‘Marketplace’ Series Examines TB in Eastern Europe

APM's "Marketplace" this week in a two-part series examined tuberculosis in Eastern Europe. Summaries appear below.

• "TB's Return Comes With High Costs": Multi-drug resistant tuberculosis is increasing in parts of Eastern Europe, particularly in Romania and Ukraine, "Marketplace" reports. In addition, although most TB cases are recorded among low-income people, an increasing number of TB cases, including MDR-TB cases, are occurring among middle-class populations. According to health economist Franque Grimard, it costs between $240 and $300 per patient daily to treat MDR-TB, or about $20,000 per person for two years of treatment. The Global Fund To Fight AIDS, Tuberculosis and Malaria provides most of the funding for the treatment of MDR-TB in Romania. TB efforts cost more than $75 million annually in direct health care costs in Ukraine, where "political disarray" has prevented the Global Fund from providing support, "Marketplace" reports. Grimard added that TB prevents people from working and contributing to the economy and that the economic benefits of treatment are greater than the cost of treatment, with every 10% reduction in TB cases leading to an economic growth of about 2%. According to Katya Gazzinha of PATH, TB has increased in Eastern Europe since the collapse of the Soviet Union. Some doctors have said the increased stress people felt during the collapse, in addition to the collapse of the TB treatment program, contributed to the increase in TB cases throughout the region. Marcos Espinal, director of the Stop TB Partnership, noted that increased TB cases in Eastern Europe can affect people living in the U.S. and Western Europe because of increased air travel (Browning, "Marketplace," APM, 9/8).
  

• "Bureaucracy Slows Ukraine's TB Fight": Bureaucratic obstacles and political instability in Ukraine have weakened the country's ability to control TB, but public and private groups are increasing efforts to address the disease, "Marketplace" reports. Ukraine has one the highest rates of MDR-TB worldwide, and 16% of the 40,000 people who contract TB annually develop MDR-TB, "Marketplace" reports. According to Vladimir Muscovi, chief doctor of the Foundation for the Development of Ukraine, doctors previously traveled to locate and treat people with TB. However, if people with TB currently try to avoid treatment, "nobody worries about it," Muscovi said. The foundation is increasing efforts to rebuild Ukraine's public health system and improve the country's capacity to control TB. According to foundation director Anatoli Zabolotny, the foundation will spend $20 million over the next five years to purchase equipment and medicine, repair TB hospitals and enhance the effectiveness of public health care. The foundation also has measured public awareness of TB and found that 28% of the population is aware of Ukraine's TB epidemic, which began about 15 years ago. According to Espinal, Ukraine's "main issue" for controlling TB is political commitment. "TB is not a medical problem, it's an economic problem," Espinal said, adding, "If we don't put that in the minds of the political leaders, then the problem will not be solved" (Browning, "Marketplace," APM, 9/9).
  
  The reports were supported by a Kaiser Family Foundation mini reporting fellowship.