March 21, 2001, Geneva — On the occasion of World Tuberculosis (TB) Day 2001, the international medical aid agency Medecins Sans Frontieres (MSF) calls for more practical and affordable treatments for tuberculosis. One third of the world's population is currently infected with TB, two million people die from it every year, and the HIV/AIDS epidemic is exacerbating the crisis. Despite these devastating statistics and a wealth of knowledge on TB, little research is being done into new medicines for the disease. The last truly innovative medicine was developed over 30 years ago and the last vaccine in 1923.
The most effective regimen currently available for treating TB is DOTS (Directly Observed Treatment Short Course). The DOTS protocol consists of direct supervision by a health care worker of the patient's daily intake of at least four drugs for six to eight months. This is to ensure the patient's adherence to treatment and reduces the risk of developing multi-drug resistant TB (MDR-TB).
"DOTS is the best tool we currently have, and we continue using it in our TB programmes. But for the majority of TB patients who are poor to begin with, DOTS isn't cheap", says Ian Small, Director of MSF's Aral Sea Area Programme in Uzbekistan
"We need to examine and expose the true cost of DOTS", Small said. "Even under the best circumstances, the treatment is long and labour intensive, and lapses can lead to MDR-TB."
Published research results and our own field experiences, conclude that the implementation of DOTS is most effective when it is coupled with a comprehensive support package for the patient that includes not only the cost of drugs and health care, but also compensation for transportation, food, and loss of salary. This requires a huge commitment of resources from governments and communities in countries where health budgets are already stretched thin, as well as from patients enrolled in the program who may not be employable during the treatment period.
"From our experience, the need for simpler TB treatments is painfully clear. Yet it is shocking how little research and development is currently taking place," says James Orbinski, M.D., who currently heads the organization's TB drug access initiative. "MSF strongly supports the Global Alliance for TB Drug Development in its mandate to foster public and private partnerships aimed at finding and developing new TB treatments", says Dr Orbinski. "But it is imperative that governments, international agencies and the pharmaceutical industry all step up their efforts simultaneously to bring new, simpler drugs on the market to combat TB."
MSF currently runs more than 20 TB programs worldwide and has launched a global campaign for access to essential medicines. For more information, see www.msf.org and www.msfaccess.org
Note: "DOTS, TB Cure For All" is the tagline of the WHO-led STOP TB initiative in 2001