Keep Us Strong WikiLeaks logo

Currently released so far... 97115 / 251,287

Articles

Browse latest releases

Browse by creation date

Browse by origin

A B C D F G H I J K L M N O P Q R S T U V W Y Z

Browse by tag

A B C D E F G H I J K L M N O P Q R S T U V W X Y Z
ETRD EAGR ETTC EAID ECON EFIN ECIN EINV ELAB EAIR ENRG EPET EWWT ECPS EIND EMIN ELTN EC ETMIN EUC EZ ET ELECTIONS ENVR EU EUN EG EINT ER ECONOMICS ES EMS ENIV EEB EN ECE ECOSOC EK ENVIRONMENT EFIS EI EWT ENGRD ECPSN EXIM EIAD ERIN ECPC EDEV ENGY ECTRD EPA ESTH ECCT EINVECON ENGR ERTD EUR EAP EWWC ELTD EL EXIMOPIC EXTERNAL ETRDEC ESCAP ECO EGAD ELNT ECONOMIC ENV ETRN EIAR EUMEM ENRGPARMOTRASENVKGHGPGOVECONTSPLEAID EREL ECOM ECONETRDEAGRJA ETCC ETRG ECONOMY EMED ETR ENERG EITC EFINOECD EURM EENG ERA EXPORT ENRD ECONEINVETRDEFINELABETRDKTDBPGOVOPIC EGEN EBRD EVIN ETRAD ECOWAS EFTA ECONETRDBESPAR EGOVSY EPIN EID ECONENRG EDRC ESENV ETT EB ENER ELTNSNAR ECHEVARRIA ETRC EPIT EDUC ESA EFI ENRGY ESCI EE EAIDXMXAXBXFFR EETC ECIP EIAID EIVN EBEXP ESTN EING EGOV ETRA EPETEIND ELAN ETRDGK EAIDRW ETRDEINVECINPGOVCS EPEC ENVI ELN EAG EPCS EPRT EPTED ETRB EUM EAIDS EFIC EFINECONEAIDUNGAGM EAIDAR ESF EIDN ELAM EDU EV EAIDAF ECN EDA EXBS EINTECPS ENRGTRGYETRDBEXPBTIOSZ EPREL EAC EINVEFIN ETA EAGER EINDIR ECA ECLAC ELAP EITI EUCOM ECONEFINETRDPGOVEAGRPTERKTFNKCRMEAID EARG ELDIN EINVKSCA ENNP EFINECONCS EFINTS ECCP ETC EAIRASECCASCID EINN ETRP EAIDNI EFQ ECOQKPKO EGPHUM EBUD ECONEINVEFINPGOVIZ ENERGY ELB EINDETRD EMI ECONEFIN EIB EURN ETRDEINVTINTCS EIN EFIM ETIO ELAINE EMN EATO EWTR EIPR EINVETC ETTD ETDR EIQ ECONCS EPPD ENRGIZ EISL ESPINOSA ELEC EAIG ESLCO EUREM ENTG ERD EINVECONSENVCSJA EEPET EUNCH ECINECONCS ETRO ETRDECONWTOCS ECUN EFND EPECO EAIRECONRP ERGR ETRDPGOV ECPN ENRGMO EPWR EET EAIS EAGRE EDUARDO EAGRRP EAIDPHUMPRELUG EICN ECONQH EVN EGHG ELBR EINF EAIDHO EENV ETEX ERNG ED
KMDR KPAO KPKO KJUS KCRM KGHG KFRD KWMN KDEM KTFN KHIV KGIC KIDE KSCA KNNP KHUM KIPR KSUM KISL KIRF KCOR KRCM KPAL KWBG KN KS KOMC KSEP KFLU KPWR KTIA KSEO KMPI KHLS KICC KSTH KMCA KVPR KPRM KE KU KZ KFLO KSAF KTIP KTEX KBCT KOCI KOLY KOR KAWC KACT KUNR KTDB KSTC KLIG KSKN KNN KCFE KCIP KGHA KHDP KPOW KUNC KDRL KV KPREL KCRS KPOL KRVC KRIM KGIT KWIR KT KIRC KOMO KRFD KUWAIT KG KFIN KSCI KTFIN KFTN KGOV KPRV KSAC KGIV KCRIM KPIR KSOC KBIO KW KGLB KMWN KPO KFSC KSEAO KSTCPL KSI KPRP KREC KFPC KUNH KCSA KMRS KNDP KR KICCPUR KPPAO KCSY KTBT KCIS KNEP KFRDCVISCMGTCASCKOCIASECPHUMSMIGEG KNNB KGCC KINR KPOP KMFO KENV KNAR KVIR KDRG KDMR KFCE KNAO KDEN KGCN KICA KIMMITT KMCC KLFU KMSG