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  • Stopping a killer (MDR-TB)

    Source: http://www.baltimoresun.com/news/opi...,1591373.story

    Stopping a killer
    By Carole Mitnick
    April 3, 2009

    China has called an urgent meeting that could affect your life, and it's not about the global economic crisis - or global warming.

    Instead, it's about a quiet global health threat that is more disturbing than you probably assume: the silent spread of multidrug-resistant tuberculosis (MDR-TB) around the world. Many global health leaders are in Beijing this week
    trying to draw attention to the danger, including Bill Gates, whose foundation has given billions of dollars to fight diseases; Margaret Chan, the director-general of the World Health Organization; and senior representatives from more than two dozen nations, including the United States.

    MDR-TB - an acronym to burn into your brain - is a killer of unknown dimensions, moving in unknown directions. It passes in the air, through a cough or a sneeze. You thought SARS (severe acute respiratory syndrome) was dangerous? SARS killed 800 people overall; MDR-TB kills 800 every two days, maybe many more. And in our attempts to protect people around the world, including the American public, those of us in public health stand in the path of this deadly infectious bug holding just crude, cruel and scarce tools.

    Crude, because the main diagnostic test for TB is 127 years old and can't detect resistance; the only vaccine is 85 years old and doesn't prevent the most common form of TB; and the last antibiotic, anti-TB medicine was discovered more than 40 years ago and is useless in the treatment of MDR-TB.

    Cruel, because the drugs we give to people with MDR-TB can make them anxious, nervous, psychotic and physically ill for hours and makes their skin burn. And this must go on for up to two years of daily doses of the toxic medicines, with a 50 percent to 80 percent hope that they will be cured.

    Scarce, because of the 1 million to 2 million cases of MDR-TB that occur each year, the World Health Organization reports that less than 1 percent will receive high-quality treatment.

    All this means that Mycobacterium tuberculosis, the bug that causes TB, has room to run because we don't have new ammunition needed to stop it.


    Those gathering in Beijing will call for a major global response to halt the spread of MDR-TB and even worse strains of TB bacterium, such as extensively drug-resistant TB, known as XDR-TB. They will call for more funding, tailored national responses to fight the disease, and a renewed commitment to treat TB well the first time so that resistance to the drugs does not develop.

    All of that is urgently necessary. But one message rarely highlighted is just as critical: More funding is needed for tuberculosis research specifically and global health research in general.

    But that's not happening. The world's 40 largest donors invested $482 million in TB research and development in 2007, according to a report released last month. That is less than one-fourth the amount recommended by the WHO and the Stop TB Partnership, and only one-tenth the amount recommended by Treatment Action Group, which released the report.


    We desperately need an infusion of global health research funding so that in the TB fight we will have better diagnostic tools, but that research in 2007 received just $42 million globally. We need a new TB vaccine (just $71 million spent in 2007) and new TB drugs (just $170 million). And we need improved delivery systems to get these tools to those who need them most (just $37 million spent in 2007).

    Despite all of this, we have a strong, committed group of practitioners and researchers who, given better tools and drugs, can get on the right track to halt the devastation of drug-resistant TB.

    Those in Beijing are trying hard to make you aware of MDR-TB. But the disease itself is emerging, and in more dangerous forms, both here and abroad. We should put our best scientists on this problem - fast.

    Carole Mitnick is an assistant professor in global health and social medicine at Harvard Medical School and a Paul G. Rogers Society for Global Health Research Ambassador. Her e-mail is carole_mitnick@hms.harvard.edu.
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