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India and the United States: Partners for a Healthy World
Today, at Mahavir Hospital in Hyderabad, President Clinton will join with local doctors, public health and government officials, foundation and NGO representatives and the people of Hyderabad to highlight the successes and future challenges for ensuring a healthy India and a healthy world. He will focus on three areas of joint India-U.S. efforts: eradication of polio, control of tuberculosis, and preventing the spread of HIV/AIDS. He will also highlight his Millennium Vaccine Initiative, which will encourage research and development of vaccines for the major killers: TB, malaria and HIV/AIDS.
In 1987, India reported over 28,000 cases of polio. The eradication program in India has since reduced the number of cases to just over 1000 in 1999, and total eradication now is in sight. Using successive rounds of "Pulse Polio Immunization Days" in which every child under 5 years old is immunized, the country is rapidly becoming polio-free. In January 2000, in the largest single public health effort in history, more than 149 million children were immunized within 3 days. Tomorrow, two more immunization rounds will be started in the 8 highest risk states in the North.
As part of this effort, The United States, along with WHO, Rotary International, UNICEF, the Bill and Melinda Gates Foundation and the UN Foundation, and many others have assisted in polio eradication activities in India and around the world.
This year, the U.S. Government, through the Center for Disease Control and Prevention (CDC) and the Agency for International Development (USAID), has contributed $120 million to the international campaign, including $15 million and substantial technical assistance and personnel to assist India in its efforts.
March 24 is "World TB Day," which commemorates the date in 1882 when Robert Koch announced the discovery of the bacteria that causes tuberculosis. Today, 118 years later, TB kills more than ever before. One third of the world's population is infected, although many are without symptoms. Each year TB kills over 400,000 Indians and costs the economy $3 billion. But India is beginning to succeed in stopping this disease -- it will soon have started more than 250,000 people on treatment, and the program has already saved more than 40,000 lives. By the end of this year, India's National Tuberculosis Control Program could cover a quarter of India and a population the size of the entire United States.
India pioneered the outpatient treatment of tuberculosis; a strategy now used throughout the world and helped lead to the control of TB in the United States. The treatment regimen, "DOTS," or "directly observed treatment, short course," combines accurate diagnosis, direct observation of treatment over a 6-8 month period, and systematic monitoring of patients in homes and outpatient clinic settings.
The U.S. has been a part of India's renewed efforts to conquer a disease that still afflicts 2 million per year in India. CDC and USAID have been long involved with TB activities, supporting a Model DOTS Project in collaboration with WHO and the Tuberculosis Research Centre in Tamil Nadu. USAID has just committed an addition $1 million annually for TB research in Chennai.
The National Institutes of Health (NIH) globally funds over $80 million in TB research for development of new vaccines, drugs, and diagnostics that will be of great use in India and other countries highly affected by TB.
Because of its size, India has more HIV-infected people than any country in the world -- over 3.5 million. However, this is still less that 1 percent of the population of the country. Some have predicted that, if uncontrolled, within the next 10-20 years the number of HIV/AIDS cases in India could surpass the total in all the countries in Africa combined.
But the Indian government, led by Prime Minister Vajpayee, has taken an aggressive and outspoken leadership role raising awareness of a disease that knows no political or geographic borders. Aggressive efforts at implementing prevention programs and widespread public awareness can prevent 3.5 million cases from becoming 35 million over the next decade.
In 1992, the GOI formed the National AIDS Control Organization to combat the onslaught of the epidemic more effectively. The U.S., led by USAID, has focused on high-risk groups in India and on the states with the highest number of reported cases.
Today, India and the United States will release a "Joint Leadership Statement on HIV/AIDS," pledging that our two countries will work to stop the global spread of HIV/AIDS through joint efforts at research, prevention, changing behavior, and patient care. Most importantly, the highest levels of government pledge to work with the private sector to take bold leadership steps to raise awareness and avoid stigmatization of those affected.
Last year, as one of India's largest donors, USAID committed $41.5 million to the HIV/AIDS program in Maharashtra, and is continuing its $10 million, 10-year commitment to prevention and control programs in Tamil Nadu. In addition, through President Clinton's new "Life" Initiative (Leadership and Investment in Fighting an Epidemic), USAID and CDC will contribute another $4 million this year for primary prevention, improved home and community-based care and treatment, care of children affected by AIDS, and infrastructure development.
In the past 10 years, the NIH, through the Fogarty International Center's AIDS International Training and Research Program, has supported the training and research of 64 Indian scientists and health professionals to establish critical biomedical and behavioral science expertise to combat the disease.
Millennium Vaccine Initiative
Malaria, TB and HIV/AIDS together kill over 5 million people worldwide each year. In his speech to the UN General Assembly last September, President Clinton called for comprehensive efforts to find ways to accelerate the development and delivery of vaccines for malaria, TB and AIDS - vaccines for which there is huge need, but little market incentive for industry to develop. In his State of the Union address this year, he proposed the following actions to address this need:
And in March, the President hosted a White House meeting to advance his vaccine initiative. For diseases disproportionately affecting India and many developing countries, the initiative is intended to help spur research into development of new vaccines - by far the most cost-effective long-term approach to control. As NIH and CDC have a longstanding relationship with Indian researchers, these agencies intend to bolster our joint work with India on developing new vaccines and drugs for these diseases.
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