An article published by the Independent over the weekend reports a dire warning made by the WHO: unless we act now, we run the risk that TB will become an incurable disease in the future. The article gives a great overview of the current situation of TB control and invalidates any belief that TB is a disease of the past.
A variety of factors have contributed to allowing TB to remain a serious public health threat. The article identifies three main factors that have undermined efforts to control the disease and have led to the emergence of drug resistant strains, namely inadequate funding for health programmes, sales of unreliable blood tests and mismanagement of drugs. Just recently the media reported cases of drug resistant TB that are not responding to any TB drugs.
Although TB continues to be the second biggest infectious disease killer in the world and the biggest killer of people living with HIV/AIDS, funding and political commitment to control the disease have faltered. This has been particularly evident when the Global Fund to Fight AIDS, TB and Malaria, which provides more than two thirds of all international financing of TB programmes, announced in December 2011 that it was forced to cancel its latest funding round and would suspend new grants until 2014 due to donors failure to live up to their funding commitments.
A lack of accurate diagnostic tools has also hampered efforts to effectively identify and subsequently treat cases of TB. In July 2011 the WHO warned against the use of blood tests to diagnose TB due to research demonstrating the tests resulted in an unacceptably high (50 percent) number of patients wrongly being given false-negative results when in reality they actually have active TB. Although such blood tests are not approved by any recognised regulatory body, many of these tests are manufactured in Europe and North America and make their way to countries with weak regulatory systems, such as India. The Indian Government recently banned these tests, yet they are still being used by private clinics as the ban is only effective within the public health sector.
Finally, inappropriate management of TB cases has resulted in increasing numbers of drug resistant TB. This can occur when drugs are prescribed incorrectly, often by private sector practitioners, or because patients fail to finish their full course of antibiotics which can be due to public clinics experiencing drug stock-outs. A study of Mumbai private doctors found that instead of following WHO prescription guidelines, 100 private doctors prescribed 80 different types of drug regimes.
TB continues to kill 1.4 million people every year. Despite these dramatic figures, we risk losing the fight against a disease that is currently treatable and curable but may not be in the future unless it is met with a concerted and sustained effort by governments to control it.