Russia needs to take decisive measures if it is to stem an epidemic of tuberculosis sweeping the country, according to a World Health Organization (WHO) report that ranked Russia 11th among the worst 22 TB-crisis countries. The WHO "Global Tuberculosis Control Report 2000" said that in 1999, Russia saw an additional 124,000 people contract TB, with 29,000 dying of the disease — a figure 2.5 times above that for 1990.

Last week, in an effort to try to find the necessary financing, the WHO and Russian government convened a donors meeting in Moscow.

"We have no time to waste. The international community, both the public and private sectors, must provide any support possible," said Arata Kochi, director of the WHO's Stop TB Initiative.

Russian specialists are also stressing both the urgency and magnitude of the problem. "Every day, 80 people are dying of tuberculosis in Russia now. We are concerned about the growth of the TB mortality rate," said Vladislav Yerokhin, director of the Russian Medical Science Academy's Central Tuberculosis Research Institute.

Organizations such as the U.S. Agency for International Development (USAID), the Soros Open Society Institute and the U.K. Department for International Development have already given money to help fight TB in Russia.

However, currently such donations are only enough to finance TB control programs in 13 oblasts.

The Finnish government has donated money to fight TB in the Karelia Republic and the city of Murmansk, capital of Murmansk Oblast, both adjacent to Finland. The Norwegian government has sponsored a TB program in the Arkhangelsk oblast, while the German government sponsored a TB program in Altai Republic and Novosibirsk.

According to specialists, one of the major concerns highlighted in the report is the increase in drug-resistant forms of TB in Russia. These are developing as a result of non-standardized treatment or no treatment at all.

The WHO survey revealed that 8.9 percent of new cases in the Ivanovo oblast and 16.7 percent of new cases in Siberian prisons (in the Kemerovo oblast) were drug-resistant. While the treatment course for regular active TB form costs up to $40 a patient, treatment for drug-resistant strains can cost up to $5,200.

Traditionally, Russian prisons are seen as the "hotbed of infection" for the disease. Of the 375,000 active TB cases in Russia, about 96,000 are prisoners. However, participants in the Moscow meeting stressed that prisons were not the sole source of the problem – the whole country's economic situation is to blame.

"The penitentiary system is not a closed system and without common action there will be no change," said Anatoly Vialkov, first deputy health minister.

Alexander Kononets, Ministry of Justice medical department chief and deputy chief of correctional facilities said that rather than most prisoners contracting the disease in jail, a significant number of active TB cases came from those entering the penitentiary system.

"There are about 50,000 active TB cases that enter the system yearly and 78 percent of those were not aware that they were sick," Kononets said, adding that that the correctional system was already massively overcrowded. "The prisons were built with a capacity of 700,000 inmates; there are 1 million prisoners now."

The organizers said they were pleased with the results of the meeting, saying that potential donors had discussed grants amounting to $3 million. No details were provided, however.

It is known, though, that the World Bank has elaborated a TB control project, which envisions the provision of $100 million in funding.

The Russian government, which last year allocated $40 million for TB control programs, has asked the WHO to also supervise World Bank money to help implement its TB control strategy in the country.