Only ten years ago health experts believed that multiple-drug-resistant TB would never present a real problem. Since then, the relentless rise of cases of MDR TB as monitored by the WHO has buried the idea that we are dealing with an easily contained phenomenon. Today, drug-resistant TB is a disease that poses a global threat.
Latest information may conceal bleaker picture
The latest WHO report on the global spread of MDR TB confirms this view. Yet the picture the report gives us is incomplete. The real situation is probably a lot worse because the information from many countries, particularly African countries is limited and often outdated.
HIV fuelling spread of drug-resistant TB in Africa
The absence of a clear picture of the progress of the disease is worrisome in those African countries where MDR TB has taken a hold among those living with HIV. Only six countries in total in Africa have returned any information at all for the latest survey. For instance, no cases of MDR TB at all are reported from Kenya based on 13 year old data from 1995. Yet MSF is at this very moment treating MDR patients in Kenya. And information on the disease from Mozambique was collected back in 1999 - nearly a decade ago.
What we do know is that difficulties in diagnosis in those countries mean that cases are indeed going undetected. And not only is it much more difficult to provide treatment to patients in places of high HIV prevalence but outcomes for those co-infected are dramatically worse - 60% of patients co-infected with HIV and TB die.
We are off track to meet the challenge
This comes against the backdrop of the wider failings to implement the Global MDR-TB & XDR-TB Response Plan. Multi-drug resistant TB is definitely on the increase but so too is the gap between those who are treated and those who are not. In 2007, only 30 000 people with MDR TB received treatment - far short of the Global Plan's 60,000 target – this year the target is set at 100 000 new cases of MDR in 2008 alone. Even if the Global Plan would be followed, it is still a far cry from reaching the estimated 490 000 new cases of MDR TB each year. It is clear that we are off track in dealing with the challenge.
Treatment scale-up is limited in many countries
Bashing international agencies doesn't answer the problem. With funding for MDR TB being available, for example through the Global Fund to fight AIDS, TB and Malaria, a major factor contributing to the lack of progress is the lack of greater efforts at country level. There has been a lack of response from governments to scale-up treatment of drug-resistant TB. Yet, without national commitments to scale up the Global Plan is dead in the water.
Without better tools, the battle is lost
But the larger lesson to be learnt is that even with renewed efforts to scale-up treatment globally, we cannot beat the challenge of drug resistant TB with the medical tools - diagnostics and drugs - currently at our disposal. They are simply not up to the task.
Tido von Schoen-Angerer