Tuberculosis: a new vision for the 21st century

Peter M Small
Kekkaku: [Tuberculosis] 2009, 84 (11): 721-6
Tuberculosis is a global problem that we can't afford to keep ignoring. In 2006, tuberculosis killed 1.7 million people--almost twice as many people as malaria--and it is the leading cause of death among people living with HIV/AIDS. This is all the more tragic because these deaths are preventable. For a long time the world thought that we had defeated tuberculosis, but just because tuberculosis doesn't make headlines doesn't mean it has gone away. The fact is that tuberculosis is getting worse, as complacency and lack of adequate tools and funding fuel the disease and the spread of drug resistance. Drug resistant tuberculosis is the wake-up call, it is an airborne epidemic of increasingly untreatable disease. Drug resistant tuberculosis develops when tuberculosis patients take low-quality drugs, do not finish their full course of treatment, or pass drug resistant tuberculosis from one person to another. In 2007, there were approximately 500,000 cases of drug resistant tuberculosis globally. MDR-TB is resistant to the two most commonly used first-line TB drugs, and requires long, complex and expensive treatment. XDR-TB is resistant to first- and second-line drugs, severely limiting treatment options. While progress is being made, much more is needed. Basic tuberculosis control is one of the most cost-effective interventions in global health. Appropriate treatment can save a life and stop the spread of disease for US$14. It is essential that countries implement the World Health Organization's (WHO) internationally recommended Stop TB strategy, which includes DOTS. But due to outdated tools and methods, DOTS alone is not enough. The remarkable fact is that global control of tuberculosis, a disease that kills someone every 20 seconds, depends upon a 125-year-old test, an 85-year-old vaccine and drugs that take six months to cure and haven't changed in four decades. To successfully treat tuberculosis and prevent resistance, we need to use current tools better and accelerate the development of new tools for the future. Simple improvements in tuberculosis control, such as expanding the use of under-utilized technologies, can have enormous impact. Fixed-dose combinations have existed for over 25 years, and could help ensure that more patients complete treatment; yet globally, only 15 percent of patients are using them. We also need new drugs, vaccines and diagnostics, as well as innovations in tuberculosis control and case management. Better diagnostics are already available, and new drugs and vaccines are coming. But more commitment and resources are needed. Better prevention and control of tuberculosis is the surest way to stop drug resistance. To ensure that drug resistance does not pose a wider threat, we need to employ a number of equally important approaches. These include improved basic tuberculosis control, increased use of underutilized technologies such as fixed-dose combinations, and new technologies and health systems innovations. At the same time, we should expand access to M/XDR-TB treatment and diagnostics for those who already have drug resistant tuberculosis. Some of the most innovative solutions can come from the private sector and through partnerships. An untapped market of two billion people carries the tuberculosis bacterium. Since tuberculosis requires a comprehensive approach, companies should also explore opportunities to work together and pool complementary technologies to ensure new tools are used most effectively. Japan is poised to play a leading role in the discovery, development and delivery of tuberculosis solutions in the 21st century.

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