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How to stop multi-drug resistant TB

Image: The Global Fund / Jonas Gratzer

Dr Eric Goosby

Director of Global Health, Delivery, Diplomacy and Economics, UCSF; Former UN Special Envoy on TB

Multi-drug resistant TB is a global health threat, a global economic threat and, for many, a death threat.

TB is the number-one infectious killer in the world. It is a contagious, airborne bacterial disease, which takes more than 4,000 lives a day. Moreover, when it comes to multi-drug resistant TB (MDR-TB), only one in five people who contract this deadly disease are ever treated.

TB and drug resistance

MDR-TB is TB that doesn’t respond, at least, to the two most powerful anti-TB drugs. Drug resistance can emerge when anti-TB medicines are used inappropriately or because of weak health systems leading to drug shortages or intermittent access to treatment.

However, a lot of recent data has also shown that most outbreaks of drug-resistant TB (DR-TB) occur through direct transmission from one person to another.

Access to new medicines

While new treatments with novel drugs are revolutionising how we treat DR-TBs, in many settings these new medications are still not available.

Access to these new drugs, development of faster, more effective treatments, and ultimately the creation of a preventative vaccine, are urgently needed to make a dent in current figures.

Antimicrobial resistance and TB

According to a recent article in The Economist, DR-TB poses a significant threat to global health security. This is because bacteria and viruses’ ability to develop resistance to drugs – antimicrobial resistance (AMR) – is a major threat to global health security as it undermines the ability to treat infectious diseases.

DR-TB is estimated to cause a third of deaths due to AMR worldwide, killing around 230,000 people in 2017 alone.

AMR deaths look set to rise more than ten-fold, to 10 million annually, by 2050.

Without action, DR-TB would be responsible for 25 million of these deaths.

The economic impact of MDR-TB

While MDR-TB takes a tragic human toll, with an estimated 480,000 people developing the disease in 2019, it also has a heavy economic cost.

Estimates are that MDR-TB could cost the world $16.7 trillion by 2050. Those figures do not account for lost opportunity costs, or the burden on health systems. Just think what that money could do if actually directed at diagnosis, treatment and prevention.

It is clear that more resources are desperately needed to help reduce the incidence – and pain and suffering – of all forms of TB.

The Stop TB Partnership has estimated that at least US$13 billion will be needed for the implementation of TB programmes by 2022, to meet the targets of the Global Plan to End TB.

For DR-TB the total funding requirement is also expected to increase, from US$2.5 billion 2018 to $US3.6 billion in 2020.

TB has been on this planet since ancient times. It is unconscionable that people are still dying from this disease.

TB is preventable, treatable and curable. Now let’s make that doable.

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