Drug-Resistant Tuberculosis: The New Face of an Old Disease

MSF doctor making rounds together with medical staff of the ministry of health in the TB wards of Makanyane clinic. Swaziland, MSF clinic in Makanyane. October 2013.
Sven Torfinn
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Tuberculosis is one of the gravest public health threats facing the world today, and is all the more serious as drug resistance takes a grip.

Tuberculosis (TB) is a curable disease, but an inadequate global response has allowed the growing epidemic of drug-resistant tuberculosis (DR-TB) to take hold. Drug-resistant forms of TB are much harder to cure: standard TB drugs don’t work, and doctors must turn to long, arduous, complex and expensive treatment regimens that only cure half the patients at best.

DR-TB originally developed because of improper use of anti-TB medicines, and now these deadlier DR-TB strains are spreading from person to person, even to people who’ve never had TB before. Today there are nearly half a million new cases of multidrug-resistant TB a year, with drug-resistant forms of TB reported in virtually all countries worldwide.

As new tools for diagnosing MDR-TB rapidly become more widely used, more and more people are being diagnosed, but only one in five people who need it can obtain treatment. And no matter where you live in the world, the only treatments available entail people swallowing well over 10,000 pills and having eight months of painful injections, with potentially horrific and long-lasting side effects.

As the numbers mount, developing countries face insurmountable drug costs, exacerbated by the long periods of care and management of side effects. It is perhaps little wonder that, with the high costs and the inadequate treatment, DR-TB care is so minimally available worldwide. Meanwhile the critical gap between the numbers of suspected DR-TB cases and those successfully treated leaves the airborne killer to spread indiscriminately.

New short, safe and effective treatment combinations are key to unlocking the global DR-TB crisis, and today there is reason for hope. The first new TB drugs in 50 years, along with developments in diagnostic tests and new approaches to care, have real potential to radically improve patient outcomes. Yet no single drug can combat this disease, and merely adding new drugs to today’s regimens won’t solve the problems of complexity, toxicity, length and cost.

Unfortunately, patients remain years from getting the cures they desperately need unless governments, pharmaceutical companies and researchers quickly mobilise the necessary resources and political will.

Collaborative research is urgently needed to find much improved treatment combinations that are fit for purpose, reasonably priced and able to be rolled out rapidly in resource-limited settings. In the meantime, increased efforts must be made to diagnose and treat more people with DR-TB today to save lives and slow the spread of this virulent disease.

The DR-TB crisis is everybody’s problem and demands an immediate international response. Each year we are diagnosing more patients with DR-TB, but the current treatments aren’t good enough to make a dent in the epidemic. It doesn’t matter where you live; until new short and more effective treatment combinations are found, the odds of surviving this disease today are dismal,

Sidney Wong
MSF doctor making rounds together with medical staff of the ministry of health in the TB wards of Makanyane clinic. Swaziland, MSF clinic in Makanyane. October 2013.
Sven Torfinn