China: MSF Halts Efforts in Opening MDR-TB Program in Inner-Mongolia

After attempting for almost two years to reach an agreement with China’s tuberculosis (TB) control program, Doctors Without Borders/Médecins Sans Frontières (MSF) has given up on its efforts to start a project in Inner-Mongolia for assisting people suffering from multi-drug resistant tuberculosis (MDR-TB). Though MSF was originally asked by the TB control program to set up such a project in Chifeng prefecture, to date no agreement has been reached. MSF finds it no longer justified to allocate resources to the opening of a project that seems unlikely to go ahead.

“The negotiations have been extremely frustrating,” says MSF’s operational coordinator in Brussels, Luc van Leemput, who earlier was MSF’s head of mission in China. “We know that administrative processes take time in China, but after almost two years of moving back and forth without a concrete outcome, we have to accept that we are blocked from bringing much-needed life-saving medical aid to MDR-TB patients in Inner-Mongolia. In a region with high levels of drug-resistant TB, this is very bad news for the people who continue to go untreated.”

Sticking points in the discussions about a memorandum of understanding included questions of control over MSF’s budget and financial means, the freedom to use drugs that have proven effective in MSF projects elsewhere, and testing of patients’ sputum, or lung fluid, in labs. Twice, MSF and Chinese health officials reached verbal agreement on all points, yet no memorandum of understanding has been agreed upon and signed.

MSF started negotiations with the Chinese authorities in April 2007 and has since been engaged in high-level discussions on national, provincial, and prefecture level. “We have exhausted our possibilities,” says Van Leemput. “We have submitted, amended, resubmitted proposals. We have sent over specialists and decision-makers from our organization’s highest level to Beijing and Chifeng; at best they have had inconclusive meetings, at worst they did not get to see anyone at all. Meanwhile, patients continue to go untreated.”

MDR-TB is a strain of tuberculosis that no longer responds to conventional medication. Treatment of MDR-TB is much more complex than treating drug-resistant tuberculosis; it takes longer, has much stronger side-effects for the patient and is very expensive. The spread of MDR-TB is seen by public health experts as one of the most serious epidemiological challenges of our time.

With an estimated 140,000 MDR-TB cases, China ranks first in the occurrence of the infection, ahead of India, which has 87,000 cases, and the Russian Federation, with 34,000. The WHO calculated that 39 percent of all cases worldwide are found in China. In Inner-Mongolia, 6.5 percent of people who test positive for TB but have not previously received treatment are diagnosed with drug-resistant TB; among those who received prior treatment, the prevalence is as high as 36 percent.

MSF has extensive experience in treating MDR-TB in many other countries, including South Africa, Kenya, and India. In China, MSF continues its HIV/AIDS program in Nanning in Guangxi Autonomous Region and its mental health program in Sichuan Province.