Drug-resistant tuberculosis could cause deadly epidemic

Dr. Margaret Chan, the director-general of the World Health Organization, took the opportunity at a recent three-day forum on drug-resistant TB in Beijing to warn participants, which included health officials from 27 countries, that traditional drugs are becoming useless against treating some strains of tuberculosis. She said that she fears that drug-resistant tuberculosis cases could "spiral out of control" and that the costs of treating patients could be up to 200 times more than regular cases of tuberculosis. "The situation is already alarming, and poised to grow much worse very quickly," she said.

William Gates, founder of Microsoft and co-chair of the Bill & Melinda Gates Foundation, also attended the forum. Mr. Gates pointed out that scientific overconfidence has led to a lack of innovation and urgency in fighting tuberculosis, which affects 9 million people each year and causes 2 million deaths. "The most commonly used diagnostic test is more than 125 years old. The vaccine was developed more than 80 years ago, and drugs have not changed in 50 years," he told participants. The Foundation is currently financing research on a new TB vaccine. "It will be about five to six years from now before we could have a completely new vaccine," said Gates.

In early 2007, 20 countries reported cases of the more fatal form of the disease. By the end of 2008, that figure had risen to 54 countries. India, China, Russia, South Africa and Bangladesh have experienced the highest outbreak of multi-drug-resistant strains of TB. And scientists are reporting that they are now seeing what they have called "extensively drug-resistant TB - even worse strains that do not respond to either of the two principal anti-TB drugs, nor to more expensive second-line drugs." Jorge Sampaio, the U.N. secretary general's special envoy to halt TB, who also attended the forum, called the extensively drug-resistant strain "a very deadly and devastating epidemic."

So why are virulent forms of TB on the rise? One reason is the improper use of drugs and poorly managed treatment regimes, notes Dr. Chan, who pointed out that treatment often lasts four to six months, and that traditional treatment typically leaves patients wishing to end the medicine. "Instead of taking two to four pills, one has to take 13 pills. Put yourself in the position of the patient. Thirteen pills are not 13 candies," she said.

During the forum, Gates offered a grant of $33 million to China's Ministry of Health to finance an innovative pilot program for TB prevention that other nations could take advantage of. The program uses new systems to reduce pill intake, provides TB patients medicine kits with built-in reminder alarms, gives incentives to doctors to monitor TB, and pays for the development of new diagnostic tests.

News Release: UN: Killer strains of tuberculosis may ‘spiral out of control' www.mcclatchydc.com April 2009