by Becky Debens,
SCRIP World Pharmaceutical News
UK, 08 Apr 2009 - Drug-resistant tuberculosis is a "time-bomb" waiting to explode into a global epidemic, World Health Organization director-general Dr Margaret Chan warned last week.
Speaking at the WHO's ministerial meeting for high TB burden countries in Beijing, China, on preventing the spread of multi- and extensively drug-resistant TB (M/XDR-TB), Dr Chan said the "potentially explosive situation" meant new plans of action were urgently required in TB-endemic countries.
The meeting, attended by ministers and representatives from 27 high-burden countries, including China, Ethiopia, India, Nigeria, Russia, Pakistan, South Africa and Ukraine, discussed the threat of drug-resistant TB and studied actions to prevent and manage the disease.
Call for action
The attending countries agreed 11 goals to tackle TB. These included: moving towards universal access to M/XDR-TB diagnosis and treatment by 2015 (in line with millennium development goal 6, halting and beginning to reverse malaria and other major diseases by 2015); developing a comprehensive M/XDR-TB management and care framework; and ensuring a sufficient supply of high-quality anti-TB drugs.
Further actions included the removal of financial barriers to TB care, development of airborne infection control policies, new tools to combat drug-resistant TB, strengthened laboratory systems and ensuring staff are trained and deployed.
The meeting also urged the WHO to provide technical support for the development and implementation of M/XDR-TB response plans, to assist national regulatory agencies to adopt international standards, and enable manufacturers to produce products of high quality.
The WHO could help evaluate newer diagnostic tests and expand access to affordable second-line medicines, and monitor the response of governments and the private sector to the call to action, the meeting agreed.
The meeting also looked at issues preventing the eradication of the disease. These included insufficient co-ordination among health ministries, the unregulated sale of medicines, and a lack of compliance with standards by manufacturers.
A lack of fixed-dose combination medicines had also hampered efforts, the meeting noted.
Additionally, late case detection and insufficient infection control had facilitated transmission, while social determinants, such as poverty and social vulnerability, left people at a higher risk of infection.
The meeting concluded that the threat of M/XDR-TB could be halted despite these issues, only if all countries "respond urgently". Dr Chan also recommended "high-level political attention", warning "national TB programmes cannot by themselves manage these new threats".
The attending countries also agreed to help mobilise $2 billion, the estimated amount required over the next two years to fund TB and M/XDR-TB control and care, via financing mechanisms including the Global Fund, UNITAID and national health budgets. This came alongside a pledge to work to enable an overall $15 billion to finance the TB and M/XDR-TB response from both domestic and international resources through to 2015.
Over half a million new MDR-TB (multi-drug resistant TB) cases are estimated to occur annually due to inadequate treatment and failures in measures to prevent transmission. Only 3% of cases are being treated up to WHO standards, and patients with HIV/AIDS remain at significant risk if infected with M/XDR-TB.
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