HEALTH: Drug-Resistant Strains of Tuberculosis Growing, Warns WHO

By Marwaan Macan-Markar Reprint | | Print |

Marwaan Macan-Markar

Mexico City, Mar 24 2000 (IPS) - A spate of reports about the drug-resistant strains of tuberculosis (TB) in a number of countries has alarmed health experts, who say that if not curbed the disease could kill more people than its current toll, estimated at two million deaths a year.

In Mexico, for instance, studies conducted in the south of the country have revealed that over 28 percent of TB cases are “resistant to two common antibiotics, rifampin and isoniazid.”

While in other regions, there is evidence that up to 50 percent of TB cases are resistant to some of the “first-line drugs” used as a cure for the disease.

According to the World Health Organisation (WHO), the situation in Mexico is mirrored in a number of countries, spread over Asia , Africa and Latin America. They include China, India, Bangladesh, Mozambique, South Africa, Cote dIvoire, Argentina and the Dominican Republic.

This week, in its first-ever study released about the levels of drug-resistant TB strains in 38 regions, the WHO was clearly worried. The “findings are most alarming,” the report said.

The report noted that developed countries have not escaped the spread of drug-resistant TB. “In Denmark and Germany, the percentage of TB patients resistant to a single drug increased by 50 percent in 1996, and in New Zealand, resistance to a single drug more than doubled in one year.”

No surprise, therefore, that the WHO has called for greater efforts to be made to raise awareness about this issue during World TB Day, marked Friday.

If this rising tide of drug-resistant TB is not addressed, “we can quickly lose ground on health and development gains,” it remarked. “Tuberculosis is a global threat.”

The WHOs remedy for the disease got national airing during Fridays activities. “All countries with high TB burdens (must) ensure nationwide coverage of the basic package for TB control, which WHO calls DOTS,” said Dr. Christopher Dye, an epidemiologist at WHO.

DOTS, which stands for directly-observed treatment short-course, is a programme that depends heavily on health workers and public health systems for its success. It calls upon the health system – not the patient – to be responsible for achieving a cure.

For health workers, that means having to conduct diagnosis through “sputum smear microscopy” and once a TB patient has been identified, ensuring an adequate drug supply, and thereafter providing “standardised short- course chemotherapy by directly-observed treatment.”

Furthermore, health workers are expected to follow the WHO- recommended system for recording and reporting treatment outcomes for all cases.

If pursued properly, added Dye, DOTS contributes to a “very high chance of cure and a very low risk of death.”

The evidence supports Dyes conclusions. “On a global scale more than 1.7 million infectious patients have received effective DOTS treatment. In half of China, cure rates among new cases are 96 percent. In Peru, widespread use of DOTS for more than five years has led to the successful treatment of 91 cases,” the WHO says.

In addition, DOTS has resulted in cure rates of up to 95 percent in some of the poorest countries where implemented. Furthermore, it prevents “new infections by curing infectious patients.”

Cost-wise, too, the WHO considers the DOTS programme affordable. According to current estimates, a six-month supply of drugs for DOTS costs 11 dollars per patient in some parts of the world. And even the World Bank has ranked the DOTS strategy as “one of the most cost-effective of all health interventions.”

According to the WHO, the failure on the part of governments to fully implement the DOTS programme has contributed substantially to the prevailing global health emergency.

“We tend to see more drug resistance in countries that do not yet have good DOTS programmes,” remarked Dye.

Studies by the WHO predict that if not addressed immediately, between this year and 2020, nearly one billion people will be newly effected, 200 million people will get sick and 35 million people will die from TB, a contagious disease that spreads through the air like the common cold.

Currently, nearly three million TB cases occur every year in South and South-East Asia, with Bangladesh, Pakistan, India, Cambodia and the Philippines among those countries recording the highest numbers of infections.

Further, 1.5 million TB cases occur every year in Sub-Saharan Africa and 250,000 cases in Eastern Europe.

This week, in fact, governments from 20 countries that shoulder the burden of nearly 80 percent of the worlds TB cases have been meeting in Amsterdam, the Netherlands, to seek ways of accelerating the current push for greater TB control.

The World Bank, which is part of a coalition of international organisations advocating stronger measures to implement the DOTS programme, warned the gathering about the debilitating impact on development as a result of TB.

“A world free of poverty will remain a mere dream, unless we join hands to overcome major global threats to the poor and marginalised people around the world. Without question, tuberculosis is one such threat, and its control must be on the global development agenda,” stressed Mieko Nishimizu, the Banks vice president for South Asia.

She added that TB and poverty were closely linked. “Poor living and working conditions stimulate transmission and disease, and disease exacerbates economic and social distress.”

And Arata Kochi, head of the WHOs anti-TB campaign, provided a telling illustration of the economic impact TB has on national economies: “India is probably losing three billion dollars a year in GDP (gross domestic product) because of TB.”

Commitments by these governments will provide much needed impetus for the WHO to achieve its projected targets: to detect 70 percent of new infectious TB cases and to cure 85 percent of those detected.