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Challenges Rise in the Fight Against TB

Prepared by: Toni Johnson
June 26, 2007

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Andrew Speaker, an Atlanta lawyer infected with a highly drug-resistant strain of tuberculosis (XDR-TB), ignited a media firestorm and a minor health panic in the United States. His ability to enter the United States against the advice of the U.S. Centers for Disease Control called attention to problems with interagency coordination on infectious disease cases (PDF). Michael Osterholm, a disaster planning expert, said the case raises concerns about what would happen in “the opening days of a flu pandemic (USAToday).” Some health experts say the actual danger posed by the Speaker case was “overblown (AJC).” They add, however, that the risk posed by the rise of drug resistant TB is quite serious.

According to data from a report (PDF) by Doctors Without Borders, about nine million active infections of TB develop annually, leading to about two million deaths. TB is one of the most common infections among the HIV infected and the top killer of people with AIDS globally. A World Health Organization report finds the rise in drug-resistant TB strains corresponds with the world’s fastest-growing HIV infection rates. Multidrug resistant strains of TB (MDR-TB) are particularly deadly and number up to 424,000 annually, with XDR-TB infecting as many as 30,000. The XDR-TB strain is so drug resistant the estimated cure rate is only 30 percent. Its existence was confirmed just last year and has now been diagnosed in 37 countries. A 2007 report card from Global Health Advocates, a nonprofit group against "diseases of poverty," shows which countries are at "significant risk" of developing MDR-TB on a large scale.

Treating these strains is complicated because of the longer treatment time, increased side-effects, lack of effective secondary drug options, and significant financial cost. Drug treatments and diagnostic tests for TB are also several decades old. Health advocates point out that most drug research focuses on curing ailments common in the lucrative markets of the United States and Europe. But a new discussion is opening among pharmaceutical companies and nonprofit groups about the profitability of treating TB (BaltSun). “There’s more going on in TB drug development now than there has been in decades,” Al Hinman, a spokesman for the TB Alliance, told the Sun. Accordingly, the WHO recently laid out a $2 billion plan aiming to provide access to drugs and diagnostic tests to all MDR-TB and XDR-TB patients by 2015.

TB represents just one of several diseases emerging as a drug-resistant threat. For example, health advocates point to an alarming increase in the number of antibiotic resistant staph infections (Science Daily). A recent report (PDF) from the European Centre for Disease Prevention and Control notes that “antimicrobial resistance is one of the most serious public health problems, globally and in Europe.” Compounding this problem is the speed at which disease can now travel. A recent National Academies of Sciences report points out that disease can now circle the globe with “near telephonic speed, making long-distance connections and intercontinental infections almost as if by satellite.”

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