Global Fight Against Tuberculosis Faces Drug Resistance
Tuberculosis (TB) remains a significant global health challenge, impacting millions worldwide.The World Health Organization (WHO) reports that in 2023, an estimated 10.8 million people contracted TB across all countries and age groups [1]. The disease claimed 1.25 million lives in 2023, positioning it as a leading cause of death from a single infectious agent, according to the WHO [1].
The Rise of Drug-Resistant TB
The emergence of drug-resistant strains, particularly multidrug-resistant TB (MDR-TB), presents a formidable obstacle. MDR-TB is a public health crisis and a health security threat [1]. Annually, half a million people become ill with MDR-TB and rifampicin-resistant TB, contributing to nearly one-third of all antimicrobial resistance (AMR)-related deaths globally [2][3]. Alarmingly, only about 40% of individuals with drug-resistant TB had access to treatment in 2023 [1].
Key Facts: MDR-TB
- MDR-TB is most prevalent in India, Russia, Indonesia, China, and the Philippines.
- It represents a significant threat to global TB elimination efforts.
- Limited access to treatment exacerbates the problem.
We need to assist those countries in their diagnosis and treatment of their patients, as they are, in a sense, a threat to TB elimination around the world.
William Schaffner,MD,professor of Medicine in the Division of Infectious Diseases at the Vanderbilt University School of Medicine
Dr. Schaffner’s statement underscores the interconnectedness of global health and the urgent need for collaborative action.
TB in Developed Nations: A different Landscape
While MDR-TB is concentrated in specific regions, its potential for global spread remains a concern.
It can be exported to the rest of the world just through travel.People could get on a plane and come here or go anywhere, and consequently spread their MDR TB.
William Schaffner, MD
However, the prevalence of MDR-TB differs significantly in developed countries.
In the United States, MDR-TB accounts for less than 1% of all the TB cases reported. This is true also in other developed countries. The market in those countries that are most able to pay is, of course, the least. The market in developing countries is international, where the market is much less certain.
William Schaffner, MD
The Drug Progress Pipeline
The WHO reports that there are 28 drugs for TB treatment currently undergoing phase 1, phase 2, or phase 3 trials, including 18 new chemical entities [4]. This represents a promising outlook for future treatments.
However, progress is vulnerable to disruptions.
Whilst the current TB drug pipeline is the most robust it has ever been, further trials and an evidence base are required to select the most effective regimens. This will require further political commitments, funding, and development of additional clinical trial and laboratory infrastructure.
Tiberi et al., Int J Infect Dis. 2021;113 Suppl 1:S96-S99.
The Critical Role of Treatment Adherence
Beyond the development of new drugs, ensuring patient adherence to treatment regimens is crucial.
sixteen percent of these MDR-TB cases, at least, are in people who’ve previously received therapy where the therapy likely was to abbreviated, too short, or they took the drugs erratically. From time to time in the United States, we’ve employed directly observed therapy. That is where a public health worker actually goes to the patient’s house every day, stands there with a little cup of water and the medicine, and watches the patient take the drug if the patient was deemed perhaps not reliable enough to take the drug by themselves. Directly observed therapy has been shown to be very effective.
William Schaffner, MD
Directly observed therapy (DOT) exemplifies strategies to improve treatment adherence and prevent the development of further drug resistance.
