'Virtually Untreatable Tuberculosis'

September 5, 2012
by Kolleen Bouchane, ACTION Director

“The global emergence of extensively drug-resistant (XDR) tuberculosis heralds the advent of widespread, virtually untreatable tuberculosis.” – CDC, August 30, 2012.

We’ve all seen the Hollywood version: a man or a woman suddenly becomes ill, assumes it’s a common illness, shrugs it off, then drops dead. The mystery illness spreads, the national guard is mobilized, the treatment serum is discovered — just in time! — and humanity is saved. But in the course of the story, the nefarious and rapidly spreading germs have left entire towns, perhaps countries, decimated.

Blockbusters like Outbreak and last year’s Contagion make us imagine the nightmare that would befall us if we were suddenly faced with a rapid, lethal epidemic.

The real-life story unfolding around global tuberculosis (TB) right now is perhaps less dramatic only in that the build-up is more like a slow burn than a sudden conflagration.

An international team led by researchers from the U.S. Centers for Disease Control and Prevention published new data on Thursday showing that an epidemic of completely drug-resistant, airborne disease is creeping steadily toward us.

Starting in 2005, researchers began collecting phlegm samples from TB patients in eight countries on four continents and testing them for drug resistance. TB is a disease that usually affects the lungs (though it can infect all parts of the body) and often shows up in the patient’s phlegm.

These patients were unique in that almost all of them were known to be sick not just with garden-variety tuberculosis, but with multidrug-resistant TB (MDR-TB). MDR-TB is defined by the World Health Organization as a form of the disease that’s resistant to, at the least, isoniazid and rifampicin — the two most powerful anti-TB medicines.

Patients with drug-resistant forms of the disease are prescribed “second-line” drugs. These are the back-up drugs that physicians prescribe when the TB bacteria have become resistant to the “first-line,” (a.k.a. more powerful) drugs.

Almost half of the MDR-TB patients in the CDC study — 43.7 percent of them — were resistant to at least one second-line drug.

This means that the back-up drugs used to treat drug-resistant TB are themselves failing in large numbers.

And there are no third-line drugs.

Did I mention that TB spreads from person to person through the air?

The CDC study comes on the heels of another recent paper, published this month in the journal Health Policy and Planning, which describes the MDR-TB scene in India. Earlier this year, physicians in Mumbai hospitalized several patients with forms of the disease that were totally resistant to all available antibiotics.

Also this month, parliamentarians in Kenya began raising questions to their minister of public health about the spread of extensively drug resistant TB in their country — asking how far the disease has spread and what is to be done to stop it.

In a world where one far-out remark from a politician can dominate the news cycle for days, life-and-death developments like this easily escape the public’s attention. But the researchers paint a stark picture that we should all pay attention to:

“The global emergence of extensively drug-resistant (XDR) tuberculosis heralds the advent of widespread, virtually untreatable tuberculosis.”

So what do we do?

First: The Global Fund to Fight AIDS, Tuberculosis and Malaria is the world’s largest international grant-maker for TB, supporting programs in over 140 countries. At its board meeting in September, the board will vote on a measure that could change its funding model to one that would arbitrarily cap the amount of resources that programs can apply for. This would be a disaster for the Global Fund and for the worldwide fight against TB. The board members, led by chairman Simon Bland of the UK, should vote against any such measure and work together to raise contributions.

Second: We need more investment in the research and development of new TB drugs. A new TB drug hasn’t hit the market in over 40 years. Enterprises like the Global TB Alliance and Otsuka Pharmaceuticals are developing portfolios of new drug candidates. These efforts need to be fully financed to bring these new drugs to market.

Third: TB needs to again rise to the top of the international political agenda. One upcoming venue for action is the Annual Meetings of the World Bank and International Monetary Fund in Tokyo this November. Global health is one of the main themes of the meetings, and the new World Bank President, Dr. Jim Kim is a renowned TB expert. Finance ministers attending the meetings should commit, with resources, to preventing a worldwide epidemic of incurable TB.

Otherwise, the ultimate consequences will be too terrifying to contemplate.

And that’s a true story.


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