Today is World TB Day. It would be nice to be celebrating it as the day that TB was wiped out. Instead, this day commemorates the discovery of the TB bacillus 126 years ago. Yes, that's right: 126 years. It's pretty clear that TB bacillus is a wily foe. We've made some progress since Dr. Robert Koch's "eureka!" moment, but not nearly enough. A big reason for the stalled progress in fighting TB is growing resistance to the drugs used to treat it.The recommended treatment for TB, known as DOTS, is designed precisely with the avoidance of drug resistance in mind. Yet TB cases are up globally and so are drug resistant cases of TB, known as MDR-TB and XDR-TB.In its Global Tuberculosis Control 2008report last week, the World Health Organization provides the good news and the bad news about the fight against TB. The report is decidedly mixed. A month ago, WHO issued a related report on drug resistant TB worldwide. Together, they tell a troubling story about a global disease that should belong to yesteryear, but has found new and more vulnerable targets especially in countries with weak health systems. Here are a few facts from the two reportsThe Good: Funding for TB control has reached an all-time high of U.S. $3.3 billion - more than tripling the funding since 2002! The Bad: There is still a funding shortfall of U.S. $1 billion per year to achieve the Global Plan of the Stop TB Partnership.The Good: The number of TB cases per capita around the world is falling, and so are death rates. Part of the reason is population increase; but if trends continue, score a win for MDG 6. The Bad: TB cases are increasing globally in absolute terms and reached 9.2 million new cases in 2006. Moreover, eight percent of those new TB cases (700,000 people) are HIV-positive people. TB and HIV are a hard-to-treat combination and emergence of resistant-TB among AIDS patients is a growing threat in some African countries. Successful AIDS treatment can be up-ended within weeks by death from untreatable TB. Africa currently has the highest incidence of new TB cases of all regions.The Ugly: Even some of the good news on TB cannot obscure the calamity that drug-resistant TB represents. The WHO reports estimate that about 5 percent of new TB cases each year are resistant to some or all available drugs for treating TB. The costs of treating patients who don't respond to the standard drug regimen can be 10 to 100 times more than for responsive TB, and most countries don’t have facilities to even diagnose MDR-TB and XDR-TB. WHO estimates only about 10 percent of patients with resistant TB will get treatment, meaning that those resistant strains of TB have plenty of opportunity to move around in the population.Many reasons can be given for the emergence and spread of drug resistant TB - and for increases in other drug-resistant diseases as well. Some of the reasons especially relevant to TB are: poor information about TB drug resistance from some parts of the world (only six countries in Africa provided information to the WHO), lack of tools in many countries to monitor patient sensitivity to TB drugs, difficulty in achieving patient adherence to the required drug regimen. All of these factors also contribute to resistance to drugs for other diseases. The CGD Drug Resistance Working Group is studying drug resistance across diseases and will offer recommendations for slowing drug resistance before the next World TB Day. In the meantime, take two minutes to do what World TB Day set out to do 8 years ago: to remind people that the sanitariums are gone, but TB is not. So go ahead: take a whack at those nasty TB bacilli!
CGD blog posts reflect the views of the authors, drawing on prior research and experience in their areas of expertise.
CGD is a nonpartisan, independent organization and does not take institutional positions.
