VZCZCXRO4568
RR RUEHFL RUEHNP
DE RUEHRO #0263/01 0641238
ZNR UUUUU ZZH
R 041238Z MAR 08
FM AMEMBASSY ROME
TO RUEHC/SECSTATE WASHDC 9923
INFO RUEHMIL/AMCONSUL MILAN 9278
RUEHFL/AMCONSUL FLORENCE 2937
RUEHNP/AMCONSUL NAPLES 3089

UNCLAS SECTION 01 OF 02 ROME 000263 
 
SIPDIS 
 
SIPDIS 
 
DEPT FOR EUR/PGI Q DAVID TESSLER 
OES/IHB - ANDREA LAURITZEN 
STATE PLEASE PASS TO HHS FOR J. COURY 
 
E.O. 12958:  N/A 
TAGS: TBIO WHO EAID SOCI AF IT
SUBJECT:  ITALIAN ACTIONS TO FIGHT TUBERCULOSIS 
 
REFTEL:  A) STATE 6989, B) 07 Rome 2436 
 
¶1.  Summary.  A GOI action plan pre-dating the Berlin 
Declaration on Tuberculosis (TB) is advancing the 
implementation of most of ItalyQs commitments under 
paragraph five of the Declaration.  Italy also has 
significantly increased its contributions to the Global 
Fund to Fight AIDS, Tuberculosis and Malaria and to the 
World Health Organization (WHO) in recent months.  In 
addition, Italy will be making a separate 1.5 million Euro 
contribution to the WHO-directed anti-TB efforts in 
Afghanistan.  Domestically, Italy has a fairly significant 
problem of TB incidence among legal and illegal immigrant 
populations.  The GOI action plan is supposed to better 
measure the incidence of TB among immigrant groups and 
improve TB-related health care services. End summary. 
 
¶2.  On January 28, Post queried the Health MinistryQs 
International Affairs Office and the Italian National 
Institute of Health re: ref a) request for information. On 
February 7, Dr. Maria Grazia Pompa, responsible for 
Infectious Disease Surveillance in the MOH Center for 
Disease Control, provided Post the Italian action plan to 
combat tuberculosis, called QStop TB in Italy,Q and issued 
in 2006.  The action plan essentially paraphrases the World 
Health OrganizationQs (WHOQs) QStop TBQ plan.  As such, it 
addresses almost all of the commitments mentioned in 
paragraph five of the Berlin Declaration on Tuberculosis, 
both at the national and the international level. 
 
¶3.  According to the planQs introduction, a 2001 Italian 
survey revealed great differences between ItalyQs northern 
and southern regions regarding TB monitoring, treatment and 
follow-up capabilities.  Moreover, it continues, although 
TB incidence in the native Italian population is very low 
(7 cases per 100,000 inhabitants in 2004), the trend has 
not been decreasing in the last 10 years as has happened in 
the U.S. where Q according to the introduction Q action 
plans have been implemented effectively.  For these 
reasons, the plan explains, the GOI decided to implement a 
TB action plan aimed at developing effective guidelines and 
increasing the quality and quantity of TB assistance in 
Italy. 
¶4.  The 17-page plan mentions all of the commitments 
included in paragraph 5 of the Berlin Declaration, except 
for the issues of Qinvolving civil societyQ and Qempowering 
people with TB and their communities, and removing stigma. 
(Since the plan is at the policy level, the different 
therapeutic options, such as the preference for short- 
course rather than normal therapy, also are not mentioned.) 
The plan underscores the GOIQs intention to strengthen 
public health and social services systems in order to 
enhance TB surveillance and monitoring, in both quality and 
quantity; to increase collaboration between TB and HIV 
programs; and to promote research and development of new 
diagnostics, drugs and vaccines, as well as program-based 
operational research.  Moreover, the issues of monitoring 
and surveillance of high-risk populations, as well as 
addressing multi-drug-resistant TB, and HIV-related TB, are 
particularly stressed in the action plan. 
¶5.  In order to implement the action plan, in 2006 the MOH 
funded two national projects dedicated to TB 
epidemiological surveillance and TB drug resistance, 
allocating 130,000 and 100,000 euros to them respectively. 
Both projects aim at better standardization of TB 
monitoring and reporting across Italy.  They also support a 
study called SMIRA (Multicentric Study of Italian Drug- 
Resistant Tuberculosis), begun in 1995.  One of the long- 
term objectives is the creation of a national TB database, 
which would contribute to the European surveillance system. 
¶6.  The TB action plan states that in order to improve 
assistance, all TB-related health-care services will be 
provided for free to all patients, including immigrants. 
According to the plan, TB incidence has more than doubled 
in young immigrants (those 25-34 years old) since 1999, 
reaching 70 cases per 100,000 immigrants in 2004.  That 
represents roughly 40 percent of ItalyQs total TB cases, 
and is ten times greater than the rate of TB incidence 
among the Italian population.  Note:  The real rate of 
incidence is difficult to establish, since it could be 
overestimated (the overall immigrant population is likely 
larger than that described in official figures, which donQt 
include illegal immigrants) or underestimated, due to 
incomplete TB survey data.  However, it is worthy of note 
that according to 2004 WHO data, TB incidence in the 
countries providing the largest numbers of immigrants to 
Italy is: 110 per 100,000 in Morocco, 146 per 100,000 in 
 
