Speaking Note document
Ms Zsuzsanna JAKAB,
Director ECDC
Event: European Commission Meeting on Tuberculosis Location: Luxembourg
Date: 30 June 2009

Introduction

Good morning

First of all allow me to express my gratitude to the colleagues at the European Commission for hosting this conference which has brought together this impressive group of speakers, donors, stakeholders, partners and most importantly those of you from countries who are in the front line of treating and controlling TB.

Your presence here today is a testimony that we are witnessing unprecedented commitment to TB control in the EU and Europe at large.

Also as you know, the numbers of initiatives that have come to life over recent years are providing new strength to the fight against this secular disease.

In particular, the adoption of the Berlin Declaration and the development of the EU Action Plan and the WHO-EURO Plan for priorities countries are providing a blueprint and directions for channeling our efforts.

Setting, threats and challenges

For too long in the recent history of disease control we have mistakenly lowered the guard against tuberculosis in Europe and particularly in the EU.

We have believed that the successes of the past decades in curbing the epidemic could have brought along the elimination of TB.

That is not so, as we all know.

Approximately half a century after the introduction of anti tubercular drugs we are still counting around 85,000 cases and close to 6,000 deaths annually in the EU.

This is certainly not acceptable given that a standardized treatment - provided under close monitoring - can and should achieve success rates close to 100%.

But even more importantly, the disease is affecting in a disproportional manner the most vulnerable populations.

Migrants from high burden countries, the socially disadvantaged and the elderly among others, are withstanding rates of morbidity several times higher than the general population.

Needless to say that stigma and misperception further aggravate this situation.

We need to ensure that the right messages are conveyed to the public.

Increasing evidence is showing that the risk of transmission from high risk groups –particularly migrants- to the native population is low with minimal impact on the overall epidemiology of TB.

The priority stands in ensuring that the principle of universality and equity of care - as stated in the European commission Health Strategy launched in 2008 – is extended to TB care.

Let us also not forget another dramatic reality represented by MDR and XDR-TB.

For too long we have defined TB drug resistance a threat rather than a reality.

And yet –even in the EU- there are settings recording proportions of multi drug resistance close to 20%. Cases of XDR-TB have been reported throughout Europe and the threat of a pan resistant strain is ever more tangible.

This brings me to what I believe being the most urgent and crucial issue in TB control and that is the rational use of TB drugs.

I am certain that we will all share this view but especially those of you who daily witness the devastating effect that drug resistant TB has on the life of a human being.

We do not want to see history repeating itself and perpetuating the dramatic cycle of drug resistance.

Rational use of TB drugs must be ensured.

If this does not occur we will run the risk of losing even the few drugs that are coming out of the research pipeline and jeopardize the life of thousands of patients throughout the Region, not to mention our future generations.

The response

But let us not be discouraged by the picture I have just described.

As I said in my opening, the response that we are witnessing in the EU and in Europe is promising and -if sustained- bound to show successful results.

In the EU the call by the Commission in 2006 for the development of a Framework Action Plan has catalyzed action at both EU and Member States level.

Countries are working on updating their plans, case management is improving in several settings and for the first time in decades we are seeing a stabilization of MDR-TB rates in the EU hot spots for drug resistance.

Let us also remember that the drafting and launching of the TB Action Plan did not occur in a vacuum.

The Plan is in line with and reflects the principles of regional and global strategies to control TB such as the Stop TB strategy and the WHO European Region Plan for 18 High Priority Countries.

Let us also not forget that the efforts and resources invested over the past decade in TB research are yielding the first promising results.

For the first time in decades new diagnostic tools and drugs are coming out of the development pipeline, providing options for upgrading TB control strategies.

We will hear in the course of the conference that the EU is playing a crucial role in this process through both financial and technical support.

ECDC in concert with these initiatives is focusing and prioritizing its work on key areas.

The TB surveillance system jointly coordinated by ECDC and WHO Regional Office for Europe is providing the pillar for all TB concerted action at European level.

It is one of the success stories that will allow progress in TB control in the region.

And let me add that this achievement would not have been possible without your collaboration.

Surveillance relies on the efforts of Member States, and your continued commitment and enthusiasm will certainly allow optimizing the system and its use.

An area where ECDC is also channelling efforts is in the development of an EU TB Laboratory Network.

Laboratory services remain the cornerstone to maintain an effective TB programme. Timely and quality diagnoses as well as treatment guidance are dependent on the performance of laboratories.

An EU TB Reference Laboratory Network will be launched before the end of the year.

The Network will set the basis for a fruitful collaboration among TB laboratories with the aim of reaching EU wide excellence in TB care and control.

Evidence assessment and review of new tools and specific interventions such as BCG and screening have been carried out or are ongoing.

In addition you might be aware that the Commission has requested ECDC to draft a follow-up to the Action Plan to define a monitoring and implementation framework.

We are actively working on this and you will hear more in the course of the conference.

Conclusion

To conclude let me remark once more on the need to take full advantage of the unprecedented opportunity that we are witnessing today in the EU and region wide.

With the Berlin Declaration we have endorsed a commitment that needs to be translated into action.

We are all aware of the interventions that TB control requires to progress towards elimination.

But we are also aware that these require tremendous efforts and tenacity.

The EU can and should achieve excellence in the provision of TB services reaching out to the most vulnerable and supporting the global fight against the disease.

We have the duty of providing the leadership and the guidance to demonstrate that TB can be eliminated not only in the EU context but also regionally and globally.

I hope you will find inspiration and guidance from the talks and interactions of the coming two days.

Thank you very much