KSEC KUM KCUL KMNP KSMT KCOM KOMCSG KSPR KPMI KRAD KIND KCRP KAUST KWAWC KTER KCHG KRDP KPAS KITA KTSC KPAOPREL KWGB KIRP KJUST KMIG KLAB KTFR KSEI KSTT KAPO KSTS KLSO KWNN KPOA KHSA KNPP KPAONZ KBTS KWWW KY KJRE KPAOKMDRKE KCRCM KSCS KWMNCI KESO KWUN KPLS KIIP KEDEM KPAOY KRIF KGICKS KREF KTRD KFRDSOCIRO KTAO KJU KWMNPHUMPRELKPAOZW KEN KO KNEI KEMR KKIV KEAI KWAC KRCIM KWCI KFIU KWIC KCORR KOMS KNNO KPAI KBWG KTTB KTBD KTIALG KILS KFEM KTDM KESS KNUC KPA KOMCCO KCEM KRCS KWBGSY KNPPIS KNNPMNUC KWN KERG KLTN KALM KCCP KSUMPHUM KREL KGH KLIP KTLA KAWK KWMM KVRP KVRC KAID KSLG KDEMK KX KIF KNPR KCFC KFTFN KTFM KPDD KCERS KMOC KDEMAF KMEPI KEMS KDRM KEPREL KBTR KEDU KNP KIRL KNNR KMPT KISLPINR KTPN KA KJUSTH KPIN KDEV KTDD KAKA KFRP KWNM KTSD KINL KJUSKUNR KWWMN KECF KWBC KPRO KVBL KOM KFRDKIRFCVISCMGTKOCIASECPHUMSMIGEG KEDM KFLD KLPM KRGY KNNF KICR KIFR KM KWMNCS KAWS KLAP KPAK KDDG KCGC KID KNSD KMPF KPFO KDP KCMR KRMS KNPT KNNNP KTIAPARM KDTB KNUP KPGOV KNAP KNNC KUK KSRE KREISLER KIVP KQ KTIAEUN KPALAOIS KRM KISLAO KWM KFLOA
PHUM PINR PTER PGOV PREL PREF PL PM PHSA PE PARM PINS PK PUNE PO PALESTINIAN PU PBTS PROP PTBS POL POLI PA PGOVZI POLMIL POLITICAL PARTIES POLM PD POLITICS POLICY PAS PMIL PINT PNAT PV PKO PPOL PERSONS PING PBIO PH PETR PARMS PRES PCON PETERS PRELBR PT PLAB PP PAK PDEM PKPA PSOCI PF PLO PTERM PJUS PSOE PELOSI PROPERTY PGOVPREL PARP PRL PNIR PHUMKPAL PG PREZ PGIC PBOV PAO PKK PROV PHSAK PHUMPREL PROTECTION PGOVBL PSI PRELPK PGOVENRG PUM PRELKPKO PATTY PSOC PRIVATIZATION PRELSP PGOVEAIDUKNOSWGMHUCANLLHFRSPITNZ PMIG PREC PAIGH PROG PSHA PARK PETER POG PHUS PPREL PS PTERPREL PRELPGOV POV PKPO PGOVECON POUS PGOVPRELPHUMPREFSMIGELABEAIDKCRMKWMN PWBG PMAR PREM PAR PNR PRELPGOVEAIDECONEINVBEXPSCULOIIPBTIO PARMIR PGOVGM PHUH PARTM PN PRE PTE PY POLUN PPEL PDOV PGOVSOCI PIRF PGOVPM PBST PRELEVU PGOR PBTSRU PRM PRELKPAOIZ PGVO PERL PGOC PAGR PMIN PHUMR PVIP PPD PGV PRAM PINL PKPAL PTERE PGOF PINO PHAS PODC PRHUM PHUMA PREO PPA PEPFAR PGO PRGOV PAC PRESL PORG PKFK PEPR PRELP PREFA PNG PGOVPHUMKPAO PRELECON PINOCHET PFOR PGOVLO PHUMBA PRELC PREK PHUME PHJM POLINT PGOVPZ PGOVKCRM PGOVE PHALANAGE PARTY PECON PEACE PROCESS PLN PRELSW PAHO PEDRO PRELA PASS PPAO PGPV PNUM PCUL PGGV PSA PGOVSMIGKCRMKWMNPHUMCVISKFRDCA PGIV PRFE POGOV PEL PBT PAMQ PINF PSEPC POSTS PHUMPGOV PVOV PHSAPREL PROLIFERATION PENA PRELTBIOBA PIN PRELL PGOVPTER PHAM PHYTRP PTEL PTERPGOV PHARM PROTESTS PRELAF PKBL PRELKPAO PKNP PARMP PHUML PFOV PERM PUOS PRELGOV PHUMPTER PARAGRAPH PERURENA PBTSEWWT PCI PETROL PINSO PINSCE PQL PEREZ PBS