ROME 00000263  002 OF 002 
 
 
Romania, and 101 per 100,000 in China.  TB incidence in 
countries sending fewer immigrants to Italy ranges from 293 
per 100,000 in the Philippines to 22 per 100,000 in Albania 
and Tunisia.  End note. 
¶7.  The plan calls for specific measures to monitor TB 
among high-risk immigrant populations, and to increase 
awareness among high-risk populations through outreach and 
educational materials.  Apart from taking into 
consideration TB prevalence in the country of origin, the 
plan notes that TB screening should be performed over the 
first two years after immigrants arrive, since almost half 
of the immigrants who develop TB do so after they arrive in 
Italy, due primarily to over-crowding and poor living 
conditions.   GOI outreach to high-risk populations occurs 
more through government channels, e.g., at out-patient care 
centers and through the newly-created National Immigration 
Medicine Institute, than through civil society 
organizations. 
¶8.  According to a 2006 MOH report on QTB and Immigration: 
Control Strategies,Q while some regional health authorities 
(e.g. Siracusa in Sicily and Treviso near Venice) rely on 
TB testing only of immigrants who visit public health 
facilities, others (Bari and Lecce in Puglia, and Brescia, 
Genoa, Milan, Reggio Emilia, and Turin in northern Italy) 
conduct active outreach efforts.  These efforts include 
screening tests of immigrants recruited from worker 
dormitories, schools, assistance centers for newly-arrived 
immigrants, communities with large immigrant populations, 
prisons, and government offices where immigrants obtain 
work permits.  Health authorities have studied 
characteristics of different immigrant groups (Chinese, 
African, Eastern European) to better target outreach 
efforts.  One key need they identified is for more cultural 
mediators/interpreters: in 2006 only four of eleven centers 
studied had one or more of such employees.  The out-patient 
care center in Reggio Emilia is the only one exclusively 
dedicated to monitoring TB in immigrant populations.  The 
only non-governmental association mentioned in the report 
is the NAGA immigrant health and advocacy group in Milan, 
which currently provides health-care services to 100,000 
immigrants Qwithout residence permitsQ per year. 
¶9.  On the international level, on December 20, 2007 Italy 
became the first donor to pay its 2008 pledge to the Global 
Fund to Fight AIDS, Tuberculosis and Malaria.  ItalyQs 130- 
million-Euro contribution to the Global Fund was made 
possible in part by the so-called Qtesoretto,Q extra 
government revenue resulting from more effective tax 
enforcement, additional taxes, and economic growth.  Per 
ref b), Italy also is contributing 16 million Euros to the 
World Health Organization (WHO) in 2008, a significant 
increase over ItalyQs 2007 donation of 9 million Euros and 
over the 4 million Euros allocated in 2006.  Like the 
Global Fund contribution, the 2008 WHO funding benefited 
from the tesoretto.  In addition, Ministry of Foreign 
Affairs Afghan Assistance Expert Walter Zucconi told 
Econoff on February 27 that Italy will be making a separate 
contribution to the WHO of 1.5 million Euros earmarked for 
the fight against TB in Afghanistan.  This money will be in 
addition to the Global Fund contribution.  However, given 
the current economic slowdown, the Finance Ministry has 
already warned that anticipated revenues for the 2008 
tesoretto will come in under projection.  It is unclear at 
this time whether this shortfall will impact funding in 
2008 or in out years. 
SPOGLI