Speaking on the eve of the conference Dr Lee Reichman of the New Jersey Medical School’s Global TB Institute revealed that more people died of TB last year than ever before. ‘TB is not sexy enough to care about,’ said Reichman, flashing a chart showing that 1.6-million died annually of TB while 813 have died of SARS, 254 due to avian influenza , 5 due to anthrax and non due to smallpox.
‘The difference is that people get excited about these diseases, but not TB,’ said Reichman.
He said it was critical to hold governments in the 22 high burden countries accountable, questioning why they are not able to control a preventable and curable disease.
‘We will make a huge impact on the epidemic if we can do something in these 22 high burden countries (responsible for 80% of TB cases in the world),’ said Reichman.
Reichman pointed out that political commitment was critical to making the World Health Organisation strategy of Directly Observed Treatment Short-course (DOTS) a success. ‘We owe it to our patients. We owe it to them that when they walk for hours to collect their treatment that the drugs are there,’ he said.
Latest global estimates for 2007 show that there were 511 000 people with multi-drug resistant (MDR) TB of which around 150 000 died. Extensively-drug resistant (XDR) TB cases were estimated to be around 50 000 in 2007, with 30 000 deaths. However, Reichman pointed out that the MDR TB figures were ‘highly suspect’ as you need laboratories and sophisticated tests to diagnose patients, and these tools and resources were missing or completely inadequate in many of the high burden countries.
‘We should not let governments get away with claiming there is not MDR or XDR TB in their countries when they have not laboratories to diagnose it,’ he said.
‘MDR TB is a man made,’ added Reichman. ‘It is caused by private doctors who are getting away with not being regulated around how they treat TB while they don’t know a damn thing about it.’
Paula Akugizibwe of the AIDS and Rights Alliance of Southern Africa concurred that there was no question that MDR TB was a manufactured phenomenon. ‘But the reasons for its emergence can’t be limited to any one sector,’ she warned. ‘There are gaps across the health system that continues to generate drug-resistant TB, even today ‘ such as poor infection control, patients lost to follow-up and lack of affordable and timely drug-resistant TB diagnostics.’
Lesley Odendal , TB Policy Researcher at the Treatment Action Campaign in South Africa said private doctors did play a role and it was problematic, ‘but it is certainly not the driver of TB’.
‘Drug-resistant TB is a man made problem but only in that we are not diagnosing and treating patients fast enough and not putting in place measures in our health systems,’ said Odendal.
‘In South Africa for example more people have drug-resistant TB due to primary infection from a drug-resistant TB infected person than those who have been on treatment before. We must also ask why patients are not adhering. Is it not because DOTS is impractical, not patient centred, our facilities are far and drug stock outs occur?’ asked Odendal.
William Wells, director at the Global Alliance for TB Drug Development confirmed they were already looking at how they will ‘protect’ future drugs against abuse and misuse and what education programmes would have to be put in place to ensure the drugs are used properly.
Reichman said it was critical that the world ensured that the more than 9-million new cases diagnosed annually with TB are diagnosed and treated and that everything is done to prevent them from becoming drug-resistant.
