptions to supply or when the patient stops treatment when he or she feels better. This is a recipe for development of resistance of the TB bacillus to drugs. DOTS (directly observed treatment, short-course) is the World Health Organisation (WHO) recommended standard treatment against tuberculosis and has developed as a result of 20 years of programme experience.

This strategy is adopted in most countries in Africa and Asia and receives the Commission's support.

TB control is an integral component part of health systems. Effective TB control and treatment should be a part of every national health programme and funded from the national budget. However due to multiple demands and inadequate health funds TB programmes, particularly in developing countries, have often relied on external donor assistance.

Many initiatives undertaken by the Community are important for tuberculosis control in Europe and in the rest of the world.

Among the Community initiatives focused on Europe, the following should be mentioned:

- Community network for the epidemiological surveillance and control of communicable diseases(1), that brings into permanent communication the institutes and public health authorities dealing with infectious diseases and

- Community action programme on immune deficiency syndrome (AIDS) and other communicable diseases(2), which provides financial assistance to projects such as Euro-TB (surveillance of TB in 51 countries of the WHO European Region which comprises also many Asian countries).

The Commission also participates in other relevant actions such as the Task Force on Communicable Disease Control in the Baltic Sea Region and the EU-US Task Force on Communicable Diseases.

The Commission provides extensive support to strengthen health systems, including TB control, in developing countries. This preference for a system-oriented approach has been a deliberate Community policy. As a consequence, a detailed disease specific Community development budget breakdown for TB is not available. Community commitments to health, AIDS and population in 1998 amounted to well over 700 million for more than 100 developing countries.

Specific collaborative research activities with developing countries particularly geared to the development and testing of new drugs, diagnostics and vaccines are administered under the regular Community research budget. For the period 1994-1998, approximately 3,5 million were spent for TB research.

Finally, on 20 September 2000 the Commission adopted a communication(3) to the Council and the Parliament on a proposed accelerated action targeted at major communicable diseases (TB, malaria and HIV/AIDS) within the context of poverty reduction. The new Community initiative offers the potential for innovative cohesive strategies for combating the disease. A high-level round table discussion on this new initiative was organised by the Commission together with WHO and the United Nations programme on AIDS (Unaids) in Brussels on 28 September 2000. An action plan will now be prepared to implement these strategies. The Commission will further enhance the availability and access to anti-tuberculosis drugs in developing countries in order to improve the compliance to the treatment, in line with the DOTS methodology.

(1) Decision No 2119/98/EC of the Parliament and of the Council of 24 September 1998 (OJ L 268, 3.10.1998).

(2) Decision No 647/96/EC of the Parliament and of the Council of 29 March 1996 (OJ L 95, 16.4.1996).

(3) COM(2000) 585 final.