E-DRUG: Less than 2% of MDR-TB patients treated
Sharp readers will have noticed a substantial difference of opinion between
the WHO and MSF statements on World TB day yesterday.
According to WHO, DOTS is proving increasingly successful, increasing the
numbers detected and the numbers cured, and we are on track to the 2005
targets (70% detected, 85% cured) and the 2015 target (halving global TB
According to MSF, more is needed than DOTS alone: present-day drugs and
diagnostics are hopelessly outdated, and overlook the major problems that
are posed by HIV/TB co-infection (such as the fact that current diagnostics
can only detect TB in 50% of HIV/TB co-infected patients).
But probably the biggest scandal in Global TB is not mentioned in both: of
the 300,000 people ill (and likely to die) of drug resistant MDR-TB in this
world, less than 2% are getting drugs at "preferred" prices. The WHO Green
Light Committee (by March 2004; official information from WHO) had only
approved 20 applications to implement DOTS-Plus (the strategy which includes
MDR-TB) in 17 projects based in 13 countries (including three countries
approved by the GFATM), enrolling a total of 5,814 patients.
Only approved projects are allowed to buy the MDR-TB drugs from IDA (see
www.ida.nl) at the "special" price of USD 500-1500 per cure (depending on
the resistance pattern). This is "low" compared to USD 10,000 - 18,000 when
bought from big farma in the private sector in USA.
When asked, WHO commented "The 5814 figure should be seen in a wider
context. This figure only refers to GLC-approved DOTS-Plus projects. The GLC
was created only three years ago and it is in scaling-up mode. But the pace
of scaling-up depends on many factors, including pace of DOTS expansion.
Rational use of second-line drugs requires adequate DOTS programmes ongoing
plus technical capacity to treat patients following the principles of
DOTS-Plus. Development of this capacity cannot be made overnight. Most of
the MDR-TB burden occurs in China, India, and former socialist countries,
which are just in the process of implementing or expanding DOTS. At the
current pace, and with support of the GFATM, we anticipate to have 20,000
patients on treatment by the end of 2005, and 100,000 by 2010."
The burning questions remain:
- are the MDR-TB patients diagnosed?
- are TB projects worldwide not so interested to try and treat MDR-TB?
- are the WHO Green Light Committee procedures too difficult?
- is the optimistic view (to have 100,000 MDR-TB on Treatment by 2010)
- what is to be done?
- other reasons for the obvious failure?
All MDR-TB and GLC documents can be accessed at
E-drug is open for a dedicated TB debate!
Wilbert Bannenberg, E-drug moderator
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