Drug-Resistant TB Threatening To Overwhelm All Current Tuberculosis Control Efforts

Note: World Lung Foundation united with The Union North America. From January 2016, the combined organization is known as “Vital Strategies.”

(March 24, 2012, New York, USA) – World Lung Foundation today warned that TB is a global and escalating crisis. In 2012, it is estimated that 2 million people will die from TB and over 8 million new cases of the disease will develop. While the total number of cases of TB may be static, the increasing prevalence and under-diagnosis of multidrug resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) means it is likely that an increasing number of people will become infected with this more deadly strain of TB and ultimately die from the disease.

At least half a billion people in the world have MDR or XDR TB. In 2011, no more than 10% of those people received treatment, which means most people who contract MDR and XDR TB will die. Before they die they are likely to spread the disease to others and the spread of these drug resistant strains threatens to overwhelm all current tuberculosis control efforts in the world. Already, in many regions, drug resistant tuberculosis is beyond the diagnostic and treatment capacities of many TB control programs, and infected patients can be offered only palliative care.

World Lung Foundation recommends a six-step approach to combat the increasing threat of TB:

1. Improved advocacy to gain attention for TB among health ministries, governments and funders around the world.
2. Existing tools of proven value – like simple diagnostics such as sputum smears for suspected TB cases – must be available globally.
3. Novel sophisticated diagnostics – such as molecular techniques capable of diagnosing drug-resistant tuberculosis within hours – should be quickly but carefully integrated into national TB control programs, without impacting other basic aspects of TB control.
4. An uninterrupted drug supply of first and second-line drugs must be assured and must be made a priority of national governments, health ministries, and TB control programs.
5. Programs of directly observed therapy (DOTS) should be supported and strengthened.
6. Accurate surveillance of cases and reporting must be made a priority, so that trends in rates of drug susceptible and resistant disease can be closely tracked and responded to.

Dr. Neil Schluger, Chief Scientific Officer, World Lung Foundation and a leading TB expert said: “More than half a century after the dawn of the antibiotic era, TB remains a terrible worldwide scourge. It is once again on the increase in the developed world, while continuing to exert a heavy toll in low and middle income countries – particularly those in which HIV infection poses a heightened risk. For example, HIV infection continues to fuel the fire of the TB epidemic in southern Africa, where rates of TB are literally hundreds of times higher than they are in the developed world. And TB continues to be more difficult to combat in low and middle income countries where significant indoor and outdoor pollution, high levels of malnutrition and overcrowded living conditions increase susceptibility to TB and the spread of the disease. Most worrisome, drug-resistant strains of tuberculosis, both multidrug resistant (MDR) and extensively drug resistant (XDR), have been reported from all corners of the globe.

Recently, the Tuberculosis Trials Consortium demonstrated the efficacy of a 12-dose regimen for the treatment of latent tuberculosis infection, raising the possibility that widespread treatment of latent TB could be employed as a tool for TB elimination. Great progress has been made in the development of novel diagnostics and several drugs are now in clinical phases of development – more than at any time in several decades. Research in TB vaccines, perhaps the ultimate answer, is progressing and the Strategic Blueprint for TB Vaccine Development is a model for coordinating efforts to advance the field as quickly as possible. This should ensure that the most pressing clinical needs are addressed by the best emerging technologies in a manner that will lead to their rapid uptake and implementation. Similar approaches would likely benefit drugs and diagnostics.

“We are paying the price for a global lack of recognition, funding and research for TB in recent decades, combined with underdiagnosis and undertreatment in the countries worst affected by the disease. For the sake of global public health – and the lives of the millions of individuals infected by TB – that situation must change. Continuing advocacy efforts to secure funding both for research and implementation in the fight against TB will be critical to these efforts,” Dr. Schluger added.