Just like Ebola, the TB threat is all too real
Posted
The Ebola outbreak has thrust infectious diseases into the spotlight, and tuberculosis is among the worst. Greater investment in TB research is literally a matter of life and death for the millions affected, write Mario Raviglione and Mel Spigelman.
The current Ebola outbreak highlights the need for strengthened health systems, strategies and tools to fight infectious diseases. The ongoing global tuberculosis epidemic provides related lessons.
Tuberculosis, though curable, remains one of the world's deadliest communicable diseases, according to the just released 2014 World Health Organization Global Tuberculosis Report. In 2013, nine million people developed TB and 1.5 million died. Of those who developed TB, more than half (56 per cent) were in the South-East Asia and Western Pacific Regions.
These numbers reflect an increase from the previous year's estimate, resulting from an investment in helping more countries produce more robust TB data. With more clarity on the burden of disease, we can now see that TB - often called a "silent killer" - actually afflicts patients in numbers that were in the upper range of former estimates.
In 2013, almost 245,000 people developed TB in the Philippines and nearly 330,000 in Indonesia, the fifth largest burden country. In China a massive 855,000 people developed TB in 2013, which makes it second only to India.
Certainly, Australia and its neighbours have excelled at reaching many targets in fighting TB. However, it is a region that is among the hardest hit by multidrug resistant (MDR) TB, with rates more than 25 per cent higher than the global average. Diagnosis remains a critical challenge, with only 16 per cent of estimated MDR-TB cases in the region diagnosed - the lowest in the world.
Finding TB is only part of the battle. Treatment remains woefully inadequate. Of the 71,000 people estimated to have developed MDR-TB in this region in 2013 only slightly more than half (59 per cent) received treatment with second line drugs. Among patients who started treatment with second line drugs in 2011 only slightly more than half (52 per cent) were cured.
One of the main reasons success rates in MDR-TB are so low is the lengthy, complex, and expensive treatment. Current MDR-TB treatment takes 18 months to two years (or sometimes longer), consists of daily injections for six months, about 12,000 pills, and is known to cause severe side effects - partial or complete hearing loss, for example. So unless we improve diagnosis and advance simple, safe, and cost-effective treatments that can be delivered to patients on a wide scale, a deadly treatment gap will continue to exist.
The good news is that the TB treatment research and development pipeline contains 10 prospective new drugs and multi-drug regimens that hold more promise than ever before. New drug combinations could significantly shorten treatment duration, avoid use of injectable medications, and reduce the cost of treating some forms of drug-resistant TB by 90 per cent, making lifesaving treatment available to many more patients across the world.
Australia has invested in the development of some of these treatments as well as other TB tools, helping advance the global response.
Additional funding is needed for these promising treatments to cross the finish line and reach people in need. WHO estimates there is a $US2 billion annual investment gap in TB control and a $US1.3 billion annual gap in TB research and development.
Research and development is one of the pillars of WHO's new "End TB Strategy" strategy that aims to end the global TB epidemic and drive deaths down 95 per cent by 2035. Greater investment is needed to push through the promising innovations that can transform how we treat this neglected disease and end its tragic impact around the world.
Such efforts are literally a matter of life and death for the millions affected.
Mario C. Raviglione MD is the director of the Global TB Programme at the World Health Organization (WHO). View his full profile here. Mel Spigelman MD is the president and chief executive officer of TB Alliance. View his full profile here.
Both are attending the 45th Union World Conference on Lung Health, taking place this week in Barcelona, Spain.
Topics: government-and-politics, diseases-and-disorders, health, infectious-diseases-other
Comments (21)
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Waterloo Sunset 2016:
30 Oct 2014 10:15:52am
"Additional funding is needed !"
of course and as the population reaches unbridled expansion, where is it going to come from - since more facilities will be needed - both at home and in other regions.
Unless we start to have meaningful global discussions about population, we will be victims of our own success (in breeding).
We have nonsensical situations where half of the population are clamouring for more from the other half.
I can see the reasoning; in that we need to look after humanity and the needy, but we are taking the piss out of nature.
The leaders of the world need a G20 population meeting: P101.
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whogoesthere:
30 Oct 2014 11:42:54am
I agree. We (understandably) are doing lots of things to stop people dying from illness or malnutrition or whatever, and to make us all live longer. Even in countries like ours where the birth rate is low our econimies would collapse without growing population from immigration.
It should be blatantly obvious that endless growth in population and consumption is impossible. So what are we doing about it ?. Nothing. Like lemmings towards the cliff is the human race.
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Ann:
30 Oct 2014 2:27:31pm
So you really have no idea of how a high mortality rate amongst young people impacts population growth? There have been so many studies and so much data...
