The sluggish international response to the resurgent threat of tuberculosis is a global health scandal of nearly criminal proportions, Stephen Lewis, the former UN special envoy for HIV-AIDS, said Wednesday.

"I don't know whether I'm just too old and losing patience but you begin to verge in the area of crimes against humanity," Lewis said in a teleconference organized by the Open Society Institute, a charitable foundation established by philanthropist George Soros.

"You begin to wonder when governments are inert and when the international community is in such obvious default whether there doesn't come a point where these are almost criminal matters. Where people are dying in such numbers, where you know absolutely that you can intervene and stop it and you fail to do so."

Lewis and several other experts on tuberculosis and global public health were commenting in advance of a major TB conference to be held next week in South Africa, one of the countries hardest hit by the emergence of multi-drug resistant (MDR) and extensively drug resistant (XDR) tuberculosis.

The World Health Organization estimates that 420,000 new cases of MDR-TB develop every year. A small but highly worrisome proportion of those cases would be extensively drug resistant, for which there are few treatment options, especially in the developing world.

Lewis noted it has been estimated only two per cent of those new cases are receiving treatment.

"The gap is huge and there's obviously an element here of extraordinary negligence. It's both a global health scandal and a global health imperative of monumental proportion, it seems to me," said Lewis, who is now co-director of the organization AIDS-Free World.

"Everybody sees this as a crisis of the developing world and therefore tend to be dismissive about it. But it is a huge crisis of the developing world which has very strong reverberations in many regions of the so-called developed world."

Dr. Paul Farmer, the founding director of the organization Partners In Health, noted that with 420,000 new drug resistant cases emerging each year, the numbers of untreated people with these dangerous forms of the disease are soaring.

"It's hard to say that there would be less than a couple of million people out there who are alive and have active drug resistant tuberculosis and are able to transmit it to others," said Farmer, a pioneer in community based strategies for management of HIV and TB who teaches in Harvard Medical School's department of social medicine.

"So it's a huge problem and one that's going to be fanned, as it has been in southern Africa, by HIV."

Lewis was highly critical of developed countries, especially those of the G8, which make and break promises on international aid and global public health.

"All of the commitments that are made internationally, particularly by the G8, seem perpetually to be dishonoured," Lewis said.

"Whether it's debt or trade or universal access to treatment for HIV-AIDS or now in the case of MDR-XDR tuberculosis the willingness to make the promises and then the equal willingness to default on the promises almost the moment they're made seems to me to mean that the G8 in particular loses every claim to integrity."