On the eve of World TB Day, governments, international donors and drug companies are being urged to step up their commitment to fighting a “health emergency”.
In the article below, Dr Marianne Gale, a TB and HIV Advisor for Médecins Sans Frontières, describes the terrible toll that this disease is taking upon people around the world.
(Update, 26 March: And more on related themes from other MSF doctors in this PLoS blog, Zero MDR-TB deaths in children in my lifetime?)
An urgent plea for help on World TB Day
Dr Marianne Gale writes:
As we mark another World TB Day and the 130th anniversary of the discovery of the tubercle bacillus by German physician Robert Koch, there is little reason to celebrate.
The global crisis of tuberculosis sadly continues, its scale only expanding as most governments and donors sit idly by. This emergency is only exacerbated by the increase in the deadlier form of the disease, the strain of TB that does not respond to the regular drug regimen, multidrug resistant TB (MDR-TB).
In light of new data collected by Médecins Sans Frontières, it is alarming to note that there is little being done to avert a health emergency.
We are finding MDR TB in shocking numbers, notably in new patients, suggesting the crisis is much larger than had been thought. In South Africa for example, our teams have seen a 211 percent increase of TB diagnosis per month in our clinic in KwaZulu Natal following the introduction of a new rapid diagnostic test. Of those patients confirmed, 13.2 percent were resistant to the drug rifampicin, one of the most effective drugs for treating TB.
As my colleagues from Médecins Sans Frontières and I see on a daily basis, MDR-TB takes a horrific toll on a patient. A persistent cough, fever, weight loss, chest pain and breathlessness will ultimately lead to death if the right treatment is not administered.
There are currently an estimated 650,000 people living with MDR-TB worldwide. Shockingly however, around 90 percent of these patients have absolutely no access to treatment.
Access to this treatment is now hanging even more on tenterhooks. The recent cancellation of Round 11 of the Global Fund to Fight AIDS, Tuberculosis and Malaria has left millions of patients suffering from these diseases in dire circumstances. Its role is paramount: the Global Fund is the leading international funding mechanism for TB, supporting over 80 percent of international commitments for TB treatment.
Practically, this means that no new grants for eligible countries are available, and therefore treatment cannot be increased. The final consequence of this is that many governments will not have the resources to tackle epidemics at a rate that can keep up with the spread of this deadly epidemic.
In Australia’s own backyard, in Myanmar, we are seeing MDR TB on an enormous scale. It is estimated that there are 9300 cases every year, and so far, just over 300 patients in total have received treatment. Myanmar’s five year plan to reach a further 10,000 people living with the disease has been seriously undermined with the Global Fund cuts.
Little medical advance to celebrate
For those who can access it, a mere ten percent of patients around the world, existing treatment remains extremely outdated and hugely expensive. The drugs that were developed decades ago are highly toxic and have to be taken for up to two years. Patients must endure intolerable side effects including extreme nausea, vomiting, loss of appetite, mental health deterioration and fever.
On top of this, we fear that current statistics may only be scratching the surface of the problem. Diagnostic tools are also extremely outdated, and we know for example that 95 percent of TB patients worldwide lack access to proper diagnosis. Thousands of patients are therefore not receiving the treatment they urgently need.
To control drug resistance, the issue of incorrect treatment and the availability of over-the-counter prescription drugs must be tackled. Although drug resistance is a man-made problem, it can be turned around with the implementation of approaches recommended by the World Health Organisation and stricter control of drug availability on the private market.
We urgently need increased access to diagnostics and treatment. New drugs and shorter and less toxic regiments are desperately needed. For this, funding is vital. The cost per patient is between US4,400 and US9,000 for treatment, clearly a price that is out of the reach of many in developing countries.
Every day, the tragic consequences of this disease are faced by thousands of patients globally.
World TB Day provides a timely reminder that governments, international donors and drug companies must immediately step up their commitment to fighting the spread of this disease.
As thousands of patients run out of breath, this crisis needs to be addressed before we run out of time.
• Dr Marianne Gale is a TB and HIV Advisor for Médecins Sans Frontières, based in Sydney