The taxpaying lumpen proletariat, fuelled by the intellectuals of Murdoch's press (Sun, Times) are now alerted to the consequences of extending the excesses of Europe, to the newly free, but still impoverished Eastern Europeans. Not only will this alien wedge steal your jobs as well as your washing, seduce your daughters, slaughter your children driving cars that are untaxed, uninsured and unsafe. Now the drawing rooms of middle England are alive to the prospect that the low paid peasantry will also bring, death, disease and decay.

Third world workers, Third world wages, that's fine, but we don't want your Third world diseases.

Consumption is good. Consumption is bad

Euroland is full of consumer junkies. Retail therapy works, not only for the air head, Jimmy Choo shod, surgically assisted la Perla chested, Harvey Nick chick flashing the plastic. It works for the City. Every time the hemline shoots up, the Sloane slick chick boots up, the GNP ticks up. I make, you consume the coal, the gas, the oil goes down. But, hey the Dow is up!

That's why they used to call Tuberculosis, consumption. It doesn't only consume the body's resources it wastes them, until there are none left.

Tuberculosis, curable but making a comeback.

Tuberculosis (TB) is caused by an infection, Mycobacterium tuberculosis a spore like bacteria that can lie dormant for years. It commonly affects the lung and lymph systems but can affect any part of the body. It was a disease of 19th Century cities, the worst being New York and London.

The World Health Organisation claim that one third of the world's population (2 billion) are infected and that annually 10 million will develop the active disease, and 3 million will die. General ill health, and poor nutrition will precipitate the condition and especially where the immune system is challenged through, alcohol, drug abuse, and most recently with Human Immunodeficiency Virus (HIV).

Global Health Emergency declared

In 1993 the prevalence of TB appearing as an opportunistic disease in HIV infected people throughout the world, prompted WHO to declare a Global Health Emergency. Largely, in the developed and broadly TB free world, this was ignored. Since the late 1940's TB is curable with a low cost, six month, multiple antibiotic drug treatment, which WHO says costs US$11 for a full course of treatment.

In the UK some 7000 cases appear a year, over half occurring in people born outside the UK, although only 206 cases in 1998 were recent immigrants. Recently there was outbreak of over 20 infected people in a school in Leicestershire, most of them connected with family connections with the Indian sub-continent.

In Denmark, Norway and Sweden in 1996 of 1,194 reported cases, 683 involved non-nationals.

Multiple Drug Resistance TB

TB is routinely treated with daily doses of a range of proven and effective low cost drugs. Treatment is lengthy and demands regular daily intake. Unsupervised patients can discontinue treatment or restrict the number of drugs used which has led to the recent and rapid development of drug resistant strains and more worrying, so called multiple drug resistant strains (MDR TB). This is not only a 3rd World problem, where WHO's program of "daily observed treatment" (DOT) of supervised drug delivery has helped. It is also a problem in New York and California where the Federal Centre for Disease Control (CDC) report 7.7% of new cases in 2002 were resistant to isoniazid, the first line drug of choice. WHO estimates that 50 million people worldwide are infected with MDR TB.

MDR TB is now increasingly recognised as a hospital acquired infection, and outbreaks have occurred in Florida, New York and there have been two widely reported outbreaks in London hospitals.

Dr Arata Kochi, Director of Global TB Programmes for WHO, said in 2002, "When you become sick with MDB TB, you have an illness often impossible to cure and costing one hundred times more to treat than ordinary TB".

Eastern Europe's HIV/AIDS epidemic

The first HIV/AIDS cases in Eastern Europe were recorded in 1995, and the region is experiencing the fastest growing epidemic in the world.

On December 20th 2002, the World Bank announced a US$60 million program for the Ukraine, which Jean De St Antoine, World Bank task manager for the project said, "…the epidemic is restricted to the high risk groups of injecting drug users and sex workers, so there is a window of opportunity to prevent the spread." He added, ominously, "This window, however, is closing."

WHO figures at the time, showed 1% of the Ukraine population, approximately 240,000 people were tested positive for HIV/ AIDS, mainly in Odessa and Kiev. Throughout the region WHO estimated the number of people "living with AIDS" at 1 million, with especial problems in prison populations. TB has also re-emerged, made worse by the resulting poverty of the breakup of the Soviet Union and deteriorating health care.

Almost a year later on September 16th 2003 the World Bank (Averting AIDS Crises in Eastern Europe and Central Asia) reported 1.2mn people living with HIV/AIDS in the region mainly affecting young drug users.

Simultaneously WHO are reporting 25% increases in TB cases in Eastern Europe, with an increasing number infected with MDR TB. The Regional Director for WHO in Copenhagen said, "Even Africa has not experienced the alarming number MDR TB cases we are seeing in Eastern Europe."

