Why Is Multidrug-Resistant TB A Health Security Threat?

Tuberculosis is a public health crisis.
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“Antimicrobial resistance poses a fundamental, long-term threat to human health.” Ominous opening words from UN Secretary-General Ban Ki-moon at the opening of this year’s General Assembly High-level Meeting on Antimicrobial Resistance (AMR). With all of the world’s pressing issues, this year the UN general assembly convened for the just the fourth time in its 71 year history to focus on a threat that is often overlooked - AMR.

Building on commitments made by the G7 and G20 countries earlier this year signaling recognition from world leaders that AMR poses a very serious threat to global economic development and prosperity, as well as health security, Heads of State and senior officials from all 193 UN member states came to together and agreed to combat the increased emergence of AMR. The world has agreed to a multi-sectoral approach to combatting AMR and its root causes from human health to animal health to agriculture. This is not going to be easy, this commitment will take more than a simple handshake to pull off. This week in the Netherlands, senior officials are again meeting to make and implement concrete new commitments to advance the Global Health Security Agenda, which includes a specific workstream on combating AMR.

There is tremendous momentum from all corners of the world but despite this momentum, MDR-TB still affects half a million people worldwide each year. It is a public health crisis where many of the people with the disease are never diagnosed, continuing to transmit within their communities and suffer from their illness. It is one of the largest public health crises that is often ignored globally and in high burden countries.

Spread silently through the air from one person to another, TB is a human tragedy that should not happen in 2016 because properly managed drug-susceptible TB can be cured. On the other hand, poorly managed TB can evolve into a form that resists multiple drugs, requiring long and expensive treatment with marginal results.

TB is a disease too often of the poor. MDR-TB wreaks havoc, not only on individual health and livelihoods but on families too, throwing them deeper into poverty when patients are relied on for financial support. The sacrifices of the frontline health workers should not be overlooked here, it is also devastating for those health workers who can become infected while they are caring for patients.

“TB is a human tragedy that should not happen in 2016 because TB can be cured.”

While the situation has been grim for many years, there is now hope. Rapid molecular tests and recently announced new shorter regimens to treat MDR-TB are transforming case management and lives of infected patients and healthcare workers. Critically, we need to get these tools urgently to those who need them despite the many health system challenges. However, the current tools are not enough. Global investments in TB research are critical to find better diagnostics, drugs and vaccines.

A necessary first step in combating MDR-TB is strengthening the overall TB response, thus preventing the creation and spread of resistant TB. Current actions and investments are falling far short of those needed to end the TB epidemic. With 1.8 million deaths in 2015 tuberculosis is among the top ten causes of death worldwide; TB kills more people than HIV and malaria. Yet, the response remains severely underfunded by most high burden countries. Middle-income countries with significant TB burdens continue to invest far less than even a basic six percent of GDP in their own health.

Investments in low- and middle-income countries, where the majority of TB cases are, fall US$ 1.7 billion short of the US$ 8.3 billion needed this year. This gap will widen to US$ 6 billion by 2020 if current funding levels are not increased by both international donors and middle-income countries such as Brazil, the Russian Federation, India, China and South Africa, which together make up close to half of the world’s 10.4 million TB cases.

Today, India accounts for more than one quarter of TB cases worldwide and has the largest number of people with multidrug-resistant TB (MDR-TB). The United States has committed to bold objectives in the December 2015 release of the National Action Plan to Combat MDR-TB. India seems also primed to increase domestic resources of TB, invest in TB research for global learning, and expand access to new diagnostic tools and treatments. Leaders in other high burden TB countries need to acknowledge the global risks of MDR-TB and take responsibility for collective tackling it.

We are seeing a growing number of testimonials by MDR-TB patients themselves posted on social media and in the press, as well as personal accounts by caregivers on the horrific burden this form of AMR poses. High-level attention to TB by the United Nations General Assembly is needed to ensure reaching global targets. How can we not respond with greater urgency? Our health and security hang in the balance.

Dr Goosby is the United Nations Special Envoy on Tuberculosis and Professor of Medicine at the University of California, San Francisco. From 2008-2013 he served as the U.S. Global AIDS Coordinator.

Dr Raviglione is the Director of the Global TB Programme at the World Health Organization.

Dr Pablos-Méndez is Assistant Administrator for Global Health at the US Agency for International Development (USAID) in Washington, DC.

This post is part of the ‘Fighting Tuberculosis’ series produced by The Huffington Post highlighting the challenges of combatting tuberculosis today. TB is now back in the top ten causes of death globally, and is the world’s leading infectious disease killer.

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