Also available in: Español

Source: Salud por Derecho

The tuberculosis (TB) is a curable and preventable disease, however, it has become the most lethal infectious disease in the world – beyond the HIV – and it is one of the ten biggest global causes of mortality: in 2017 alone, around 1.4 million people died of, and some ten million people became ill with tuberculosis.

On March 24th, today, is the world TB day. A disease spread around the world, although during 2017 more than 95% of deaths took place in low and middle income countries. Seven countries accounted for 64% of total deaths: India, Indonesia, China, the Philippines, Pakistan, Nigeria and South Africa, which also account for two thirds of the TB new cases.

Through scaling up, diagnosis and treatment of people with TB mortality has decreased almost 40% between 2000 and 2017, preventing around 54 million deaths during the same period.

Notwithstanding, there are still huge and persistent gaps. For example, in the diagnosis: In 2017 only 6.4 million of the new infections were reported, even though there were 10 million estimated. Although this is a historic peak for new detected cases, possibly more than 3.5 million people remained undiagnosed and, consequently, without treatment.

 A disease resistant to drugs

In addition, TB has drug resistant, multiresistant (MDR-TB) or extremely resistant (XDR-TB) strains, not responding to one or more of the common drugs. In 2017 there were 560,000 estimated new cases of drug-resistant tuberculosis, out of which only 160,000 were detected and less than 140,000 (25% of the total estimated) under treatment.

People with TB drug resistant, multiresistant, or extremely resistant should receive different usual treatment to be healed. However, these treatments are not always available and are usually extremely toxic and with a lengthy period (about two years of pills and vaccines, in contrast with the 6 months for normal TB treatment). Furthermore, the figures show only a 55% cure rate with these treatments for MDR-TB and a 35% cure rate in cases of XDR-TB.

The TB drug-resistant epidemic disproportionately punishes Eastern Europe and Central Asia regions, almost half of the TB cases detected there are multiresistant and the number of people with resistance increases by more than 20% each year.

Two new drugs for DR-TB 

After more than 50 years without new drugs, the bedaquiline and delamanid were the first effective drugs with fewer side effects emerging to treat the resistant strains of the disease, these drugs were approved by the European Medicines Agency in 2012 and 2014, respectively. However, up to date, only 12% of patients in need have had access to these drugs since then, despite the WHO recommendation in August 2018 to include bedaquiline as the central axis of medication regimens to fight MDR-TB.

The main reasons are the concerns about the lack of data demonstrating the safety of drugs, the reluctance of governments to include new drugs in their national programs, or the few incentives of pharmaceutical companies to register and market their products in poor countries. The current prices of drugs also represent an insuperable access barrier. Research by Doctors Without Borders shows that the new treatments, including the two drugs entail a large increase in the price versus the traditional treatments. For example, a 20 months treatment with bedaquiline and delamanid could reach $ 9,000, 500% more than the current price.

Commitments after the first United Nations High Level Meeting on TB

The Sustainable Development Goals (SDGs) signed at the United Nations aim to reach the end of the tuberculosis epidemic in 2030, but at the current rate we would not be able to reach that goal for up to 180 years. And, despite the progress made in recent years, the incidence of new cases has only decreased by 2% per year.

In September 2018, the first United Nations High Level Meeting on tuberculosis took place in New York, demonstrating the need to act jointly and at the highest level against this pandemic. World leaders, Ministers of health, civil society and people affected by the disease signed a joint Political Declaration with epidemiological goals for the TB prevention, diagnosis and treatment.

One of the commitments, among many others, is to guarantee diagnosis and treatment in order to successfully treat 40 million people with TB from 2018 to 2022. To this effect, it is crucial the commitment to overcome the disease – resistant forms through drugs and diagnostics access programs, and the commitment to accelerate R&D on essential tools such as vaccines, drugs and affordable, effective and safe diagnostics for all strains of the disease.

Financing

The High Level meeting also bringing in its wake a commitment for funding. According to estimates of Stop TB Partnership, to end this pandemic it will be necessary to double the $6.9 billion available in 2018 for prevention, diagnosis and treatment in low and middle income countries, to reach at least $13 billion by year through 2022, including WHO and funding agencies contributions.