Global Call to End Drug Resistant Tuberculosis


An Analysis By Vivian Ihechu, News Agency of Nigeria (NAN)

Antimicrobial (including antibiotic, antiviral, antifungal and antiprotozoal) agents are critical tools for fighting diseases in humans, terrestrial and aquatic animals and plants, but they are becoming ineffective.

Antimicrobial resistance (AMR) has become terrifying as diseases that were once easy to treat are being rendered virtually incurable.

One of such is Tuberculosis (TB), one of the top 10 causes of death worldwide, a curable and preventable disease caused by the bacteria (Mycobacterium Tuberculosis) that most often affects the lungs.

The World Health Organisation (WHO), in its report “No Time To Wait: Securing the Future From Drug Resistant Infections April 2019’’, notes that drug-resistant diseases already cause at least 700,000 deaths globally a year, including 230,000 deaths from multidrug resistant tuberculosis.

The figure could increase to 10 million deaths globally per year by 2050 under the most alarming scenario if no action is taken, the report presented to the Secretary-General of the UN, Antonio Guterres says.

Recent discourse alerts that Multidrug Resistant TB (MDR-TB) remains a public health crisis and a health security threat, hence the urgent call to action to end TB and MDR-TB because of the huge economic, health, environmental, mental and social implications.

Also, ending the TB epidemic by 2030 is among the health targets of the Sustainable Development Goals.

A new report by the Economist Intelligence Unit (EIU) also emphasises the urgent need for focused global action to address the growing threat of drug resistant tuberculosis (DR-TB) as it is the leading contributor to deaths from antimicrobial resistance (AMR).

The EIU is the thought leadership, research and analysis division of The Economist Group and the world leader in global business intelligence for executives.

The report:“A Call to Action: It’s Time to End Drug Resistant Tuberculosis’’, published on Tuesday, May 7, was made possible with support from Johnson & Johnson.

Read report:

According to the report, TB has been adjudged as one of the world’s deadliest infectious disease as nearly one-quarter of the world’s population, 1.7 billion people, are infected with Mycobacterium tuberculosis, the bacterium that causes tuberculosis.

In most of them, the infection is in a dormant state; but every year, 10 million people develop active tuberculosis and approximately 1.6 million people die from the disease.

In the past 200 years alone, TB has killed over one billion people, this is more deaths than from malaria, influenza, smallpox, HIV/AIDS, cholera and plague combined.

On Drug-Resistant Tuberculosis (DR-TB), it is a particularly complicated form of the bacterial infection and is characterised by resistance to at least one of the most powerful drugs in the first-line treatment regimen.

DR-TB is the leading contributor to deaths from antimicrobial resistance (AMR); it is an airborne infectious disease that does not respond to the most commonly used TB medicines.

The EIU report says that in 2017 alone, DR-TB affected 558,000 people in 2017, causing 230,000 deaths; only an estimated one in three people with DR-TB are diagnosed, and one in four treated.

Among the treated, only 55 per cent are cured.

To make matters worse, TB is airborne, and one untreated person can infect 10-15 others in a year through close contact.

Beyond its devastating impact on human lives and the global health security threat it poses, DR-TB also takes huge impact on the economy.

The analysis shows that DR-TB costs billions of dollars from loss of life and worker absenteeism, and could reduce foreign direct investment and tourism.

“Estimates and forecasts now show the enormous cost of inaction; unchecked DR-TB could cost the global economy 17 trillion dollars by 2050.

“These impacts will play out across multiple direct and indirect channels.’’

According to the report, based on current incidence and prevalence rates, DR-TB deaths in a single year are estimated to cost the global economy at least 17.8 billion dollars.

“This represents a loss of future gross domestic product in purchasing power parity (PPP) terms, due to deaths from DR-TB globally (i.e., 230,000 in 2017).

“In addition, in a single year, DR-TB causes a loss of at least 3 billion dollars in PPP terms due to work absences in the approximately 100 countries for which data were available.’’

In Nigeria, the report shows that the country incurred 0.26 billion dollars Future GDP at PPP losses due to early mortality from Drug Resistance (DR-TB) in 2017.

Speaking with NAN in an earlier interview, Dr Victor Babawale, a Senior Medical Officer in the National Tuberculosis and Leprosy Control Programme (NTLCP), Federal Ministry of Health (FMoH), Abuja, had highlighted the challenges of MDR-TB.

“MDR-TB is resistant to drugs and it is more difficult to treat; it has a higher mortality and morbidity rate but in all, TB disease has high mortality.

“At least we have recorded 67 per cent out of a 100,000 population in terms of mortality rate of TB in Nigeria.

“From our data surveillance system, it shows that out of that estimated 400,000 cases of tuberculosis annually, we are only able to detect 140,000, which is one fourth of TB that can be detected in Nigeria.

“This means that ¾ (three over four) are out there spreading the disease and the mode of transmission of TB is easy, it is by air,’’ he said.

Alarmingly, the EIU report states that the estimates are conservative.

They do not include the economic impacts of work absences among the approximately 400,000 people annually with DR-TB who are not diagnosed and treated, or the nearly 70,000 estimated undocumented deaths from DR-TB.

Without urgent action and a robust policy response to reverse these trends, these costs will only grow, yet more people will lose their lives.

Jaak Peeters, Global Head, Johnson & Johnson Global Public Health, Janssen-Cilag GmbH says: “The EIU report sounds the alarm on DR-TB.

“If the disease continues to be left unchecked the damage to people’s lives and entire economies could be devastating.

“Turning the tide on this disease requires that we act immediately; by working together in new ways and with a real sense of urgency, we can end this deadly airborne threat,’’ Peteers said.

Going forward, addressing the trend requires the world to act immediately as the cost of inaction is high and it will require good value for money.

The EIU report says there must be investment in diagnosis and treatment of DR-TB because of the high benefit-to-cost ratio.

It also recommends full funding for Research and Development; also proper diagnosis and linkage to care are essential.

“Addressing DR-TB must align with other important health, economic and societal priorities.

“ National leaders, in partnership with other stakeholders, must be held accountable for progress to end DR-TB.

“Stronger public advocacy is required; it will be critical to ensure that governments and policymakers remain committed to the fight against DR-TB and tuberculosis as a whole.

“The voice of the TB community is critical for engaging a wider group of stakeholders to drive change,’’ the report advises.

Peter Sands, Executive Director, the Global Fund to Fight AIDS, TB and Malaria, says innovation, collaboration, improved execution and better use of data are essential if we must achieve the SDG ambition of ending TB by 2030.

In summary, millions of lives can be saved over the coming years, and the very real threat of DR-TB can be ended by a combination of increased commitment, investment and coordination at the local, national and global levels.

“This disease can be ended, and we all have a role to play,” the report says.

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