Dear Mr President:
I am writing on behalf of the medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) to urge the United States government to combat the global threat of multidrug-resistant TB (MDR-TB) by ensuring that stepped-up action, ambitious MDR-TB treatment targets and increased support for affected countries to utilize new diagnostic and therapeutic tools are included in its forthcoming National Action Plan to Combat Drug Resistant TB.
According to the World Health Organization’s recently released 2015 Global Tuberculosis Report, TB has surpassed HIV as the most deadly infectious disease in the world, killing 1.5 million people in 2014.[i]Alarmingly, it is estimated that only one in four (26%) people with MDR-TB was diagnosed in 2014, with fewer people diagnosed in 2014 than in 2013, although the number of new MDR-TB cases remained roughly the same.[ii] While 3.3% of new TB patients and 20% of previously treated TB patients are estimated to have MDR-TB globally, rates of MDR-TB are frighteningly high in many parts of the world. These numbers jump as high as 15% of new TB patients and 48% of previously treated TB patients in the WHO European Region (most severely in the countries of the former Soviet Union).[iii]
MSF has extensive firsthand experience with the enormous challenge posed by DR-TB. We have been providing TB care to patients across the globe for over three decades and operating MDR-TB treatment programs since 1999.[iv]As one of the largest non-governmental providers of DR-TB treatment, MSF provided TB treatment to 21,500 patients in more than two dozen countries in 2014, of whom 1,800 were being treated for MDR-TB.[v] Still, they represent only a fraction of those in need. Even those fortunate enough to access diagnosis and treatment face grim prospects. According to WHO, 50% of MDR-TB patients successfully complete treatment, and for extensively drug-resistant (XDR-TB), the number drops to just 26%.[vi]
We welcome the US government’s National Action Plan to Combat Drug Resistant TB, which we understand aims to initiate treatment for 50% of MDR-TB patients in ten of the highest MDR-TB burden countries by 2020.[vii]The current US government target is to have 360,000 MDR-TB patients treated by 2019; the new plan can and should expand this target to at least 560,000 MDR-TB patients on treatment by 2020. We encourage the Administration to publically release an ambitious plan as soon as possible, and to ensure that there are adequate funds committed to realizing its aims.
This is a pivotal moment in the fight against TB: new TB diagnostics and treatment regimens have provided the world with an unprecedented opportunity to halt the growth of MDR-TB around the globe. In the field of diagnostics, for instance, the development of devices such as the GeneXpert MTB/RIF diagnostic test has made it possible to greatlyexpand access to accurate DR-TB testing. For those diagnosed with drug-resistant TB, new drugs such as bedaquiline and delamanid—the first new TB drugs to enter the market in over 40 years—offer an alternative to older, less effective treatments that come with horrific side effects and dismal cure rates.[viii]While expanded implementation of these new diagnostics and treatments is vital to fighting MDR-TB, it is also necessary to increase the investment in research and development (R&D) to ensure even better diagnostics and treatments in the future. Thus, the President’s Plan must also include support for robust, sustainable R&D and should consider innovative R&D solutions to help develop the new regimens that MDR-TB patients so desperately need.
Medical breakthroughs have increasingly made it possible to effectively combat MDR-TB, but without substantial political will and financial resources to implement these breakthroughs—and subsequent innovations—they will do little to reverse the global MDR-TB epidemic. As healthcare providers on the front lines of this struggle against MDR-TB, MSF urges the US government to move swiftly to address MDR-TB, beginning with the release of the National Action Plan to Combat Drug Resistant TB, the setting of bolder targets and a commitment to marshal the resources necessary to achieve these goals, beginning in 2017.
Sincerely, Jason Cone, Médecins Sans Frontières
Denis McDonough, Assistant to the President and Chief of Staff
Valerie Jarrett, Senior Advisor and Assistant to the President for Intergovernmental Affairs and Public Engagement, EOP
Gayle Smith, Special Assistant to the President and Senior Director for Development and Democracy, NSC, EOP
John Holdren, Assistant to the President for Science and Technology and Director, OSTP, EOP
Rob Fairweather, Deputy Associate Director International Affairs Division, OMB, EOP
Heather Higginbottom, Deputy Secretary for Management and Resources, DOS
Ambassador Alfonso Lenhardt, Acting Administrator, USAID
Dr Thomas Frieden, Director, CDC, DHHS
i World Health Organization. 2015 Global tuberculosis report. [Online] 2015 October [Cited 2015 October 23]. Available from: http://apps.who.int/iris/bitstream/10665/191102/1/9789241565059_eng.pdf?ua=1 (pg. 1)
ii Ibid. (pg. 60)
iii Ibid. (pg. 2, 152, 181-184)
iv Médecins Sans Frontières. Out of Step: Deadly Implementation Gaps in the TB Response. [Online] 2014 October [Cited 2015 October 23]. Available from: https://www.msfaccess.org/sites/default/files/MSF_Out-of-Step_Final_for_printOct17_0.pdf (cover page)
v Médecins Sans Frontières. International Activity Report 2014. [Online] 2015 July [Cited 2015 October 27]. Available from: http://www.msf.lu/fileadmin/WEBLibrary/6_RO/International_Activity_Report_2014_EN.pdf (Countries include: Armenia, Bangladesh, Cambodia, Chad, Colombia, Ethiopia, Georgia, India, Kenya, Kyrgyzstan, Lesotho, Madagascar, Malawi, Myanmar, Niger, Mozambique, Papua New Guinea, Russia, South Africa, Tajikistan, South Sudan, Sudan, Swaziland, Uganda, Ukraine, Uzbekistan, Zimbabwe)
vi World Health Organization. 2015 Global tuberculosis report. [Online] 2015 October [Cited 2015 October 23]. Available from: http://apps.who.int/iris/bitstream/10665/191102/1/9789241565059_eng.pdf?ua=1 (pg. 67-68)
vii Aziz R. Ambitious new U.S. plan may put hundreds of thousands on MDR-TB treatment. Science Speaks: HIV & TB News, Center for Global Health Policy. [Online] 2015 July 23 [Cited 2015 October 27]. Available from: http://sciencespeaksblog.org/2015/07/23/ambitious-new-u-s-plan-may-put-hundreds-of-thousands-on-mdr-tb-treatment/
viii World Health Organization. WHO interim guidance on the use of delamanid in the treatment of MDR-TB. [Online] 2014 October 28 [Cited 2015 October 27]. Available from: http://www.who.int/tb/features_archive/delamanid/en/