A regional and global solution to the spread of multidrug-resistant tuberculosis (MDR TB)

Controlling the spread of multidrug-resistant tuberculosis (MDR TB) and other infectious diseases is a multi-national problem that requires a multi-national treatment response, a Policy Forum article published in PLOS Medicine this week argues.

The paper, written by Kevin Cain of the United States Centers for Disease Control and Prevention and colleagues from the Kenya Ministry of Health, The United States Agency for International Development (East Africa Regional Office), the International Organization for Migration (Kenya), and the United Nations High Commission on Refugees (Kenya), presents strategies which, if adopted by governments and health agencies, could prevent further spread of MDR TB among refugees and local populations in East Africa.

MDR TB and other infectious diseases commonly occur in states suffering from political turmoil and armed conflict, such as those in East Africa. The same conditions that promote MDR TB and other diseases often diminish the capacity of the public health system to address these needs, leading patients to seek care in other countries.

An essential first step in combating MDR TB is to establish a principle, consistent with the pillars of the World Health Organization End TB Strategy, that all individuals with the disease should be treated, regardless of country of birth, citizenship, or permanent residence. In many cases, this will require people to be treated outside of their home country.

Building capacity to treat and prevent MDR TB in troubled countries is an essential goal, but can take many years. While capacity is being built, it is essential to find other ways to provide treatment for people with MDR TB.

Echoing the World Health Organization policy for TB control, the authors state that identification and management of MDR TB must be a priority for countries in East Africa and beyond, both for humanitarian purposes and for protection of their own residents.

The authors argue that regional and global solutions not only provide an ethical approach to the challenge of MDR TB but also serve enlightened self-interest for national health protection.