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Cablegate: Multi-Drug Resistant Tb in China: Government Inertia

VZCZCXRO3498
RR RUEHAST RUEHHM RUEHLN RUEHMA RUEHPB RUEHPOD RUEHTM
DE RUEHBJ #4506/01 3460853
ZNR UUUUU ZZH
R 110853Z DEC 08
FM AMEMBASSY BEIJING
TO RUEHC/SECSTATE WASHDC 1334
INFO RUEHCN/AMCONSUL CHENGDU 9573
RUEHGZ/AMCONSUL GUANGZHOU 0057
RUEHHK/AMCONSUL HONG KONG 0753
RUEHGH/AMCONSUL SHANGHAI 9568
RUEHSH/AMCONSUL SHENYANG 9234
RUEHBK/AMEMBASSY BANGKOK 6545
RHMFIUU/DEPT OF HOMELAND SECURITY WASHINGTON DC
RUEAUSA/DEPT OF HHS WASHINGTON DC
RUEHC/DEPT OF INTERIOR WASHDC 0745
RUEHPH/CDC ATLANTA GA
RUEHZN/ENVIRONMENT SCIENCE AND TECHNOLOGY COLLECTIVE

UNCLAS SECTION 01 OF 02 BEIJING 004506

SENSITIVE
SIPDIS

STATE PASS TO USAID
BANGKOK FOR ESTH AND CDC
CDC ATLANTA FOR CCID AND COGH
HHS FOR FDA AND NIH

E.O. 12958: N/A
TAGS: TBIO KFLU ETRD CH
SUBJECT: MULTI-DRUG RESISTANT TB IN CHINA: GOVERNMENT INERTIA
HAMPERING TREATMENT EFFORTS

BEIJING 00004506 001.2 OF 002


1. (SBU) SUMMARY: Growing numbers of multi-drug resistant
tuberculosis (MDR-TB) cases in China are challenging the ability of
government and NGO health officials to provide adequate TB patient
care. Nongovernmental health organizations, such as Medecins Sans
Frontieres (MSF)- also known as "Doctors Without Borders" -- have
proposed provincial level projects to treat MDR-TB patients, but so
far, officials within China's National Center for TB Control (NCTB)
have not given approval for this, insisting that government
treatment programs are sufficient. In April 2009, China's Ministry
of Health (MOH) will host a World Health Organization (WHO)
ministerial-level conference on MDR-TB diagnosis and treatment that
will encourage countries with a high incidence of MDR-TB to
accelerate implementation of national programs. In the meantime,
Chinese health officials are finding it difficult to meet China's
own MDR-TB challenges, which include obtaining reliable TB data,
providing adequate medication regimes to MDR-TB patients, and
improving access to affordable treatment regimes. END SUMMARY

----------
BACKGROUND
----------

2. (SBU) According to the WHO's 2008 Global Tuberculosis Control
Report, TB continues to be a major cause of illness and death
worldwide. Every year, 1.7 million people die from TB, and 9
million more develop active infections annually. Those who are most
susceptible live in the poorest regions of the world, and those with
compromised immune systems, like HIV/AIDS patients, are especially
prone to catching TB. China has roughly one quarter of the world's
cases of TB and ranks second on the list of the top five TB-endemic
countries, after India and before Indonesia, South Africa, and
Nigeria. In 2006, China had a total of 4.5 million cases of TB,
with the annual number of new cases estimated to be 1.3 million,
according to the WHO report on global TB control. As is true
elsewhere, TB in China hits the poor hardest, particularly the
millions of migrants who move from rural to urban areas where their
access to health care is limited. Reliable TB data is often
difficult to obtain because of challenges associated with diagnosis.
Non-governmental organizations (NGOs) do not play a meaningful role
in TB treatment in China, because of the government's desire to
maintain strict control over TB treatment. Similarly, importation
of other drugs is restricted by the government, even though many TB
drugs manufactured in China do not meet international standards.

