On Wednesday, government ministers and senior officials from 27 countries pledged to intensify efforts to control the spread of drug-resistant tuberculosis (TB) following warnings from the World Health Organization (WHO) that the various drug-resistant forms of the disease are emerging as a major global threat.

Ministers from what the WHO describes as “high multidrug-resistant TB (MDR-TB) burden countries,” are meeting this week in Beijing from 1 to 3 April to address the alarming threat of MDR-TB. The meeting is being organized by the WHO, the Ministry of Health of the People’s Republic of China and the Bill & Melinda Gates Foundation.

Also attending are WHO Director-General Margaret Chan and Bill Gates, who co-chairs the Foundation.

At the end of the first day of the meeting, the countries endorsed the Beijing “Call for Action” on TB Control and Patient Care. This requires 2 billion US dollars over the next two years to fund TB and MDR-TB control and care.

TB is a bacterium that spreads when an infected person coughs, sneezes or spits, for example while talking. But as Chan explained at the meeting, the HIV/AIDS epidemic took the spread of TB to another level: global control was largely successful before then.

TB would still be a highly treatable disease, except for one alarming thing: it is evolving into drug resistant forms that are also more deadly. One form is multidrug-resistant TB (MDR-TB) which does not respond to two top first line drugs. The other form is extensively drug-resistant TB (XDR-TB), which is virtually untreatable.

The main reason that these forms are on the rise is because people do not complete their course of treatment. This means the drug is in the body long enough for the TB bacteria to “learn” about it, but not long enough to kill them off, so they mutate into resistant forms and spread.

Countries developed prevention and treatment strategies after the WHO declared TB a global public health emergency in 1993, but, as Chan explained, “substandard treatment of normal TB drives the development of multi-drug resistant strains”.

TB can be treated in 6 months with four antibiotics, whereas drug resistant forms need more expensive drugs and treatments can take up to 2 years.

Many experts blame poor healthcare systems for the spread of drug-resistant TB, because they fail to monitor or educate their patients on the importance of completing their treatment. Others say it is very difficult to do this in conditions where people move from town to town to escape their conditions, to find work, or because it is part of their culture to move around a lot.

However, at the meeting, health ministers agreed that a large part of the problem for them in dealing with emerging M/XDR-TB cases is lack of trained health care workers, unregulated sale and use of anti-TB drugs, and not enough use of fixed-dose combination medicines, reported Xinhua, China’s state run news agency.

Under the Call for Action plan, the countries with the highest drug-resistant TB burden will get help to provide universal access to diagnosis and treatment by 2015. If fully implemented on time, this will meet the global target of treating 1.6 million people with MDR-TB and XDR-TB by 2015.

Chan said the action needs a new kind of urgency because “because national TB programs cannot, by themselves, manage these new threats.”

Existing TB programs only detect less than 5 per cent of estimated MDR-TB cases, she said, and less than 3 per cent of them are getting treatment in line with standards recommended by the WHO.

She also warned that the cost of treating MDR-TB can be up to 200 times that of treating normal TB.

China’s Health Ministry and Bill Gates also announced a joint initiative to improve detection and treatment of TB in China, which according to the WHO has 15 per cent of the world’s TB cases. This is 1.3 million new cases and more than 200,000 deaths a year.

Also, China has more than 20 per cent of the world’s drug resistant cases, the second highest rate in the world.

Under the new project, to which the Bill & Melinda Gates Foundation will donate 33 million US dollars, China will bring in new diagnostic tools, drugs and patient monitoring, with new ways to help patients complete their treatment.

Health Minister Chen Zhu told a press conference that the Chinese government invested 1 billion yuan (146 million US dollars) last year in TB control, and has also been financing a national project to find new diagnostic tools and drugs for HIV/AIDS and TB by 2020.

Bill Gates said:

“Because of its skill, its scale, its TB burden, its love of innovation, and its political commitment to public health, China is a perfect laboratory for large-scale testing of new tools and delivery techniques to fight TB.”

The aim of the 3-day meeting is to:

  • Build consensus and political commitment globally and in high M/XDR-TB burden countries.

  • Rapidly scale up the prevention and management of MDR-TB.

  • Initiate 5-year national strategic plans for MDR-TB, as part of national TB and health sector plans.

Sources: Xinhua, Associated Press, Bill and Melinda Gates Foundation, WHO.

Written by: Catharine Paddock, PhD