APPG-GTB members express concern on the growing threat of multi-drug resistant TB

In a Lancet Comment discussing the WHO Global Tuberculosis report 2013 published today [Wednesday 23 October], members of the UK All-Party Parliamentary Group on Global Tuberculosis (APPG-GTB) and lead author Professor Ali Zumla from University College London sound an alarm as the growing threat of multi-drug resistant TB (MDR-TB) to regional and global health security becomes more apparent.

“The report details some striking successes towards achieving the Millennium Development Goals (MDGs) and related 2015 targets for global TB control but it also identifies specific areas of concern for which urgent political and funder attention is required”, state the authors. “In particular, a large number of people remain undiagnosed and untreated and continue to spread TB in the community.”

Despite the achievements—there has been an overall decline in TB incidence and mortality; and the global target of a 50% reduction in TB mortality over the period 1990–2015 seems possible—only around a fifth of the 450 000 people estimated to have MDR-TB in 2012 were detected. Additionally, the success rate of MDR-TB treatment remains below 50% as a result of high levels of death and losses to follow-up.

But the authors remain confident that these challenges are not insurmountable: “Recent advances in new tuberculosis diagnostics, drugs, laboratory methods for detecting MDR tuberculosis, and strategies for proactive screening for tuberculosis, now present opportunities and fresh solutions…Commitment from high burden countries, the Global Fund to Fight AIDS, Tuberculosis and Malaria, bilateral agencies, and the pharmaceutical sector is imperative to find solutions to problems with drug supply and capacity for tuberculosis care which stand in the way of scaling up MDR tuberculosis treatment.”

The authors urge donor and high burden countries to see TB as a top killer alongside HIV and malaria that deserves the same level of collective commitment, adding that, “To address these priority concerns, existing commitments must be sustained and, as the report outlines, at least an additional US$2 billion per year is needed. The full replenishment of the Global Fund in 2013 is essential for donor-dependent countries, since the Global Fund provides about three-quarters of international donor funding for tuberculosis.”

They conclude, “We now have the tools, knowledge, and expertise to achieve global tuberculosis control, and the time has come for swift and visionary action13 to step up tuberculosis control efforts and drive down tuberculosis incidence rates as rapidly as possible.”