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Spread of drug-resistant TB must be stopped to avoid catastrophe

Kalikesh Singh Deo and Nick Herbert

There are crises that are so terrible and urgent that they merit immediate attention: an outbreak of a killer disease that wreaks havoc across a region, or a natural disaster which leaves tens of thousands desperate and destitute. But there are others to which the world has become inured. Tragically the global tuberculosis epidemic, still killing 1.5 million people a year, is one of these.

Of the 8.6 million people who contract TB every year, one-third do not have access to medical services. Many of them live in the world’s poorest and most vulnerable communities.

The term ‘Missing Million’ was given to the large number of people in these communities who are left undiagnosed and untreated by the healthcare systems across the globe. In this given time and age, with advancements in medical sciences, a preventable disease such as TB claiming millions of lives is simply appalling and unacceptable.

The West once knew TB all too well. The disease was as common a century ago in the UK as flu is today. It claimed the lives of luminaries such as Keats, Orwell and Emily Bronte. It featured in the popular culture of the day. It was responsible for as many as one in four deaths in Victorian England.

Yet today TB is a forgotten disease. Too many people in the West believe that the battle has been won when in much of the world it still rages. A vaccine, widely thought to be effective, in fact offers negligible protection. Now the disease has evolved into a new threat. The golden age of antibiotics has passed: drug resistant strains of the disease are emerging that are effectively impossible to treat. Only half of all patients with drug-resistant TB today successfully complete treatment.

Twenty-two years ago, the WHO declared TB a ‘global health emergency’ but the world failed to mobilise sufficiently. Since then nearly 30 million lives have been lost. Some progress has been made, but at the current rate of reduction, TB will remain a threat to public health for two hundred years.


Calls to step up the global response have been led by the BRICS nations and particularly Dr Aaron Motsoaledi, South Africa’s inspirational Health Minister. With some of the highest rates of TB in the world, South Africa has launched one of the biggest diagnosis and treatment campaigns, showing what can be done. The challenge is to repeat this success worldwide.

India, with more than 2.3 million cases a year, stepped up the fight against TB in 1997. The Indian government has played a stellar role in upping the ante by setting up the largest TB programme in the world, the Revised National Tuberculosis Control Programme (RNTCP) which places more than 100,000 patients on treatment every month. The programme reached complete geographical coverage in 2006, with treatment success rates tripling from 25% to 85%. The RNTCP’s aim to increase case treatment of 90% by 2017 is a welcome move.

In 2013, the National Forum for TB (NFTB) was formed in India, which brought together parliamentarians, policy makers and civil society representatives to discuss the challenges of TB prevention and control in India. The NFTB devised and implemented innovative methods for engaging various stakeholders such as private medical practitioners, technical experts and civil society.

The forum has been at the forefront of pushing for national level policy changes. The forum has also had extensive interactions with policymakers and experts from other countries to learn from successful programmes and interventions. Cross pollination of ideas and strategies from different countries can go a long way in fighting the disease in a quicker and more efficient manner.

There is an urgent need for increased funding and a magnified focus on TB prevention and control and therefore, we believe that parliamentarians have a critical role to play. Keeping this in mind, an international initiative, the Global TB Caucus was founded at the inaugural Global TB Summit in Barcelona. A network of parliamentarians from around the world, the Caucus met for the first time late last year and launched a Declaration that articulates a vision for a world free from TB.

The launch of the Caucus has come at a critical time. The world is at crossroads: we can urgently scale up existing interventions and invest to develop new ones – a road that the WHO estimates could lead to the elimination of TB within a generation – or we can continue on the same path, witnessing millions of lives lost in the years to come and risking an explosion of drug-resistance that could undo all progress.

Figures released today highlight the scale of the catastrophe that could unfold if drug resistant TB is allowed to spread. Over the next 35 years, multidrug-resistant tuberculosis will kill 75 million people and could cost the global economy a cumulative $16.7 trillion – the equivalent of the European Union’s annual output

TB, the disease responsible for claiming more lives in the world’s history than any other, is anything but a problem of the past: it is a present and future threat. That is why we must act now.

Published: Tue, 24 Mar 2015. By Kalikesh Singh Deo and Nick Herbert
Copyright © 2015 Thomson Reuters Foundation

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