Ladies and Gentlemen,

Every year, we commemorate World Tuberculosis Day on 24 March. On this day in 1882, Dr Robert Koch reported his discovery of tuberculosis bacilli to the scientific community. After 119 years, we have good reasons to commemorate this day in the Eastern Mediterranean Region of the World Health Organization.

First of all, the countries of the Region have made excellent progress in promoting the strategy against tuberculosis known as directly observed treatment, short-course, or DOTS. In 1995, only one country was using DOTS. Other countries then realized the importance of DOTS: in 1997 the Regional Committee for the Eastern Mediterranean adopted a resolution that called on Member States to achieve nationwide implementation of the DOTS strategy, or DOTS ALL OVER, by the year 2000.

Today, 20 out of 23 countries in the Region have implemented DOTS ALL OVER programmes. Seventeen countries have already achieved DOTS ALL OVER, and the three remaining countries are expected to achieve it in early 2001. This is remarkable progress.

Countries of the Region have made steady progress towards the accomplishment of the global targets for tuberculosis control, particularly with regard to treatment success rate. Many countries are achieving treatment success rates of more than 85% in DOTS areas. Of course, high treatment success rates should be accompanied by a high case detection ratenamely 70%so as to make an epidemiological impact on tuberculosis incidence.

Of especial note is the fact that countries of the Region have taken innovative approaches to tuberculosis control. One is collaboration with the private health sector, the so-called private–public mix. A good example can be observed in Egypt. The national tuberculosis programme there has set up a functioning national tuberculosis board involving all interested parties, and consequently all partners public and private¾have accepted DOTS as the strategy of choice. A pilot project with general practitioners and private laboratories started in 2000. Egypt is one of the few countries in the world that receives notifications of cases from the private sector.

Another innovative approach is operational research. The Regional Office for the Eastern Mediterranean has a special scheme, with special funds, to support operational research activities on communicable disease control, called the "small grant scheme". The Special Programme for Research and Training in Tropical Diseases, or TDR, which is a joint venture of the United Nations Development Programme, the World Bank and WHO, also supports the scheme. Seven operational research activities on tuberculosis control received grants in 2000.

However, with due acknowledgement to the above-mentioned progress, I must emphasize that tuberculosis has not yet come under real control in the Region, and this is why we still observe, but do not celebrate, World Tuberculosis Day.

Tuberculosis will remain an important public health problem for the following reasons.

The first reason is its tremendous morbidity and mortality. Tuberculosis still kills 115 000 people and affects 650 000 people every year in the Region. Moreover, there are two countries in the Region with a high burden of tuberculosis. These are Pakistan and Afghanistan. They account for 43% and 12% of the regional burden respectively, and are still slow in DOTS expansion.

The second reason is the quality of DOTS activities. Most countries of the Region have achieved DOTS ALL OVER. However, this achievement should be accompanied by high treatment success rates and case detection rates. To date, case detection rates are lower than the global target of 70% in many countries. In such a situation, we cannot make a real impact on tuberculosis.

The third reason is the lack of comprehensiveness of DOTS ALL OVER in some cases. All health partners should be effectively involved in DOTS activities. In some countries, the ministries of defence, interior and higher education all have some public health responsibilities. However, only the public health sector under the aegis of the ministry of health is involved in the DOTS strategy.

Ladies and Gentlemen,

In light of the above, the Regional Office set new regional targets for tuberculosis control, which were endorsed by the Regional Committee for the Eastern Mediterranean during its 47th meeting in November 2000. The new regional targets are:
 

To detect at least 70% of all cases of tuberculosis in the Region, and successfully treat at least 85% of those detected by 2005, and to sustain these rates
 

To enrol all detected tuberculosis patients in the DOTS strategy by 2005
 

To reduce the prevalence of and deaths from tuberculosis in the Region by 50% by 2010.

These are minimum achievements for all countries. Some countries that have already made good progress however need to move further. Therefore, there are three specific targets for countries:

 

All countries, except for Afghanistan, Pakistan and Somalia, which are lagging in DOTS implementation, should be detecting at least 70% of all cases of tuberculosis and successfully treating at least 85% of those detected by 2003.
 

Countries with intermediate incidence of tuberculosis should reduce the incidence of tuberculosis by at least 50% by 2010.
 

Countries with low incidence of tuberculosis should reduce the incidence of smear positive pulmonary tuberculosis to at least as low as 1 per 100 000 population by 2010¾that is to say, eliminate tuberculosis, as required by the 1997 Regional Committee resolution on tuberculosis elimination.

World Tuberculosis Day 2001 is an occasion to reflect on the present circumstances and look to the future, and to make a firm commitment to our fight against tuberculosis. It is a day to mobilize political leaders and decision-makers to redouble their efforts to alleviate the condition of tuberculosis sufferers, and to consider the implications of tuberculosis for human development. There is no excuse for inaction with the existence of an available, cost–effective cure.

With this in mind, the theme for World Tuberculosis Day 2001 is:

The theme reflects the important role of government and the private sector in providing tuberculosis drugs and services at the highest level of quality. It highlights the crucial role of DOTS workers and the community in ensuring that the right to health for each patient becomes a reality throughout every country. It is also a call to civil society and its partners to provide an environment that encourages everyone with tuberculosis to seek treatment and cure. It challenges DOTS providers to continue to reach out and adapt DOTS to the needs of their tuberculosis patients. Of course, to address the above issues, all countries should achieve and maintain the high standards and comprehensiveness of DOTS ALL OVER.

Let us observe, and not celebrate, World Tuberculosis Day together, and reaffirm our commitment to the fight against tuberculosis. I wish you all every success in your activities on this World Tuberculosis Day.