Agencies warn of global TB "powder keg", funding gap

LONDON/GENEVA Mon Mar 18, 2013 10:33pm IST

A volunteer holds sputum samples from tuberculosis patients at the Indonesian Union Against Tuberculosis clinic in Jakarta, April 4, 2011. REUTERS/Beawiharta/Files

A volunteer holds sputum samples from tuberculosis patients at the Indonesian Union Against Tuberculosis clinic in Jakarta, April 4, 2011.

Credit: Reuters/Beawiharta/Files

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LONDON/GENEVA (Reuters) - Deadly strains of tuberculosis that are resistant to multiple drugs are spreading around the world, and authorities urgently need another $1.6 billion a year to tackle them, global health officials said on Monday.

Donors should step up with "significant funding" to help experts track down all existing cases and treat the most serious ones, the World Health Organisation (WHO) and the Global Fund to Fight AIDS, TB and Malaria said in joint statement.

Margaret Chan, WHO director general, said nearly 4 percent of people newly infected with TB worldwide were resistant to multiple drugs from the start - signalling that resistant forms of the disease were being transmitted directly from person to person.

In some countries, including regions of Russia, up to 35 percent of new cases are multi-drug resistant.

"This gives you an idea of powder keg we are sitting on," Chan told a news briefing in Geneva, where both agencies are based.

TB is often seen as a disease of the past - but the emergence over the past decade of strains that can not be treated with existing drugs has turned it into one of the world's most pressing health problems.

Of all infectious diseases, only HIV - the human immunodeficiency virus that causes AIDS - kills more people.

In 2011, 8.7 million people fell ill with TB and 1.4 million died of the disease. The WHO says as many as 2 million people may be infected with drug-resistant strains by 2015, up from the current estimate of 630,000.

Treating even typical TB is a long process. Patients need to take a cocktail of antibiotics for six months and many fail to complete the treatment. That, alongside overuse and misuse of antibiotics, has fuelled drug resistance.

Multi-drug resistant TB withstands two standard drugs. And an even more severe form known as extensively drug-resistant TB - which can evade even the most highly effective drugs - was reported in at least 77 countries in 2011, according to the WHO.

Doctors in India have also reported cases of totally resistant TB, for which there are no effective drugs.


The WHO and the Global Fund said they had found an anticipated gap of $1.6 billion in annual international support for the fight against TB in 118 low and middle income countries.

If this gap were filled, it could mean 17 million patients with TB and multi drug-resistant TB could be fully treated, saving about 6 million lives between 2014 and 2016, they said.

Mark Dybul, executive director of the Global Fund, said if donors did not act now, costs of dealing with drug-resistant TB could rocket. "It is invest now or pay forever," he said.

Russia, India, China and South Africa together account for nearly two-thirds all multi-drug resistant TB cases, said Mario Raviglione, director of the WHO's Stop TB department.

"This is a global epidemic and one that we need to take seriously globally," Dybul said.

The agencies said most of the extra money was needed to step up the accurate diagnosis of TB, and the process of establishing which drugs it may resist. Cash was also needed to improve access to effective medicines.

On top of the $1.6 billion funding gap, the WHO and its partner health agencies said another $1.3 billion a year was needed to boost research on TB and encourage the development of new drugs, diagnostic tests and vaccines.

The vaccine known as Bacilli Calmette-Guerin, or BCG, is given routinely to babies in countries with high rates of TB to prevent severe disease. But its protection wears off in a few years and it does not protect against the most common form of TB that invades the lungs of adults and adolescents.

Eagerly awaited results last month from trials of the first new TB vaccine for 90 years were disappointing, showing it offered no added benefit over BCG. Drug companies and research groups are working on other potential new vaccines but scientific progress is proving tricky and slow.

(Editing by Alison Williams)


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