An op-ed from the Huffington Post published on World TB Day.
By Salmaan Keshavjee and Sophie G. Beauvais
“How unromantic it is to die of tuberculosis in the twenty-first century.” These were the words of a Russian man in his twenties, written just before he died from drug-resistant tuberculosis (TB). Unromantic indeed: 130 years after it was first discovered, and almost 60 years after the first antibiotics became available, one third of the world’s population is infected with TB. Every four seconds someone becomes sick, every day 4,500 people die from this largely treatable disease because they do not have access to proper diagnosis, medicines and care. We do not even know how many children die from TB because until very recently pediatric TB has been largely ignored by the global community. TB continues to be the leading killer of people with HIV.
It gets worse: a growing proportion of those infected with TB, like our Russian man, have drug-resistant forms which require longer courses of treatment with more toxic second-line drugs. Many patients die without any treatment, but not before transmitting the disease to others in their communities. These strains are now found everywhere. Some of them have become resistant to all known treatments.
But drug-resistant TB is not new. An outbreak in New York City in the late 1980s was successfully contained by building appropriate diagnostic capacity, using second-line drugs, and by supporting care to patients over the grueling two-year long treatment. Resistant TB strains were also found in poor countries, but the global response was limited by international health policies that said that in poor countries it was “too expensive” to treat these forms of TB. This was a mistaken approach to an airborne disease.
There was a moment of hope at the turn of the century. A group of non-governmental organizations and global health advocates — most notably Drs. Paul Farmer and Jim Yong Kim and our team at Partners In Health as well as colleagues from Médecins Sans Frontières and the U.S. Centers for Disease Control— proved that drug-resistant TB could be treated in poor countries. The Green Light Committee (GLC), a mechanism to help countries access quality-assured second-line drugs at affordable prices, was created. This partnership negotiated massive price reductions (from more than $30,000 per patient per year to less than $3,000). In 2003, the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) voted to require the use of this mechanism for countries receiving its funding. This was done to make sure programs were using good quality medications, but led to unexpected bottlenecks and effectively created a monopoly.
So why are patients still dying and the problem of drug-resistance getting worse?
Dr. Salmaan Keshavjee is a Senior TB Specialist at Partners In Health. He is the Director of the Program in Infectious Disease and Social Change in the Department of Global Health and Social Medicine at Harvard Medical School and a physician at Boston’s Brigham and Women’s Hospital. He was Chair of the Green Light Committee from 2007 to 2010. Sophie G. Beauvais is the Communications Manager at the Global Health Delivery Project at Harvard University.