But even there, the problems are worsening, as SA health Minister Manto Tshabalala-Msimang said on Februrary 9th during a Parliamentary Media Briefing Week in Cape Town, "The number of TB cases is rising, with up to 50% of HIV/AIDS sufferers infected, often with MDR TB."

The costs of doing nothing

The World Bank points out the risks of an uncontrolled epidemic of HIV/AIDS and TB in Eastern Europe. Spreading through the working age groups, it will affect economic growth, compounded by rising health expenditure, and will increase the dependency ration (ratio of economically active to non active people)which will place strains on social systems and healthcare services.

Evidently the emigration of the young, fit, healthy, educated and economically active from the region to the prosperous West will exacerbate the problems. Especially if, as seems likely, this includes medical and health workers.

Health screening of migrants

No official announcements have been made, but there is enormous pressure to introduce health screening of migrants from the new EU states. However there has been a Public Health Medicine Environmental Group (PHMEG) which assists in developing Government policy on health assessments of new entrants to the UK.

This work has been underway for over 7 years and established and written procedures at the port of entry and upon registration with doctors are continuously revised. The emphasis is on TB and "unusual infections", Ebola, Lassa fever etc., In March 2001 they "urged the Government to introduce pre-entry assessment for expected new entrants", which they also said, "could be done before starting the journey to the UK".

Immigrants seeking permanent residence in Canada and Australia are screened for HIV.

A recent correspondent (5th Feb 2004. BMJ Vol. 328 pp298-300) to the British Medical Journal, Richard Coker of the London School of Hygiene and Tropical Medicine, emphasises that early detection of TB provides few health benefits. Also he points out that, "…any compulsory controls may result in delaying treatment and the incentive to avoid legal routes of entry, which poses even greater health threats if a positive HIV status (as has been proposed) excludes entry."

It is to be hoped that his medical colleagues support his view that, "The UK has an enviable reputation in international public health, which would be tarnished through an ill considered conflation of immigration and communicable disease control."

Nick Partridge, CEO, Terrence Higgins Trust said the Trust opposed any plans to screen immigrants for HIV. "This isn't an immigration issue, it's about the global effects of HIV on the UK epidemic", he said to the BBC.

Big problem. Small profits

Global pharma companies specialise in the illnesses of the rich. The treatment of the emerging Indian middle class and their diabetes, provides life time sources of income. For an industry which hasn't produced a new antibiotic drug in 12 years, or identified new methods of chemical pathways to attack communicable disease, generating new treatments for TB when six months dosage costs only US$11…TB doesn't even appear on the radar.

Much better to deal with the developed world and the depressives who can't get it on, or the sexual dysfunction of those who cannot get it up.

Big ideas, Big bucks and an unlikely pair of heroes

As another virus exploits your Windows based PC, or some clown sends an e-mail utilising Microsoft's Outlook(tm) with that carefully built in bug, an "attachment", just remember that some of your hard earned goes into Bill's pocket.

Well, up to a point Lord Copper.

Bill Gates and his fragrant wife Melinda fund a Charitable Foundation which announced at the recent American Association for the Advancement of Science in Bill's hometown of Seattle, a grant of US$82.9 Million to support development of new TB vaccines. The largest grant ever for TB research, this will DOUBLE the annual amount spent on TB vaccine research worldwide and forms part of US$217 total grants for TB research and control that the Foundation have made.

Recipients, Bethesda MA based, Aeras (Greek for courage) Global TV Vaccine Foundation, led by Dr. Jerald Sadoff (ex-Merck) will, with associates in the US, Europe (EU Developing Countries Clinical Trials Partnership) and South Africa (Biovac Inst. Cape Town), concentrate on 3 areas, to license and deliver a new vaccine within 10 years.

Vaccine Trials : 2 new vaccines are currently being tested, one (labelled rBCG30) a genetically engineered replacement of the currently used Bacillus Calmette-Guerin (BCG) vaccine developed by Marcus Horwitz at University of California. A second is a fusion protein that is designed by Stefan Kaufman of the Max Planck Institute in Berlin to boost the body's immune response.

Improved animal models : To help augment research on animal trials on the next generation of TB vaccines to identify the most promising for human trials.

Next generation vaccines : Research continues on finding new candidate vaccines which may result eventually in human trials.

WHO estimate a shortfall of US$3.8 billion in TB research in the period 2001 – 2005. It is hoped say the Gates Foundation that this grant will encourage other donors in the US and globally.

If you seek his monument, look around

It is one of the great benefits of the American business world and their curious reluctance to tax the rich that the immensely rich can personally use that wealth for the public good. As Cicero said of Ribirius Posthumus, a Roman and unpopular arriviste, it may also be said of Bill (…and he's made more money out of bugs than the whole of the global pharma industry), "In his pursuit of wealth it was plain that he sought, not food for avarice, but an instrument for doing good".

More information

www.worldbank.org
www.gatesfoundation.org
www.aereas.org