Doctor Without Borders is criticizing countries and government agencies alike for seemingly downplaying the impact of tuberculosis around the world.
Earlier this year, the World Health Organization (WHO) found itself at the center of a firestorm when it opted to leave tuberculosis (TB) off its “most dangerous bacteria” list.
Apparently, they are not the only entity that can be accused of underestimated the impact of TB.
In its third annual “Out of Step” report, released on July 5, 2017, the international organization Médecins Sans Frontières (MSF), or Doctors Without Borders, reviewed policies and practices with regard to the infectious disease in 29 countries—primarily in Asia and Africa—and found many of them lacking when it comes to funding and supporting initiatives to properly prevent, diagnose, and treat the disease. The countries analyzed account for 82% of the world’s TB burden, according to MSF.
“The Zika and Ebola crises with their rapidly rising death tolls and numbers of cases were reported in the media with urgency, [but], even though TB is the world’s deadliest infectious disease and is highly transmissible, the media has generally failed to report on it with the same sense of urgency,” Sharonann Lynch, HIV and TB Policy Advisor at MSF told Contagion®. “[And], it has become the biggest infectious disease killer globally and extremely drug-resistant forms [of TB] have developed.”
Although WHO had its reasons for omitting TB from its list of dangerous pathogens, the disease was included on the agenda for the most recent G20—a first—and the United Nations has scheduled its first “high-level meeting” on TB for September 2018, Lynch added. “The question is whether governments will seize this opportunity to take stock and recommit themselves to measurable and ambitious goals as well as accountability mechanisms, or simply spout slogans about ending TB and then fly home without any intention to take action,” she said, adding that MSF was disappointed that the G20 “did not commit new and additional investments in TB” during its most recent meeting in Hamburg.
Certainly, the countries included in the “Out of Step” analysis have plenty of work to do. The 29 countries assessed included: Armenia, Afghanistan, Bangladesh, Belarus, Brazil, Cambodia, Central African Republic, China, Democratic Republic of Congo, Ethiopia, Georgia, India, Indonesia, Kazakhstan, Kenya, Kyrgyzstan, Mozambique, Myanmar, Nigeria, Pakistan, Papua New Guinea, the Philippines, the Russian Federation, South Africa, Swaziland, Tajikistan, Viet Nam, Ukraine, and Zimbabwe. The MSF assessment found that only 15 of them have a policy of providing the Xpert MTB/RIF assay test to all their citizens—and that only 7 of these 15 have “widely implemented the test.” Despite the rise of rifampin-resistant TB, MSF researchers found that only 18 of the 29 countries recommend drug-sensitivity testing, and only 9 of them have implemented it broadly.
Furthermore, the report notes that only 15 of the countries studied allow healthcare workers to start adults on treatment for drug-sensitive TB (DS-TB). And, while 19 of the surveyed nations initiate treatment from drug-resistant TB (DR-TB) at the district level, only 11 have implemented the policy nationally. Additionally, although hospitalization should be reserved for severe cases of DR-TB, according to published guidelines, 10 of the countries studied still recommend it for all patients.
The report also found that fixed-dose combination therapy for children with DS-TB is the standard of care in only 14 of the countries, and short-course therapy for DR-TB is only recommended in 13. In addition, preventive therapy for those with latent TB is only widely available in 9 of the countries studied.
Despite these policy failures, there were some positive findings of the report. In all, 25 of the countries allow access to unregistered TB medicines as part of compassionate care programs, a vital element as only 21 of those countries have procedures in place for the accelerated registration of anti-TB drugs. Interestingly, none of the countries included in the analysis list all the anti-TB medicines recommended by WHO for the treatment of DR-TB in their respective national Essential Medicines Lists.
According to Lynch, all countries worldwide need to improve access to available treatments for TB and bolster existing research and development efforts to develop new ones, as MSF data suggests that, currently, only slightly more than half of those with multidrug-resistant TB benefit from available treatments because of issues with access to the medications. In addition, all countries should be making Xpert MTB/RIF testing available universally to “clos[e] the diagnostic gap.”
“In recent years, countries have implemented new policies to tackle TB; however, there remains a gap between policy and practice and the most vulnerable continue to lose out,” according to Lynch. “We insist that all actors—governments and WHO—take care to include TB in any new efforts involving antimicrobial resistance. After all, according to experts, one quarter of the potential 10 million annual antimicrobial resistance deaths by 2050 are projected to be caused by DR-TB.”
Brian P. Dunleavy is a medical writer and editor based in New York. His work has appeared in numerous healthcare-related publications. He is the former editor of Infectious Disease Special Edition.