3. (U) Drug resistant TB emerges as a result of treatment
mismanagement, especially when a treatment regime is initiated but
not followed thoroughly, and it is also increasingly being passed
from person to person, even among those in China who have never
taken TB drugs before. (NOTE: MSF estimates that at least half of
new MDR-TB patients contract the resistant strain directly from
other MDR-TB patients. END NOTE). As confirmed by U.S. Center for
Disease Control contacts in China, the situation is getting worse
because general health centers are not promptly identifying and
referring TB patients to TB treatment centers, partly due to a lack
of awareness among patients and health staff. MDR-TB is a form of
TB that cannot be treated with standard "Line 1" anti-TB drugs
isoniazid and rifampicin, but must instead be treated with "Line 2"
options, which include protionamide and cydoserine. The highest
rates of MDR-TB are in China and in countries of the former Soviet
Union. According to the WHO, 8.9 percent of all TB cases in China
are MDR-TB.

------------------------------
NGOs FACING GOVERNMENT INERTIA
------------------------------

4. (U) Government statistics show that in northern China provinces
of Inner Mongolia Autonomous Region and Jilin, the situation is more
severe than in other parts of the country. According to Sherry
Dubois, Acting Head of Mission for MSF's Belgian Section in China,
MSF has since 2007 been involved in in-depth negotiations to
establish an MDR-TB prevention and management program for these
areas. MSF's goal is to set up a sustainable model for prevention
and management of MDR-TB in collaboration with central and
provincial TB authorities. To curb the TB epidemic in China,

BEIJING 00004506 002.2 OF 002


improved adherence, improvements in the health system, better
diagnostic tools, and access to second-line anti-TB drugs are
urgently needed.

5. (U) To date, the Chinese government has not yet approved MSF's
MDR-TB treatment plans, and MSF/Belgium has said that it will likely
cease all of its China operations if an approval is not forthcoming.
Chinese NCTB health officials maintain that the government is
already treating MDR TB patients, but MSF says this is done by using
a regime of drugs that do not adhere to international standards, and
that treating patients with less than adequate regimes is more
dangerous to the patient than no treatment at all. Dubois said she
could not be certain why the government refuses to allow TB drugs to
be imported into the country, but thought perhaps that China is
seeking to protect its domestic drug manufacturing industry.

----------------------
GLOBAL FUND ACTIVITIES
----------------------

6. (U) Under Round Five (R5) of the Global Fund to Fight AIDS,
Tuberculosis and Malaria, 31 pilot sites in six Chinese provinces
are being prepared with plans to enroll up to 5,000 MDR-TB patients
by 2009. However, currently only nine MDR-TB patients, out of tens
of thousands of infected patients, are being treated in China.
Round 7 provides the resources to expand drug resistant TB treatment
to ten or more provinces where an additional 10,000 patients can be
treated by 2011. Although the pilot sites are ready to start
treatment of identified MDR-TB cases, enrollment of patients has not
started due to delayed procurement of quality-assured drugs and lack
of quality assurance for drug resistance testing. With Round 8,
further expansion of MDR-TB is planned as soon as R5 and R7 are
judged to be progressing satisfactorily.

7. (SBU) COMMENT: The Chinese refusal to approve NGO-sponsored
MDR-TB projects will not likely end soon, particularly as health
officials continue to be reluctant to allow outsiders to work in a
field they feel should be run by the government. Providing care and
treatment for the growing numbers of TB cases in China, and the lack
of access to affordable and effective treatment for MDR-TB, will
challenge Chinese health officials as the government moves forward
to enact national health care reform. Other critical issues that
need to be addressed will be funding and population migration as
people from high TB prevalent provinces move to lower prevalence
cities in search of jobs and money. The upcoming WHO conference on
MDR-TB, hosted in Beijing by the Chinese government in 2009, may
provide an important opportunity for external organizations to
coordinate with China in addressing this global health crisis.
END COMMENT
PICCUTA

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