Drug-resistant TB: A Growing Global Health Threat

29 March 2017 by Jon Lomøy and Mark Dybul

Emerging superbugs that can resist even the most powerful antibiotics and medical treatments present one of the biggest global health threats in history.

When manifested in a simple throat infection, a lingering stomach bug or a serious disease like tuberculosis, resistance to medicine is tremendously threatening. Global development partners must move faster to contain the threat of antimicrobial resistance before it escalates to claim millions of lives around the world.

Tuberculosis, a disease that has affected the poor for millennia but that has mostly dropped from sight in upper-income countries like Norway, kills more than 1.8 million people a year around the world. While global health partners have made great progress toward halting the disease, drug-resistant forms of TB are threatening to undo those gains. Deaths from drug-resistant TB now account for about one-third of all antimicrobial resistance deaths worldwide and the resistant strains are spreading, presenting a potentially catastrophic risk to global health security. 

Treating drug-resistant TB is costlier, takes longer, the drugs have often debilitating side effects, and the disease is more lethal. Standard TB treatment takes up to six months, while drug-resistant TB treatment can take three to four times as long – and not all people survive. In 2015, there were approximately 580,000 cases of drug-resistant TB; nearly half of those people died.

To achieve the global goal of ending TB as an epidemic by 2030 and prevent a potential health disaster, we must stop the spread of drug-resistant TB. Ending TB will not only save millions of lives and reinvigorate communities and economies in vulnerable, low- and middle-income countries, it will also have an impact in improving the health security of high-income countries like Norway. As we have seen in recent years with the Ebola outbreak in West Africa and Zika in Latin America, diseases know no borders. Unlike Ebola and Zika, TB is airborne; untreated, a person with active TB can transmit the infection to 10-15 people over the course of a year. In our globalized world, ending TB is critically important for us all.

This year’s World TB Day – Friday 24 March – comes just a few months after the Global Tuberculosis Report 2016 reported that TB has become the leading killer among infectious diseases. This is unacceptable. TB, a disease nearly as old as human history, is preventable and curable.

Response to TB often means huge costs to national health care systems and to the families caring for sick relatives. A family can spend up to 20 percent of their household income treating a relative with TB – in cases of drug-resistant TB, costs are even several times higher. In South Africa alone – one of the world’s high-burden TB countries – 9.6 million work days are lost to the disease every year. Ending TB would deliver rapid economic development in the affected countries. Essentially, that would mean improved global productivity and healthier, more prosperous economies all over the world.

There has been progress, but not enough. Between 2000 and 2015, TB treatment averted 49 million deaths globally. Countries like Norway have invested strongly in the Global Fund partnership and in other programs that fight this disease.. Programs supported by the Global Fund and Norway have provided testing, treatment and care for 16.6 million people with TB since 2002. Yet the fight against TB is far from over. Global efforts against the disease still fall far short of those needed to end it.

First, the world must invest more. While the Global Fund partnership provides two-thirds of external financing for TB, governments in low- and middle-income countries need to step up their investments against the disease. Some estimates show that each dollar invested in the fight against TB returns about US$43 in terms of family income and contribution to economies. With more resources, we can develop new and better tools to prevent, detect and treat TB. To find the four million missing cases each year – the people who go undiagnosed, untreated or unreported and who could be spreading the disease – we must invest in interventions that seek to reduce stigma and discrimination associated with TB. We must ensure access to TB treatment and care for the most vulnerable and at risk people such as prisoners, migrants, refugees, people who inject drugs, miners – and make sure they stay on treatment. Every time a patient stops taking their TB treatment before the disease is cured, they run the risk of developing drug-resistant TB – and passing it to others.

Across the world, we must scale up investments in communities – often vulnerable and poor – where the disease continues to thrive. Though tuberculosis is typically a disease of poverty, 50 percent of the world’s cases are found in the higher-income BRICS countries: Brazil, the Russian Federation, India, China and South Africa. These countries must invest more in improving access to quality TB care among their poor and vulnerable populations, and implement more effective programming.

To defeat drug-resistant TB and other antimicrobial resistant superbugs around the world, we need to invest more, develop better tools, and expand approaches and programs that have been proven to work. If not, we risk losing the progress made in the past two decades, and tuberculosis will steadily grow as a global health threat – at a magnitude we have never seen before. 

Jon Lomøy is Director General of the Norwegian Agency for Development Cooperation (Norad).

Mark Dybul is Executive Director of the Global Fund.