Features

Human catastrophe

"Human catastrophe" Continued...

Issue: "Ideal Idol," June 2, 2007

CureTB is one of the Global Plan's many partners that receives no direct funding from WHO. The plan calls on the high-burden countries, especially those with developed economies like Russia and China, to fund many of the Stop TB activities themselves. The countries so far have committed to less than half the cost of the plan. Even less will be funded through the UN Global Fund, made famous by celebrity spokesperson Bono, and by private donations. The Bill and Melinda Gates Foundation has committed almost $900 million.

That leaves a funding gap of about $31 billion. WHO is calling on G8 countries to fund 40 percent of the gap and the affected countries to fund the remainder.

WHO officials justify the high price of the Global Plan by noting the much higher cost of inadequate TB treatment. The outbreak of drug-resistant TB in New York City in the late 1980s and early 1990s was estimated to have cost $1 billion to treat and had an 80 percent death rate.

A more recent outbreak of drug-resistant TB in South Africa was even deadlier. In 2005, the Church of Scotland Hospital in the KwaZulu-Natal province of South Africa reported some patients there were not responding to treatments they were given for multidrug-resistant TB, or MDR. Doctors later realized the patients had extensively drug-resistant TB, or XDR, which was resistant to the two most common, or "first-line," TB drugs and three of the six second-line drugs. Within a year, all but one of the more than 50 patients with XDR died in Kwazulu-Natal. All of the XDR patients who were tested were HIV-positive. Since then, South Africa has discovered XDR in all of its provinces.

The high death rate from XDR led doctors and journalists to call it "virtually untreatable." But Farmer, the physician whose life story is recounted in Tracy Kidder's book Mountains Beyond Mountains (Random House, 2003), says it's not too late to treat XDR. Patients who died in South Africa received only standard treatment for drug-sensitive TB. By the time test results confirmed that they had XDR-TB, all but one of the patients had died.

In March, Partners In Health announced it had received a $3 million grant from the Open Society Institute to develop a treatment model for XDR. It will start its work in Lesotho, a landlocked country within the borders of South Africa.

That same month the CDC released a report stating that there were 49 cases of XDR in the United States from 1993 to 2006. The report said the United States and global health organizations could target XDR by gathering more information about its incidence, prevalence, and causes.

WHO's Stop TB coordinator, Paul Nunn, in February called on nations to immediately fund the $650 million needed annually to combat drug-resistant TB with the Global Plan.

"If these resources are not found," Nunn told convention-goers in Geneva, "we face, over the next few years, the replacement of the current global epidemic of mostly drug-susceptible TB, with multi- or extensively drug-resistant disease, and the need to solve a human catastrophe, at vastly greater expense than if we address it now with all the skills and dedication of which we are actually capable."

  • Left untreated, each person with active TB disease will infect on average between 10 and 15 people every year.
  • Someone in the world is newly infected with TB bacilli every second.
  • Overall, one-third of the world's population is currently infected with the TB bacillus.
  • 5-10 percent of people who are infected with TB bacilli (but who are not infected with HIV) become sick or infectious at some time during their life. People with HIV and TB infection are much more likely to develop TB.

SOURCE: WORLD HEALTH ORGANIZATION

Lynde Langdon
Lynde Langdon

Lynde lives in Wichita, Kan., with her husband and two daughters. She holds degrees from the University of Missouri in journalism, Russian, and business administration. She is in a long-term, committed relationship with the Lutheran church. Follow Lynde on Twitter @lmlangdon.

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