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. Last Updated: 07/27/2016

Health Ministry Says TB Criticism Unfair




Russian health officials on Monday defended the country's record in fighting the spread of tuberculosis and said there were no plans to drastically change the method of treatment, despite criticism from the World Health Organization.


WHO released a report last week naming Russia as one of 16 countries stalling global control of the airborne disease.


"Some countries did not take WHO's declaration of a global TB emergency seriously," Dr. Arata Kochi, the director of WHO's global tuberculosis program, said in a statement.


Russia is ranked ninth among the countries most affected by tuberculosis. Vietnam, Tanzania and Pakistan are listed as having better success in containing the epidemic.


Gennady Anishchenko, Russia's first deputy health minister, said such a ranking makes no sense, as many countries have no system for tracking the number of TB cases.


But he agreed that the TB situation in Russia is grave. "TB is a social problem. If it were just a medical problem we would've solved it long ago," he said.


A drastic increase in the number of infected was noticed here in 1993. By 1996, the number of newly registered cases had almost doubled compared to 1991 and reached 99,000 a year. In prisons, the level of infection is 50 times higher than in the general population.


Currently, Anishchenko said, more then 2 million Russians have tuberculosis. But he insists the rate of infection is slowing.


WHO, though, has warned that the problem is not only the number of infected, but the emergence of new drug-resistant strains.


The main problem in Russia, said Dr. Malgosia Grzemska, WHO's leading specialist on the country, is the use of old methods of diagnosis and treatment.


The international organization promotes its own strategy, commonly referred to as DOTS, which it says is both cheap and effective. The main component is quick tests of coughed-up mucus to screen out the infected.


Russian health officials are not convinced. "They say it is a very primitive method that could be used in Africa, and Russia is not Africa," Grzemska said in a telephone interview from WHO headquarters in Geneva.


In Russia, she said, "a lot of money is spent on diagnosis, but then, at the end of a day, there is no money left for the drugs."


But Anishchenko said Russian methods are more precise.


"They might cost more, but in the past we didn't count money spent on health care," the deputy health minister said. Russian programs rely heavily on X-rays and lengthy culture tests. The infected are then often hospitalized for up to two years. But Grzemska said the long hospital stays scare patients away. "They don't go to a doctor," she said. "Or they come very late."


Russia has had some success using WHO's DOTS program in three regions. On Sunday, WHO started training physicians in the region around St. Petersburg. The WHO report accused Russia of having insufficient "political commitment" to handle the tuberculosis outbreak, which has been made worse by the country's social and economic problems.


In February, Russia announced a 17 billion ruble ($2.8 billion) initiative to fight the TB epidemic through 2005. But the government has not yet specified what methods would be used, and Anishchenko said the health ministry supports the traditional Soviet techniques.


The core of the new program will be the construction of new facilities and the development of new drugs in pill form, he said. Most Russian tuberculosis drugs are now given by injection.


Last month, the Russian government sacked its top TB official, Alexei Priymak, who opposed WHO's methods. Western TB experts viewed the firing as a signal of Russia's strengthened commitment. No replacement for the top TB official has been named, though.


Many donors, including the Soros Foundation and World Bank, have signaled their willingness to assist Russia in the battle against tuberculosis. But they insist Russia first accept WHO's methods, the WHO report said.


The deputy Russian health minister showed little sign of being swayed. "I don't want to offend my colleagues, but they seem to overestimate the importance of methodology in fighting tuberculosis," Anishchenko said. "It doesn't meant that we refuse any help, though."