By Betsy McKay (Wall Street Journal)
Nov. 26, 2013
There are few prizes or awards in the field of tuberculosis treatment, where doctors can spend years trying to cure patients, only to watch many die. Tsetan Sadutshang appeared to be one of the chosen few when he was told in October by the organization that oversees the Kochon Prize, a prestigious honor for major contributions to the fight against TB, that the TB program he leads tentatively had been selected a winner.
Based at a hospital in Dharamsala, India, at the foot of the Himalayas, the Tibetan Tuberculosis Control Program treats Tibetans in exile as well as Indian patients. Despite high rates of TB and drug-resistant TB in the community, the program says 93% of its patients in 2012 were either confirmed cured or were well after their treatment ended.
“We have one of the highest rates of TB in the world,” said Dr. Sadutshang, chief medical officer of the Tibetan Delek Hospital and personal physician to the Dalai Lama. “One of the biggest health problems in the Tibetan community is TB.”
Yet Dr. Sadutshang’s program wasn’t given the award, in a turn of events illustrating a collision of politics and public health.
While the Kochon Prize selection committee of TB experts chose the Tibetan program, according to people close to the selection process, the winner must be approved by the director-general of the World Health Organization, Margaret Chan. A WHO spokesman confirmed this and said the WHO administration, which advises the director-general, didn’t approve the choice because the hospital has ties to the Tibetan government-in-exile. The Central Tibetan Administration, as that entity is known, isn’t recognized by the United Nations. The WHO is the U.N.’s public-health agency.”The WHO is not able to recognize any entity that is not in turn recognized as a legal authority by the UN,” said WHO spokesman Gregory Hartl in response to a question. He said the prize committee’s selection was reviewed by the WHO administration’s legal department.
China also objected to the choice of winner, according to people familiar with the selection process, calling the TB program a political organization because it was linked to the government in exile, an entity China asserts threatens its sovereignty over Tibet. China’s Permanent Mission in Geneva didn’t respond to a request to comment on whether it had raised concerns.
The controversy reflects the diplomatic challenges the WHO faces as it tries to combat TB and other health problems globally. The Kochon prize is funded by the Kochon Foundation, a nonprofit organization in South Korea, and winners are selected by the Stop TB Partnership, an international body that is housed at the WHO and subject to its rules. The Stop TB Partnership declined comment. The Kochon Foundation didn’t respond to an email requesting comment. The status of the selection of this year’s winner is now unclear, the people close to the process said.
The Dalai Lama is a patron of the Tibetan Delek Hospital, which people associated with it say means that he endorses and supports it but doesn’t monitor its activities. Three Central Tibetan Administration officials serve on its board of directors, including the minister of health as board chair. But the TB program is registered as a charitable organization in India and its administration is “completely autonomous,” Dr. Sadutshang said. He said the program doesn’t take money from the CTA, funding its budget of about $200,000 a year instead from small grants from nongovernmental programs and individual donors. It gets some TB drugs from India’s TB program.
“We have a relationship with the Central Tibetan Administration, but for all practical purposes we are independent,” said Dr. Sadutshang, who had planned to travel to Paris to receive the award.
The $65,000 prize, which would have been shared with another winner, would have helped the Tibetan TB program fund treatment for patients and possibly apply for grants from larger funding agencies, said Kunchok Dorjee, who directed the program through September and now advises it while in graduate school. “It would have really helped us run our program and save a number of lives,” he said.
“It’s a violation of the mission of the prize to deny an award to a program that is saving the lives of a huge number of poor people,” said Mark Harrington, executive director of the Treatment Action Group, an AIDS research and policy think tank that also focused on TB issues.
Tibetans were once relatively shielded from TB, but now tens of thousands live in exile in India, Nepal and elsewhere, and the germ transmits easily in their communities. Drug-resistant TB is increasingly common, fed in part by a migrant population that is hard to treat.
The incidence of TB among Tibetans in India was 461 per 100,000 in 2010, according to Dr. Sadutshang’s program. That compares to the incidence among all Indians, which WHO put at around 176 per 100,000 in 2012.
The program currently has about 300 people under treatment, Dr. Dorjee said. It gets about 200 new cases a year, about 14% of whom have drug-resistant forms of the disease, including some that require lengthy doses of expensive medications, he said.
Print
Email