New Delhi/New York, March 24, 2004 (World TB Day) - The international humanitarian medical organization Doctors Without Borders/Médecins Sans Frontières (MSF) today said that we are losing the battle against tuberculosis (TB) because we rely on archaic diagnostic tests and drugs. The HIV/AIDS pandemic has magnified this problem as TB often coincides with, and is made harder to treat by, HIV/AIDS. MSF calls for an urgent increase in worldwide investment in TB research and development.
TB patient in Minsk prison, Siberia. Photo © Roger Job
"Delivering adequate TB care would require a reliable diagnostic test for TB to begin with, but we don't have one," said Dr. Rowan Gillies, president of MSF International, at the Stop TB Partners' Forum in New Delhi. "A growing number of TB patients worldwide also have HIV/AIDS, but the current diagnostic tool can only detect TB in 50% of HIV-patients even in a well-run TB program."
Diagnosis of children is particularly problematic as it mainly relies on detailing the symptoms and signs of TB, but can most often not be confirmed accurately.
Current first-line TB drugs were developed in the 1940s to 1960s. "We can't be satisfied with the TB treatment we and our colleagues in national TB programs have at our disposal today," said Olivier Brouant, head of mission for MSF's TB project in Mumbai. "A patient must take TB treatment daily during six to eight months - surely we can do better than this," Mr Brouant said. In addition, most easy-to-use fixed-dose combinations of TB drugs are not available in pediatric doses in many of the countries MSF works in.
Pharmaceutical companies are carrying out some R&D for TB, but they have generally disinvested themselves from antibacterial R&D. They cannot be relied on to bring a new TB drug to a market that mainly consists of people with very little purchasing power.
Givi, 37, was almost dying when he was transferred to the anti-tuberculosis hospital in Abkhazia. Givi's one obsession is not to infect his 13-year-old daughter, Lama. He weighed thirty kilos when he was transferred from prison to Guliripchi. Alisa, one of the TB specialists at the hospital who visits patients in prison, found him in agony, vomiting blood on his straw mattress. Photo © Serge Sibert/Cosmos
MSF is therefore calling for governments and the World Health Organization to take the lead in defining and funding an ambitious R&D agenda for TB based on public health needs.
A diagnostic test for SARS was developed by the Genome Institute of Singapore just months after the outbreak of the disease last year. "TB kills two million people every year, but where is the sense of urgency that will secure resources and accelerate the process of developing new tools to fight it?" Dr Gillies asked.
MSF currently treats approximately 20,000 TB patients in 30 projects around the world. The organization is also providing antiretroviral treatment to people living with HIV/AIDS in more than 20 resource-poor countries.
TB kills two million people every year. About one third of the world's population is currently infected with TB, and roughly eight million of them develop active TB each year.