Of the 9.4 million new tuberculosis (TB) cases diagnosed each year, approximately 5% are multidrug resistant (MDR). The global scope of multidrug-resistant tuberculosis (MDR-TB) is much more vast than previously estimated according to alarming new data, requiring a concerted international effort to combat this deadlier form of the disease, the medical humanitarian organisation Médecins Sans Frontières (MSF) said.
The global MDR-TB crisis coincides with a huge gap in access to diagnosis and treatment. Existing diagnostic tools and medicines are outdated and hugely expensive, and inadequate funding threatens the further spread of the disease. Worldwide, less than 5% of TB patients have access to proper diagnosis of drug resistance, and only 10% of MDR-TB patients are estimated to have access to treatment – far less in low-resource settings where prevalence is highest.
“Wherever we look for drug resistant TB we are finding it in alarming numbers, suggesting current statistics may only be scratching the surface of the problem,” said MSF President Dr. Unni Karunakara. “With 95% of TB patients worldwide lacking access to proper diagnosis, efforts to scale-up detection of MDR-TB are being severely undermined by a retreat in donor funding – precisely when increased funding is needed most.”
Data collected from MSF projects around the world have shocked doctors tackling the disease.
In the north of the Central Asian country of Uzbekistan, 65% of patients treated by MSF in 2011 were diagnosed with MDR-TB. Of those patients, 30-40% had presented to the MSF clinic for the first time, an unprecedented number globally – indicating that drug resistance is not only fuelled by incorrect treatment of TB, but is also transmitting in its own right.
In South Africa, where the TB burden is one of the highest worldwide, MSF has seen a 211% increase in TB diagnosis per month in its program in KwaZulu Natal, following the introduction of a new rapid diagnostic test. Of those patients confirmed with TB, 13.2% were resistant to the drug rifampicin, one of the most effective first-line drugs for treating TB.
In India, over-the-counter drug sales and an unregulated private health sector continue to fuel the development of drug resistance. An estimated 99,000 people are infected with MDR-TB each year, of whom only 1% receive adequate treatment.
In Myanmar, of an estimated 9,300 new cases of MDR-TB every year, so far just over 300 patients in total have received treatment. The cancellation of an entire round of funding from the Global Fund to Fight AIDS, Tuberculosis and Malaria threatens to seriously undermine a five-year plan to reach a further 10,000 people living with MDR-TB in Myanmar, along with scale-up plans in many other countries.
The global crisis is exacerbated by a perfect storm of lengthy treatment regimens (around two years) with highly toxic drugs, most of which were developed mid-last century and have unpleasant side effects.
Reduced funds—notably recent Global Fund cuts—and a small market with few manufacturers, have kept the costs of some of the drugs prohibitively expensive. Furthermore, expanded use of a new rapid diagnostic tool with the potential to massively increase early detection of drug-resistant TB in low-resource settings is inhibited by unaffordability. It is exactly in those places where the ability to detect TB within hours—as opposed to days or weeks—is most needed to save lives.
MSF is calling on governments, international donors, and drug companies to fight the spread of drug-resistant TB with new financing and new efforts to develop effective and affordable diagnostic tools and drugs. Far shorter and less toxic drug regimens are needed, along with currently non-existent formulations for children, and a point-of-care diagnostics test.
Regulatory measures need to be enforced to prevent further spread of the disease due to mismanagement by practitioners.
Despite existing since antiquity, TB is the second biggest killer globally today – and there are more and more cases of TB resistant to first-line drugs normally used to treat it. Currently, an estimated 12 million people are living with TB, according to the WHO Global TB Report 2011.
“We need new drugs, new research, new programmes, and a new commitment from international donors and governments to tackle this deadly disease,” said Dr. Karunakara. “Only then, will more people be tested, treated and cured. The world can no longer sit back and ignore the threat of MDR-TB. We must act now.”
Source: Médecins Sans Frontières (MSF)