Embassy of the United States Vilnius, Lithuania

September 4, 2012

Ladies and gentlemen, distinguished guests, dear friends –

I am proud to be here today in Kaunas and participate in such an important event for Lithuania – the opening of the Tuberculosis Information Center.

I want to congratulate Stop TB on the important work it is doing.

You may ask yourselves, “Why does the United States care about tuberculosis in Lithuania?”  Simply put, the bacterium that causes TB does not respect borders.  TB is a global health concern.  In 2010 alone, there were almost 9 million new cases and 1.45 million deaths around the world from TB despite the availability of effective treatment worldwide.  As U.S. Secretary of State Hillary Clinton said, TB “destroys families, undermines economic opportunity, and holds back progress.”  The U.S. is committed to leading the global effort to battle TB as part of President Obama’s Global Health Initiative.

According to the World Health Organization (WHO), TB is a major public health problem in Lithuania.  In addition to the number of existing cases of TB in Lithuania, the spread of multi-drug resistant tuberculosis (MDR-TB) in Lithuania is particularly troubling.  Since 2008, the WHO annual report on Global Tuberculosis Control has listed Lithuania as one of 27 high MDR-TB burden countries in the world.  According to the 2011 WHO report, 11% of all new TB cases in Lithuania are MDR-TB.  An estimated 52% of the cases of MDR-TB occur because of incomplete treatment of TB.

This is a problem which requires an urgent response.

In 2000, the then-Lithuanian government requested U.S. Government assistance in addressing the problem of TB in Lithuania.  The U.S. Government and the U.S. Centers for Disease Control and Prevention (CDC) spent five years and almost half a million dollars assisting the Lithuanian National TB Hospital to prepare a standard anti-tuberculosis drug resistance survey, based on WHO protocols.  We also assisted Lithuania in its application to join the WHO Green Light Committee Initiative.  

At the time, Lithuania was interested in joining the Green Light Committee Initiative, and the U.S. was interested in helping Lithuania to do so, because this important program provides countries with access to quality‐assured drugs to treat MDR‐TB at significantly reduced prices.  MDR-TB is a form of TB that is highly resistant to normal TB drugs, and therefore requires special drugs and a rigorous treatment regime to combat.  In most cases, MDR-TB occurs when a patient with TB does not complete his/her treatment program, and the bacterium becomes highly-resistant to normal treatment measures.  The highest share of MDR-TB cases are in countries of the former Soviet Union.

In almost all high-burden MDR-TB countries, treatment costs for MDR-TB cases are greater than the gross national income per capita.  This means that many patients who cannot afford the necessary medication do not fully complete their treatment regimen, which allows TB bacteria to evolve into more antibiotic-resistant strains.  Use of poor-quality or counterfeit drugs also facilitates the emergence of MDR TB, which can then spread to others.  The Green Light Committee (GLC), and its drug procurement agency, the International Dispensary Association (IDA), are able to provide a consistent supply of affordable and quality-assured drugs to patients.  WHO-recommended programs such as Stop TB are effective in helping patients by ensuring that they successfully complete the treatment regimen and receive necessary support.

Summing up, the Green Light Committee Initiative helps countries to save money and to save lives.  However, until now, Lithuania has not used the benefits of the program.  It is encouraging that this year for the first time the government invited the GLC/IDA to participate in a tender to provide TB drugs in Lithuania.  The GLC/IDA won the tender to provide two drugs out of the necessary nine.  This is a good first step.  However, the GLC does not normally participate in tenders, and consequently, this approach results in administrative burdens and delays.

In order to fight this terrible disease effectively, a consistent supply of affordable drugs must be regularly available to patients and rigorous treatment protocols must be followed without breaks over the long term.  To realize fully the financial and other public health benefits of the initiative to aggressively address Lithuania’s TB problem, we hope that Lithuania will, as a next step, consider full participation in the initiative -- including procurement of other necessary drugs through a single source tender from the International Dispensary Association.  By buying the necessary drugs directly from IDA, countries save a lot of money each year.   

We are often told that this is not possible because Lithuania’s procurement law does not allow it.  We note, however, that the law states contracts awarded pursuant to the particular procedure of an international organization, may be deemed as “excluded” from public procurement law.  If this is inadequate, the law can be changed allowing Lithuania to use the benefits of the GLC Initiative.  We are also often told that the drugs provided by the IDA are not registered in Lithuania.  However, an exception can be made to the import of necessary drugs, as was done this year.   

The bottom line is that more active participation in the Initiative provides Lithuania a strong tool to fight MDR-TB, saving money and lives.  Obstacles to full participation in the Initiative can be overcome, if there is a will.    

Estonia provides a good example of the potential benefits of participation in the GLC Initiative.  Estonia has a procurement law similar to that in Lithuania.  Estonia was able to grant an exception for single source procurement under an exception provided for cases deemed “directly needed to protect significant state interests.”  As a result, the Estonian government is able to avoid long delays or dangerous breaks in receiving supplies of anti-TB drugs.  Since starting the GLC program in 2001, new cases of TB in Estonia have decreased by 50 percent and the Estonian government has saved up to $3 million annually on TB treatment for the past 12 years. 

The U.S. remains committed to working closely with the Lithuanian government, the Stop TB Association and all interested in fighting MDR-TB in Lithuania.  To this end, the U.S. Embassy is working to bring a TB expert to Lithuania for 3 months to assist governmental and non-governmental organizations strengthen their strategies to fight this terrible disease.  

In closing, I would like to underscore that lack of public awareness about TB is also a serious challenge in Lithuania.   Even TB patients tend to hide their condition from everyone, even family members, because they see the disease as a stigma.  This must change.  Anyone can catch TB, and anyone who does, deserves treatment.  That is why we are pleased to see that Stop TB is opening the first TB information center in Lithuania.  The information center will help raise public awareness about TB, treatment options, and how to prevent it.  We are looking forward to close cooperation with the center.

Thank you for your attention and I wish you the best of luck in the future.