Matters arising from WHO’s declaration of MDR-TB as crisis

By: Chioma Umeha

Wednesday, the World Health Organization (WHO) declared multi drug-resistant TB (MDR-TB) a ‘public health crisis’ – and released an evidence-packed report to prove it. A lot has been written about what can be done to curb the spread of ‘virtually untreatable tuberculosis’ announced by the U.S. Centers for Disease Control and Prevention. 

However, the release of the world health body’s annual global TB report two days ago should be the data-filled nudge that demands everyone’s effort. The persistent creep of drug-resistant tuberculosis continues unabated. Here is a quick breakdown: 

• About one in five of the 94,000 people diagnosed with MDR-TB (resistant to two of most commonly used drugs in the current four-drug regimen) are not being treated. 

• Only about half of those being treated for drug-resistant TB are successfully completing treatment. Trends suggest this gap is only increasing. 

• 10 percent of these cases are morphing into extensively drug-resistant TB (resistant to two first line drugs and at least two second line drugs). 

The world has reached a point where an ancient disease is outrunning all attempts to control it. Despite some visionary political commitments – such as recent U.S. and UK commitments to the Global Fund to Fight AIDS, Tuberculosis and Malaria – ultimately, the global fight against TB is starved of political leadership and funding. The new WHO report reveals this massive disconnect between what is clearly a crisis situation and a lacklustre global response to TB – a disconnect demonstrated by the $2 billion that is lacking annually to mount a smart and effective response to TB in the low- and middle-income countries where it is needed most. This makes no sense – not from a public health perspective, or an economic perspective. 

There is evidence of the oppressive and unnecessary costs associated with TB and its drug-resistant strains. A recent study showed that tuberculosis (the care of patients and the enormous costs in lost productivity) costs the European Union €5.9 billion per year. According to researchers, this estimate is conservative, as several sets of data were not available and the real costs may actually be twice as high. There is not a national budget anywhere prepared to bear these burdens. The good news: the solutions to this crisis are multifaceted, long-term, and outlined in the ‘priority actions’  of the WHO report. 

First thing to do At its Fourth Replenishment in December in Washington, D.C., the Global Fund must receive the $15 billion it is requesting from donors to scale up its programmes, save more lives, and ultimately bring these three epidemics under control. Nearly 90 per cent of international donor financing for TB is provided by the Global Fund, and its programmes have put 11 million people on TB treatment. In 2011, Global Fund programmes supported about one-quarter of cases enrolled in MDR-TB treatment. Failing to scale up TB programmes could have a catastrophic impact on the spread of drug-resistance. TB anywhere is TB everywhere. 

As an airborne disease that can be spread through the simple of act of coughing, decision makers have an obligation to heed the evidence and ramp up the slowing fight against an ancient disease, before its control spins out of grasp. Thanks to the WHO, the evidence is available. There is no doubt on what to do. What is needed now is visionary leadership, particularly the delivery of commitments and new resources for the Global Fund.

 This story was published in Newswatch Times on October 26,  2013.


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