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Infectious Diseases

The looming threats of tuberculosis


Dr Eric P. Goosby

United Nations Special Envoy on Tuberculosis (TB), and Professor of Medicine, UCSF

Tuberculosis is a triple threat – a global health threat, a global security threat and a domestic economic threat.

TB is the world’s most lethal infectious disease, taking the lives of more people who are HIV positive than any other disease. No one is immune from TB. One cough from a person suffering from active TB can spread like wildfire. There is not one country across the globe that does not have TB. TB knows no borders.

Drug Resistant TB (DR- TB) is the number one antimicrobial resistance (AMR) killer and a serious global health security problem.

We can prevent, treat and cure TB. The world has joined together to set the goal to End TB by 2035, but we will not do so without changing the path we are on. At the current rate – reducing the global incidence by 2% per year – it will take nearly 200 years to achieve this goal. [WHO, 2018]

The emergence of multidrug-resistant (MDR-TB) and extensively drug resistant tuberculosis (XDR-TB) during the past 20 years has severely heightened the challenge. Drug Resistant TB (DR-TB) is the number one antimicrobial resistance (AMR) killer and a serious global health security problem. Prompt diagnosis and early treatment is essential to contain this threat.

Drug-resistant tuberculosis is harder to diagnose

Compared to susceptible TB, DR-TB is harder to diagnose and requires sophisticated laboratory equipment and resources that are often unavailable, especially in high burden countries. DR-TB develops because of a perfect storm of imperfect diagnostics, inadequate treatments and lack of access to care. More research and development focused on potent, better-tolerated drugs is necessary. Furthermore, accurate diagnostics including, but not limited to, Gene Xpert, that can identify TB rapidly and distinguish DR from drug susceptible TB, need to be affordable and widely available.

The cost of tuberculosis

Increasing research and development will also have a positive impact on domestic economic threats. In many countries, DR-TB treatment can exceed $10,000. This can have catastrophic financial consequences for health systems, as well as for those suffering with TB who are unable to work. Ministries of Health and Finance need to mobilise funds for TB, recognising the great return on investment in treatment. The costs on the health system are equally profound. In economic terms, it is projected that drug-resistant TB will kill 75 million people and cost a total of $16.7 trillion globally between 2015 and 2050.

At the UN High Level Meeting on TB in September we took significant steps forward to address these three looming threats. Now, we need countries to strengthen political will and donors to stand up and support resources that will improve the tools necessary to fight TB.

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