Poor progress means multidrug-resistant tuberculosis continues to spread and cost lives
July 7, 2011
The global response to help countries scale up treatment of multidrug-resistant tuberculosis (MDR-TB) is underfunded and ineffective, according to a new report released today by three medical and medical advocacy organisations. A 20-month effort to reform the Green Light Committee Initiative, a World Health Organization (WHO)-hosted programme designed to help countries gain technical support for scale up of MDR-TB and access to quality-assured MDR-TB drugs, needs to be closely monitored to see if the reforms will address many key bottlenecks.
The report – issued by Médecins Sans Frontières (Doctors Without Borders, or MSF), Partners In Health (PIH) and Treatment Action Group (TAG) –identifies why efforts and progress to scale-up treatment for MDR-TB have been so sluggish. Over the past ten years, an estimated five million new cases of MDR-TB have occurred, with one and a half million lives lost.
“We found that a lack of urgency and commitment from governments is a major stumbling block”, said Javid Syed, TB/HIV Project Director at TAG. “Many affected governments appear to be in no hurry to address the serious treatment needs of this devastating disease, and this is impeding efforts to identify new MDR-TB cases. Donors are not making TB overall a priority and almost all of the major donors we contacted were unable to tell us how much of their funding was directed at DR-TB diagnosis and treatment. Besides funding, many countries will need global and regional support to build their capacity to diagnose and treat MDR-TB.”
Unpredictable and expensive drug supplies also contributed to the poor scale-up of treatment. The report – which looked at the MDR-TB treatment programmes of India, Russia and South Africa – also found that countries were prone to drug shortages and stock-outs, at both a national and international level – with serious consequences for patients. The price of certain key second-line anti-TB drugs – most off-patent and many more than 50 years old – has increased over the last ten years.
“There are just too many barriers to scale-up at the country level, such as the high price of second-line drugs”, said KJ Seung, Clinical Manager of PIH-Lesotho. “Countries know they need to address MDR-TB, but with the high price of medications and lack of laboratory capacity they are often unable to scale up programmes. International support mechanisms need to be more efficient and effective at helping address these barriers.”
But the report states that the guidance and support given by such international support mechanisms falls far short of what is needed. It highlights three support mechanisms: the Green Light Committee (GLC) which monitors and assesses the progress of country MDR-TB treatment programmes; the Global Drug Facility (GDF) which supplies drugs to programmes approved by the GLC; and the Global Laboratory Initiative (GLI) which supports countries in setting up new diagnostic services for TB. All of these mechanisms are hosted by the WHO.
The report findings show that countries, the GLC and GDF were not able to complement national efforts appropriately; barely 0.6% of the five million new MDR-TB patients over the last decade were treated through GLC-supported programmes. It also concluded that the GLI, though driven by laudable goals, was not transparent about what it had accomplished and was unable to provide data, making it impossible to evaluate its performance.
“The old GLC mechanism was no longer suited to help countries scale up treatment programmes”, said Dr Tido von Schoen-Angerer, Executive Director for MSF’s Campaign for Access to Essential Medicines. “The recent effort to reform the GLC has resulted in creating more committees, which I doubt will help countries and certainly do not address many of the bottlenecks that countries are facing.”