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