The global drug-resistant tuberculosis crisis

Drug-resistant tuberculosis (DR-TB) is a major global health crisis, no doubt.

  • 9 million people affected by TB and 1.5 million deaths

  • 480,000 people estimated to have multiple DR-TB (MDR-TB)

  • 136,000 MDR-TB case diagnosed, yet only one in five are put on treatment

  • In parts of Eastern Europe and Central Asia MDR-TB rates in re-treatment cases are reaching 75%

  • Global cure rates for MDR-TB are 48%, dropping to 22% for XDR-TB

Resistant forms of TB, including extremely-drug resistant TB (XDR-TB), are increasingly spreading directly from person to person. In Central Asia, the high rates of DRTB among newly diagnose TB cases is sobering. Undiagnosed and untreated the disease continues to spread and kill. The lack of good and affordable drugs, increasing levels of resistance, and the sheer number and extent of DR-TB cases present a grave global challenge.

To those people lucky enough to receive medical care they face a dreadful two-year course of treatment with thousands of pills, painful injections, severe side-effects and a 50-50 chance of being cured. Indeed DR-TB patients require immense strength of will and psychosocial support from health workers and family.

The drugs commonly used to attack DRTB were strong antibiotics developed in the 1940s, and the combination of pills and injections have severe mental and physical side effects.

A 50-year-old patient in Armenia, now cured of DRTB, shared that “it was difficult to take these drugs. I was unable to explain what was happening to me. I was unable to stand, I was unable to walk, I could not lie down and I felt nauseous.” For some patients, they experience psychosis, hallucinations, suicidal feelings, deafness and vomiting. If patient has pre-existing medical conditions, the severities of the side-effects become unbearable. On that case, sometimes the patient doesn’t want to take the drugs or they find it so difficult to complete the two-year treatment because of the side-effects.

New drugs that are proven highly effective with less side-effect remain largely out of reach. Patients are missing out on the potential of new and promising treatment because companies and countries are dragging their feet with registrations. Meanwhile, the lack of clinical trials incorporating new TB drugs into much-needed short, tolerable and effective regimens highlights the failings in the way medical innovation is conducted and incentivized.

Yesterday, ‘Out of Step’, the new report released yesterday 30 October by Médecins Sans Frontières/Doctors Without Borders (MSF) reveals that efforts to control the epidemic are dangerously out of a step with international recommendation and proven best practices, leaving drug-resistant forms of TB to spread unabated. The research is based on surveys done in eight countries – South Africa, Myanmar, Brazil, India, Kenya, Uzbekistan, Zimbabwe and the Russian Federation.

The research found that testing for drug resistance, crucial for preventing misdiagnosis and incorrect treatment, is grossly insufficient in most of the countries surveyed. Around 75% of MDR-TB patients diagnoses are enrolled in treatment in half of the countries surveyed. Some form of routine hospitalization takes place in half of the countries, despite community-based care having proven more tolerable for patients and more cost-effective while delivering similar medical outcomes. Five out of eight national TB programmes face critical funding gaps, with Kenya, Myanmar and Zimbabwe less than 50% of the required funding available.

Lagging implementations in the countries mentioned are indicative of the challenges faced globally by low- and middle-income countries in implementing and funding all the various components for a comprehensive and effective TB programme. What is clear is that drug resistant tuberculosis will continue to spread unabated unless a stronger and more concerted effort to scale-up DR-TB services in step with the implementation of optimal tools, guidelines and policies, is made at the country level.

Now countries and global health actors at every level must step up their commitment and actions to ensure major strides are taken in the fight against TB, and in particular to curb the global DR-TB crisis. It’s time for TB research and development efforts to be prioritized and funded in a way that ensures lifesaving diagnostics and treatments rapidly reach the people who so desperately need them.

Rémi Carrier is the Executive Director of MSF Hong Kong.