3.24 WORLD TUBERCULOSIS DAY

Tuberculosis (TB) kills nearly 2 million people every year and makes 9 million people sick. The catastrophic situation will only get worse: TB and AIDS coinfection rates skyrocket - one third of the 40 million people who are HIV+ are co-infected with tuberculosis - and multidrug-resistant TB (MDR-TB) shows an alarming increase - currently there are 2 million people with multidrug-resistant TB and 500 000 new cases appear each year (Footnote 1).

In this context, the optimism displayed by the World Health Organisation (WHO) in announcing "A World free of tuberculosis by 2050" is surprising. The strategy advocated by the WHO has been unsuccessful in containing the pandemic, and above all, has been ineffective in providing proper treatment for the sick. "WHO has spent years carrying out a campaign promoting its TB-control strategy rather than recognising the limits of this strategy" said Dr. Jean Hervé Bradol, president of MSF in France, "As a result the response to the TB catastrophe amounts to temporary makeshift solutions".

The efficacy of the commonly used BCG vaccine is being questioned by experts. The diagnostic test for TB is 124 years old and only detects the bacillus in half of the cases, leaving millions of people without treatment, particularly children. The most recently developed medicine used to treat TB is 40 years old, must be taken for a period of 6 to 8 months, and risks becoming ineffective if treatment is interrupted. Moreover, the WHO stubbornly insists on the relevance of DOTS (Footnote 2), a strategy which has shown limited success in dealing with TB/HIV coinfection and the emergence of MDR-TB.

Finally, few actors respect international standards of quality when supplying anti-TB drugs. WHO remains ambiguous in this respect. WHO rightfully advises the use of WHO pre-qualified drugs, but does not devote the necessary means to carry out the validation process. Furthermore, WHO does not ensure that the validated drugs are made available. The main anti-TB drug procurement centre for developing countries, The Global Drugs Facility, which is hosted by WHO, should give immediate priority to WHO pre-qualified drugs. "In most of the countries where we carry out tuberculosis projects, the national TB programmes use drugs which have not been pre-qualified by WHO," says Sophie-Marie Scouflaire, pharmacist for MSF.

Despite all of MSF's efforts to overcome the lack of tools available to treat the 16,000 TB patients in programmes in 27 countries, the results remain unsatisfying. "For simple tuberculosis, the current tools are obsolete and DOTS has shown its limits. Only a tiny minority of patients with multidrug resistant TB have access to drugs which are terribly expensive, toxic and have shown limited success. Lack of adapted tests for TB/HIV co-infected patients, means that many patients are not even diagnosed," said Dr. Brigitte Vasset, MSF's TB advisor.

Advances in research and development (R&D) for new drugs largely dependent on private philanthropy, not public investment, are foreseen in the next ten years. However, the first new molecules for the development of possible new medicines will not be ready before 2015 at the earliest. By then, TB could kill another 20 million people.

Footnote
1. Source : WHO
2. "Directly Observed Treatment, Short course"