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BMJ. 2007 June 30; 334(7608): 1340–1341.
PMCID: PMC1906639

WHO launches plan to fight drug resistant tuberculosis

The World Health Organization and the Stop TB Partnership, a global alliance of health, research, and funding organisations, last week launched a $2.2bn (£1.1bn; €1.6bn) plan to contain drug resistant tuberculosis, which includes multidrug resistant tuberculosis (MDR-TB) and the recently identified extensively drug resistant strains of the disease (XDR-TB).

Extensively drug resistant tuberculosis raises the possibility that tuberculosis that is susceptible to drug treatment will be replaced by a form with “severely restricted treatment options.”

WHO warns: “If this happens it would jeopardise the progress made in recent years to control TB globally and would also put at risk the plans to progress towards universal access to HIV prevention and treatment. Patients with XDR-TB would have to be managed like TB patients before the antibiotic era.”

The economic, social, and health security of countries with a high prevalence of tuberculosis would be threatened by “virtually untreatable TB among the breadwinners, parents, and economically productive age groups,” WHO says.

WHO's director general, Margaret Chan, said, “XDR-TB is a threat to the security and stability of global health. This response plan identifies costs, milestones, and priorities for health services.”

Paul Nunn, WHO's coordinator for HIV and tuberculosis drug resistance, said, “We have only recently come to realise the size of the problem, where we now see 400 000 new cases of MDR-TB and 27 000 new cases of XDR-TB annually.”

These numbers, he said, should serve “as a wake-up call to governments to turn off the tap of the creation of drug resistance, which has been due to underinvestment, lack of infection control, and not enough staff.”

Dr Nunn explained that although the emergence of XDR-TB has been linked to cases of tuberculosis related to AIDS in Africa, the bulk of resistance is occurring among HIV negative people, and countries such as the United Kingdom cannot afford to be complacent just because they have a low burden of HIV.

The plan emphasises the urgent need to boost basic control of tuberculosis and to aim investment at key areas, including “programmes to treat drug resistant TB; building capacity in diagnostic laboratories; expanding infection control and surveillance; and funding research into new and improved diagnostics, drugs, and vaccines.”

Fully equipped laboratories should achieve a 10-fold increase in the detection of cases of multidrug resistant tuberculosis. If fully implemented the plan will also increase by 10-fold the number of patients with either multidrug resistant or extensively resistant disease being treated and cured.

“A highly important element of the plan is a steady supply of quality drugs to treat MDR-TB and XDR-TB in underserved countries,” said Marcos Espinal, executive secretary of the Stop TB Partnership. “The partnership's global drug facility is ensuring the supply of these drugs to a growing number of countries.”

Mario Raviglione, director of WHO's Stop TB department, said, “We have sounded the alarm on the potential for an untreatable XDR-TB epidemic. Today we issue our response on behalf of all patients and communities whose lives are most at risk. It is an ambitious plan that must be fully supported if we are to keep a stranglehold on drug resistant TB.”

Notes

The Global MDR-TB and XDR-TB Response Plan 2007-08 is at www.stoptb.org


Articles from The BMJ are provided here courtesy of BMJ Group