Let me make it super simple for you. When disease is rampant and people regularly die young, families are big. They have to be, in order to get enough adults making it through the gauntlet to reproduce themselves.
When medicine and sanitation are introduced, the first couple of generations continue to be large, but then when they don't die off quickly, people soon get the idea that they don't need to have as many babies - 10 babies now means 10 mouths instead of 5, because deaths have been reduced.
This leads to a population peak (which we are out now) but then a dive (which is projected for the future).
Helping poverty-stricken countries to reduce their mortality rate for the young will actually help with population control in the long run.
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Waterloo Sunset 2016:
30 Oct 2014 4:54:08pm
Yes, I learnt that at prep school....And as that has been going on for many years we obviously need to address global growth!
For instance; Australia, a waterless country should be stabilised at around 30 million; Egypt around 40million: the population that it had around 40 years ago.
If you had travelled - or observed and read as much as I have, you would be more able to make an informed comment instead of being downright rude!
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Waterloo Sunset 2016:
30 Oct 2014 4:54:23pm
Yes, I learnt that at prep school....And as that has been going on for many years we obviously need to address global growth!
For instance; Australia, a waterless country should be stabilised at around 30 million; Egypt around 40million: the population that it had around 40 years ago.
If you had travelled - or observed and read as much as I have, you would be more able to make an informed comment instead of being downright rude!
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Erick Quang:
30 Oct 2014 10:26:10am
Sounds like another attack on the tax payers hip pocket .
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Peter of Melbourne:
30 Oct 2014 11:52:52am
bloody hell... a representative of the WHO demanding even more resources after the complete screw up that organisation has been guilty of in coordinating efforts to deal with ebola.
once again it is "WE WANT MORE MONEY". well mr raviglione where i come from you have to prove you are worth the investment and the WHO as with most other UN agencies is proving they are worth completely disregarding in all matters.
well past time for the WHO to show it is worth the continuing investment of funds by taxpayers across western society by actually being prepared for such pandemics when they occur.
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Ann:
30 Oct 2014 2:24:04pm
"prove you are worth the investment"
Yeah, I guess saving the lives of all those poor people isn't worth it, right?
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Good Grief:
30 Oct 2014 4:04:02pm
Not if 70 cents to every dollar I give ends up as commissions, travel expenses, and 'administrative' fees for people living in first world countries.
I'd rather donate to an institution that gives a definite percentage of my money goes directly to tackling the problem on the front. Assuming of course, the premise is that Australians are sitting on an inexhaustible cornucopia of wealth and resources that somehow be used to solve all of the world's problems mentioned in bi-weekly articles from the ABC asking for more money.
It's not like we aren't afflicted with inflating bills, rising costs, new taxes, housing inflation and high youth unemployment, right?
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Ann:
30 Oct 2014 5:26:31pm
So basically Good Grief, unless a fantasy organisation exists in which everyone involved works for free and covers most of their own expenses, you won't give a cent of your money to help poor people dying of treatable diseases.
If you really cared about their lives, it would be worth even the 30c per dollar that was spent to help them.
If you think the overheads of charity organisations are too high - and I can assure you that many aren't, and you can easily find out because they are independently audited - then why don't you start up one yourself and see how easy it is to run?
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Good Grief:
30 Oct 2014 5:54:34pm
I won't start one because I don't pretend to be doing volunteer work while still being on a payroll? Telling me that unless I fork over my wallet or else people will die is not, in my definition "volunteering".
Saying that I don't care about their lives is truly a copout. Do you not care about the homeless the moment you pass by one and not give them change? Even if you gave change the last 5 times you saw one hand peddling?
There's a reason why all of this is called "charity" and not "obligation". The idea is that you "give" (not hand over) what you can "afford" for a seemingly "worthwhile" cause.
If I don't feel like the organization is "worthwhile" due to the bureaucracy involved, the mismanagement and the malpractice reported from previous ventures, then it is up to ME to decide whether I should "give" to such an establishment.
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Caffettierra Moka:
30 Oct 2014 2:39:34pm
The USA spends about half of the estimated 1.7 TRILLION dollars that goes on the military and war each year. That is $2 billion every DAY! The WHO annual budget is only $4 billions. I hope that juxtaposition helps you realise that every bomb and bullet and missile-toteing drone is basically just stealing from the rest of the world.
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Get Real:
30 Oct 2014 1:01:56pm
I agree with the AMA that the whole response both here in Australia and around the world has been a absolute b........ disaster. One could ignore the good-doers if it was only affecting them but they come home to affect other countries/communities. Why was not an immediate 21 day period of isolation required (not just those that have a temperature from what ever reason) on all returning persons from affected areas -like we do for cats, dogs and horses coming from overseas ?
