By Tara Ornstein (TREAT TB Technical Officer at The International Union Against Tuberculosis and Lung Disease)
Twenty years after the World Health Organization declared tuberculosis (TB) a global public health emergency, one-third of the world’s population is infected with the disease, multidrug-resistant TB (MDR-TB) is now present in every country in the world, and extensively drug-resistant TB (XDR-TB) has been reported in 92 countries. Although it is curable and preventable, TB causes approximately 20% of infectious disease-related deaths among people between the ages of 15 and 54 every year. In 2012, 8.6 million people contracted TB and 1.3 million died from the disease. This May, the 67th World Health Assembly will be held in Geneva, where the global health community will discuss global TB control efforts, including access to life-saving medicines.
On the positive side, the global health community will have some progress to report. According to the WHO, the TB incidence rate has been falling for the last decade and the mortality rate has been reduced by 45% since 1990. After 125 years of relying exclusively on 19th century diagnostic techniques, a new test called Xpert MTB/RIF was rolled out in 2013. Xpert MTB/RIF can simultaneously detect TB and rifampicin resistance in two hours , which enables clinicians to give patients the right medicines at an earlier stage, when the chances for recovery are higher. In late 2013, UNITAID announced that it will expand the Strategic Rotating Stockpile for multidrug-resistant medicines, which will help contain MDR-TB by ensuring the supply and improving the delivery times of these drugs. And just last week, UNITAID also pledged to give Partners in Health $60.4 million dollars to accelerate the uptake of two new medicines for MDR-TB, bedaquiline and delamanid, by treating 3200 patients in 17 countries with these drugs.
But progress is not being made fast enough and what has been achieved so far can still be lost. As MSF explained in their March 2014 crisis alert, Xpert MTB/RIF “is not perfect: it needs electricity to run so it is unsuitable for off-grid health centres; it only detects resistance to a single drug…; and it still does not meet the needs of diagnosing TB in children.” MSF also noted that while the emergence of new drugs is a welcome development, these new compounds will not cure TB. “If new drugs are merely added to the current MDR-TB regimen, the resulting course of treatment will remain lengthy, cumbersome, and toxic.”
In its most recent Global Report on Tuberculosis, the WHO confirmed that US$8 billion is needed to respond to the TB epidemic in low- and middle-income countries, but only US$6 billion was received in 2013. Even worse, funding for TB research declined severely. According to the Treatment Action Group (TAG)’s TB/HIV Project Officer Mike Frick, “TB research is gravely underfunded, falling in absolute terms, failing to keep pace with inflation and reliant on a small number of primarily public and philanthropic donors.” A report published by TAG in late 2013 calculated that private sector funding for TB research fell by 22% while sequestration-related cuts substantially reduced U.S. government contributions to TB research, which is alarming because the U.S. was a key global health donor.
During the assembly next week, the global health community will have to take action to alleviate the crisis in the immediate future. As Frick explained, “The grants announced by UNITAID are visionary and should be celebrated, but they are focused on implementation of existing technologies or recently approved tools and so do not address the critical shortfall in funding for TB research.” He added, “The UNITAID grant to Partners in Health to accelerate access to new treatments for MDR-TB could in theory encourage more players to get involved in TB drug development by consolidating the heavily fragmented market for MDR-TB drugs, but this downstream effect will take several years to be felt.”
Aside from garnering the appropriate level of support, the greatest challenge facing the delegates next week may be the need to generate new ideas and robust political commitment for TB control. The severity of the crisis requires the global health community to move beyond resolutions and to respond to TB with newfound creativity.