Browse by classification

Community resources

courage is contagious

Viewing cable 08BEIJING4496, MULTI-DRUG RESISTANT TB IN CHINA: GOVERNMENT INERTIA

If you are new to these pages, please read an introduction on the structure of a cable as well as how to discuss them with others. See also the FAQs

Understanding cables
Every cable message consists of three parts:
  • The top box shows each cables unique reference number, when and by whom it originally was sent, and what its initial classification was.
  • The middle box contains the header information that is associated with the cable. It includes information about the receiver(s) as well as a general subject.
  • The bottom box presents the body of the cable. The opening can contain a more specific subject, references to other cables (browse by origin to find them) or additional comment. This is followed by the main contents of the cable: a summary, a collection of specific topics and a comment section.
To understand the justification used for the classification of each cable, please use this WikiSource article as reference.

Discussing cables
If you find meaningful or important information in a cable, please link directly to its unique reference number. Linking to a specific paragraph in the body of a cable is also possible by copying the appropriate link (to be found at theparagraph symbol). Please mark messages for social networking services like Twitter with the hash tags #cablegate and a hash containing the reference ID e.g. #08BEIJING4496.
Reference ID Created Released Classification Origin
08BEIJING4496 2008-12-11 05:52 2011-08-23 00:00 UNCLASSIFIED//FOR OFFICIAL USE ONLY Embassy Beijing
VZCZCXRO3361
RR RUEHAST RUEHHM RUEHLN RUEHMA RUEHPB RUEHPOD RUEHTM
DE RUEHBJ #4496/01 3460552
ZNR UUUUU ZZH
R 110552Z DEC 08
FM AMEMBASSY BEIJING
TO RUEHC/SECSTATE WASHDC 1316
INFO RUEHCN/AMCONSUL CHENGDU 9563
RUEHGZ/AMCONSUL GUANGZHOU 0047
RUEHHK/AMCONSUL HONG KONG 0746
RUEHGH/AMCONSUL SHANGHAI 9558
RUEHSH/AMCONSUL SHENYANG 9224
RUEHBK/AMEMBASSY BANGKOK 6541
RHMFIUU/DEPT OF HOMELAND SECURITY WASHINGTON DC
RUEAUSA/DEPT OF HHS WASHINGTON DC
RUEHC/DEPT OF INTERIOR WASHDC 0742
RUEHPH/CDC ATLANTA GA
RUEHZN/ENVIRONMENT SCIENCE AND TECHNOLOGY COLLECTIVE
UNCLAS SECTION 01 OF 03 BEIJING 004496 
 
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 00004496  001.2 OF 003 
 
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, 
improved adherence, improvements in the health system, better 
diagnostic tools, and access to second-line anti-TB drugs are 
urgently needed. 
 
BEIJING 00004496  002.2 OF 003 
 
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. 
 
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 
 
BEIJING 00004496  003.2 OF 003 
 
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. 
 
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