The whole thing does not make sense-eg
(a) if the virus is only spread by direct contact with body fluids why are the workers dressed up in full kit like it was nuclear accident or bird flu-surely only gloves and face mask would be all that is required?
(b) as there is no spray that kills viruses as such, what exactly is being sprayed around the infected persons welling ? roundup?!
GR
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Caffettierra Moka:
30 Oct 2014 2:11:36pm
This article is about tuberculosis, not the Ebola virus. Re-read it, as your comments make no sense.
TB has a incubation period of years - in a healthy individual might take two years to develop. And as it sits domant (latent TB after inflection) about 90% of people infected don't develop the full-blown disease. Historically, TB has been present for millenia - it turns up in Egyption mummies. It is a disease of poverty, and basically untreatable until after WW2. My mother worked as a nurse in the TB ward of a hospital here in Sydney in the late 1950s.
In spite of the comments here about 'do-gooders' and 'wasting my money' it is well within our capacity and reach to do something about it. Like a lot of public health initiatives, it can be avoided by a mix of hygiene and generic drugs. The only problem is when white folks in rich countries lock down when more spectacular viruses (which are harder to isolate and treat) appear. By slamming the door on this and issues like malaria and dehydration, we are effectively condemning millions to an unpleasant painful death.
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Ann:
30 Oct 2014 2:29:37pm
Do you really have to swallow every scare pill the ebola hysteria feeds you? It's not going to cause an epidemic here, the conditions aren't right for it. It's no danger to us, even if a few aid workers come back with it.
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david:
30 Oct 2014 1:33:01pm
Tb is an ongoing disease. Of course people suffering from it wasn't help. A very worthy comparison to ebola.
Reading several comments, people who aer against funding it seem to be against healthcare.
Why we find healthcare and by how much is very debatable. The is not a people shortage in the world. There is certainly a self interest excess as people are always happy for someone else to find their treatment or prevention.
If you are critical of this article I hope you are also critical of ebola actions. Ebola is a media sensation more than a very permanent and risky disease to Australia.
Whilst in Liberia thousands have died from ebola fat more would have died from starvation and dirty water. In the US at least ten fold more people would have died from car crashes, drugs , heart attacks , flu and so many other things.
Ebola is hyperEbola in the news
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david:
30 Oct 2014 1:33:02pm
Tb is an ongoing disease. Of course people suffering from it wasn't help. A very worthy comparison to ebola.
Reading several comments, people who aer against funding it seem to be against healthcare.
Why we find healthcare and by how much is very debatable. The is not a people shortage in the world. There is certainly a self interest excess as people are always happy for someone else to find their treatment or prevention.
If you are critical of this article I hope you are also critical of ebola actions. Ebola is a media sensation more than a very permanent and risky disease to Australia.
Whilst in Liberia thousands have died from ebola fat more would have died from starvation and dirty water. In the US at least ten fold more people would have died from car crashes, drugs , heart attacks , flu and so many other things.
Ebola is hyperEbola in the news
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FJM:
30 Oct 2014 2:25:17pm
Whatever happened to TB vaccinations? I was vaccinated in my early teens in a government program in the UK.
Not Sure if Australia ever had a similar program but my 21 yr old son was never given a TB vaccination
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K.:
30 Oct 2014 2:37:10pm
Unfortunately, the current vaccine isn't very good.
In the under 2's it has 80% effectiveness while all other ages, it has an effectiveness of 30%.
Furthermore, the BCG (TB vaccine) WILL NOT stop you from getting infected- or from having disease for that matter. What it DOES do is prevent the more serious manifestations of the disease (e.g. brain, meninges, bones etc...) from occurring in children who are at greater risk- hence why its mostly given to children in TB endemic areas.
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Ann:
30 Oct 2014 2:30:38pm
Tuberculosis can be immunised against, although I believe the immunisation can have bad side-effects.
Still, what is the cost-benefit analysis for making the immunisation cheap and widespread throughout SE Asia?
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Orion:
30 Oct 2014 4:19:03pm
Approximately 1000 new cases of TB are diagnosed in Australia each year. Most of these patients were infected overseas and recent transmission within Australia is rare and limited to small clusters.
Infection is most likely in poorly ventilated, crowded environments.
In Australia for the first 150 years after settlement there was no effective treatment. Mass chest X-ray screening and effective bacteriological examination of World War II army recruits resulted in reliable diagnosis. The Australian Tuberculosis Campaign 1948-76 utilized the army experience for detection, and the use of specific treatment virtually eliminated the disease. Failure to maintain strict screening of high-risk groups, especially immigrants, has led to a resurgence of tuberculosis.
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