Voice of America - October 19, 2006
Scott Bobb
Pretoria

Health officials from southern Africa and the World Health Organization (WHO) met Tuesday and Wednesday in South Africa to discuss ways to deal with growing cases of drug-resistant tuberculosis. Because new drugs to fight the disease may be more than a decade away, experts say a global plan must be implemented to strengthen existing forms of detection and treatment.

International health officials are alarmed by the rise of drug-resistant strains of tuberculosis, and say international strategies are urgently needed to combat them.

South Africa's health ministry this week hosted a meeting of experts from the World Health Organization and 11 southern African nations. Executive-director Thami Mseleku said African governments were among the first to raise the alarm.

"It was the region itself that actually identified the challenge of TB as an emergency in Africa and resolved that all countries in Africa should start developing strategies for dealing with the emergency," he said.

Mseleku said a recent outbreak of drug-resistant TB in South Africa has killed more than 100 people, nearly one-third of those diagnosed with the strain.

Tuberculosis is highly contagious disease caused by bacteria that usually attack the lungs. It is spread when a victim with active TB coughs or sneezes.

Multi-drug-resistant tuberculosis is resistant to all of the main anti-TB drugs, known as first-line drugs. It is also resistant to older medicines, known as a second-line drugs. These were abandoned decades ago because of their serious side effects but are now being brought back into use.

An even more serious strain, called extreme drug-resistant TB, resists almost all drugs known to science.

Experts are worried because new anti-tuberculosis drugs may not be available for another 15 years.

The director of the WHO's tuberculosis department, Mario Raviglione, said a recent survey found drug-resistant tuberculosis on every continent.

"Multi-drug-resistant TB is present everywhere in the world where we surveyed, in 102 out of 109 countries that have been surveyed in the past decade," he noted. "So its a universal problem."

A total of 1.5 million people died of TB last year. Additionally, 9 million new cases were reported, of these 400,000 cases were drug-resistant.

The highest recorded numbers of victims were in China and countries of the former Soviet Union, but the highest number of deaths per capita were in Southern and Eastern Africa.

A WHO specialist on TB, Ernesto Jaramillo says drug resistant TB strains could be avoided.

"Drug resistance is man-made," he explained. "The causes are not only biological, but social and economic."

He says drug-resistant strains emerge because of improperly managed treatment of TB, including the use of low quality drugs and the incorrect use of drugs.

Drug-resistant strains also surface when patients abandon treatment before they are cured.

In the developing world, treatment for TB can cost one-half of the average monthly wage. In addition to the expense, the movement of migrant workers between rural and urban areas makes it difficult for them to maintain treatment programs.

Experts note that Southern Africa, with 11 percent of Africa's population, recorded two-thirds of the continent's deaths from TB. They said this is due in part to the high incidence of HIV/AIDS in the region.

A director of the WHO's department of HIV/AIDS, Teguest Guerma, said more than 50 percent of the people with TB in southern Africa are also infected with the HIV virus.

She says that HIV sufferers, because of their weakened immune systems, are prone to re-infection and this makes them susceptible to extreme drug-resistant TB (XDR-TB).

"The XDR-TB crisis will not in most parts of the world be solved unless HIV is properly considered," she said.

She says that the because of the stigma of HIV many people avoid being tested, which means many cases of TB go undetected. And she says a lack of collaboration between the two programs mean that people diagnosed with HIV often are not tested for TB.

She says in order to combat both scourges, HIV and TB programs must work closely together.

Dr. Jaramillo says it is possible to cure 100 percent of those people infected with non-resistant strains of TB and up to 60 percent of those with extreme drug-resistant TB. As a result, he says strong anti-TB programs are highly effective against drug-resistant strains as well.

But an advisor in the WHO's Africa office, Wilfred Nkhoma, says a lack of resources in Africa is a major challenge.

"Time is not on our side," he said. "I think that we all owe it to our people. It is an individual responsibility. It is also a public responsibility, a collective responsibility."

He says as a result, human and financial resources must be mobilized to strengthen the continent's health systems.

A 10-year global plan was launched in January to treat 50 million TB patients and save 40 million lives. The plan calls for $56 billion in funding, $47 billion for detection and treatment, and $9 billion for research. Two-thirds of the funding is to come from individual countries and the rest from multi-lateral organizations.

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