Totally Drug-Resistant Tuberculosis

We need to get ahead of drug-resistant tuberculosis. This means detecting TB early, testing for drug resistance and providing appropriate treatment in both the public and private sectors.
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Last night I had dinner with one of the smartest people I know. We talked about our work. She asked me, "What is tuberculosis actually?" I was stuck for a second about where to start. Because usually I start with the good news -- that TB (a contagious lung disease that spreads through the air) is curable.

Then the bad news.

That in spite of this, TB kills 1.5 million people a year, is among the largest killers of women of reproductive age and is the largest killer of those living with HIV. But TB is curable. We just need new tools for detection, better drug regimens and better integration of TB-HIV services.

This week however, was different. We have long been concerned about drug-resistant tuberculosis and in recent years, more concerned about the extremely drug resistant tuberculosis (XDR-TB). Both of these are manmade problems, the result of inadequate care and treatment of standard tuberculosis. In the first reported outbreak of XDR-TB in KwaZulu-Natal Province, South Africa, 52 of 53 patients with XDR-TB died. Of the 43 patients tested for HIV, all were positive and many of them were on a life-saving anti-retroviral drug regimen for HIV/AIDS.

This week, the conversation changed. It got worse.

Now we are talking about totally drug-resistant tuberculosis (TDR-TB). TDR-TB isn't new. It was first documented in Italy in 2007 and in 2009, 15 cases were reported in Iran. This week, when doctors in India reported 12 cases -- it became big news. It became a new reality. Another obstacle in the fight to save lives from this "curable" disease.

My team at ACTION know that I don't like to use fear as a motivator for getting people to care about tuberculosis or any of the global health issues we work on. But how can we not fear the creation of a totally drug-resistant strain of a disease that is already among the world's top killers? A silent killer that we have created ourselves with our inattention -- with a lack of political will and resources to take on tuberculosis? I don't have to tell you to be afraid of this. It's just scary all by itself.

We need to get ahead of TDR-TB. This means detecting TB early, testing for drug resistance and providing appropriate treatment in both the public and private sectors. Right now it's possible to detect drug resistance in an hour and a half using GeneXpert, but the machine is very expensive and most laboratories can't afford it. If the price isn't lowered, we're going to need a low-cost tool to diagnose drug resistance - and fast.

TDR-TB is happening just as the biggest international funder for TB is in crisis. Jan. 28 marks the 10th anniversary of the Global Fund to Fight AIDS, Tuberculosis and Malaria. This is cause for a serious celebration.

The successes of the Global Fund are revolutionary.

  • 4.1 million survivors of tuberculosis
  • 6.6 million people currently on AIDS treatment
  • 1 million HIV positive women celebrating the births of their HIV negative children (due to successful prevention of mother-to-child transmission)

The Global Fund -- and our commitment to it -- is humanity at its best.

And yet, just as the science tells us to scale up, donor governments tell us they are too broke -- they can't keep or make new commitments to fight these three diseases.

Of the 12 cases of totally drug-resistant TB in India -- three are already dead. One is a 13-year-old girl. So yes, I am afraid.

Kolleen Bouchane is the director of ACTION, an international partnership of civil society advocates working to mobilize resources to treat and prevent the spread of tuberculosis (TB), a global disease that kills one person every 20 seconds.

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