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Kari Stoever

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New G20 Austerity Measures Required To Address Tuberculosis

Posted: 06/18/2012 1:21 pm

As G20 leaders meet in Mexico to discuss the economic woes in Europe, imagine what the global economy could do with an additional $300 billion or more a year? That's more money than has been given to Greece in bailout loans by the EU and IMF since 2010.

The World Bank estimates that tuberculosis (TB), one of the world's biggest killers from infectious disease, reduces some countries' GDP by 4 to 7 percent, and is estimated to cost the global economy 0.5 percent of GNI. In 2010 terms, that equates to nearly $380 billion. So how is it that a treatable disease that has plagued humanity since the time of the Egyptian pharaohs is still wreaking havoc on mankind?

Look no further than the global leaders gathering in Mexico this week attending the G20 meeting, and to their predecessors going back more than a century.

Tuberculosis is a political disease. And although it has been around for antiquity, scientists have identified it as primarily a disease of the 19th century, with symptoms that typify cultures in the midst of industrialization. Tuberculosis also symbolizes what happens when a disease transitions from one that impacts the affluent, as was the case throughout Europe and the U.S. at the turn of the century, to one that becomes predominately a disease of the poor. Less visible, political will wanes leading ultimately to complacency and neglect.

But like many neglected infectious diseases, it won't stay silent for long, and it is in this regard that in 1993 the World Health Organization took an unprecedented step and declared tuberculosis a global emergency.

Since declaring the global emergency, more than 46 million people have been successfully treated, saving millions of lives. Despite these achievements, in 2010, there were an estimated 8.8 million new cases of tuberculosis globally, causing more than 1.4 million deaths. Even more alarming is the fact that more than 2 billion people are infected with the bacterium that causes TB. Control programs have been less effective than expected in reducing transmission mainly due to the limitations inherent in an antiquated set of tools -- diagnostics, drugs and vaccines.

The drugs used today are more than 40 years old, the most commonly used diagnostic is over a century old, and the BCG vaccine is more than 85 years old providing only marginal protection for infants against various types of TB, with no significant impact on transmission, or on the greater burden of pulmonary disease. Complacency and an underinvestment in research has rendered the world ill equipped to deal with this ancient scourge.

The future of TB control and elimination rests on the global community's ability to develop and rapidly deploy new technologies such as vaccines, drugs and diagnostics.

Today, as G20 leaders meet in Mexico, six Member-States are among the 22 countries with the highest burden of tuberculosis: Brazil, China, India, Indonesia, Russia and South Africa.

South Africa is struggling to combat one of the worst tuberculosis epidemics in the world, with disease rates more than double those observed in other developing countries and up to 60 times higher than those currently seen in the U.S. or Western Europe.

China, according to a article publish last week in The New England Journal of Medicine, has a "serious epidemic of drug-resistant tuberculosis," noting the results of the first national survey of the disease, which revealed that a third of those with new cases and half of those with previously treated cases had multi-drug resistant disease (MDR TB). China's minister of health, Chen Zhu, recently reported that there are 120,000 new cases of MDR-TB diagnosed every year across the country, representing 25 percent of the world's total -- killing as many as 80 percent of its victims.

Three areas in Russia have the highest rate of multi-drug resistant (MDR) tuberculosis ever recorded, according to a report by the World Health Organization. And, in an article last week in The Moscow Times it was reported that state spending on TB in Russia has increased dramatically in recent years and will most likely reach more than $100 million in 2012. While notable, it is still well below what will be required to adequately address their epidemic, which is now spreading throughout the broader region.

In India, recent outbreaks of what doctors have dubbed "totally drug-resistant tuberculosis" have rippled through the global media headlines, alarming health officials around the world. This form of TB, which has also been identified in Iran and Italy and is likely present elsewhere, is virtually untreatable with existing drugs, leading to almost certain death.

Globally, more than 70 countries have reported cases of extremely drug resistant TB (XDR TB), defined as being resistant to at least four of the core anti-TB drugs.

It's not just the high-burden countries that are impacted by TB. Australia has a burgeoning tuberculosis crisis right next door, with many patients from Papua New Guinea seeking treatment in Australia's border health clinics. The province of Queensland spends $18 million a year treating PNG nationals, posing a threat to Australia's mainland. According to the World Health Organization's Western Pacific Region, TB is the leading infectious killer, causing some 1,000 deaths a day, far more than AIDS.

According to the CDC, the cost of hospitalization for one XDR TB patient is estimated to average $483,000, and because of the limited responsiveness of the drug resistant strain to available antibiotics, mortality rates among patients with XDR TB are similar to those of TB patients in the preantibiotic era. Treating one case of MDR TB in the U.S. averages $250,000. In 2010, the CDC reported a total of 109 cases of MDR TB in the U.S, and in the early 1990s, an outbreak of MDR-TB struck New York City, costing at least $1 billion to treat patients and prevent further spread of the disease.

In Europe, rates of MDR TB are rising and can cost 200 times more to treat than drug-susceptible strains. According to the World Health Organization, 15 of the 27 countries with the highest burden of MDR-TB are in the WHO's European region, which includes 53 countries in Europe and Central Asia. More than 80,000 MDR-TB cases occur in the region each year -- almost a fifth of the world's total.

The United Kingdom has a particular problem in London, the Olympic host, which has been recently been dubbed "the TB Capital of Western Europe." According to the NHS, the cost of treating an uncomplicated case of TB can be as low as £2,000 but can exceed £50,000 for complex or drug resistant cases. More than 12 percent of the cases in London are considered complex -- almost 400 people.

So how far away are we from changing the paradigm of this disease?

Over the past decade, investments by the European Commission, the U.S. and the U.K., the Netherlands, the Bill & Melinda Gates Foundation among others, has rocketed TB research and development into the modern era, with the first big win coming through for diagnostics.

GeneXpert is a rapid diagnostic that can test for drug-resistant strains, significantly improving the sensitivity and time to diagnosis when compared to the century-old microscopy and culture method. As well, several new drugs, developed with support from the TB Alliance, are in late-stage clinical trials and may be available for use in the near future.

However, the ultimate, most cost-effective weapon in the battle to eliminate TB is a vaccine that could prevent adolescents and adults from developing disease. The only way to stop the spread of TB is to prevent its emergence.

Today, we stand at the precipice of a new paradigm for this disease -- since 2005, global investments of more than $600 million has allowed more that 15 vaccines to be tested in more than 50 human trials.

Aeras, the largest nonprofit biotech dedicated to developing new generation TB vaccines, the Europe-based research consortium led by TBVI, industry and academic institutions around the world have joined forces to develop a robust global pipeline of new vaccines, some now in late stage clinical testing and numerous more in pre-clinical development. China, one of the largest investors in TB vaccine research today, could play a leading role in the development and global rollout of new vaccines.

The message to our G20 leaders is one of hope and fortitude. We should not lose sight of the tremendous gains underway to address one of the biggest killer diseases in the world today. Accelerating progress will require new commitments from governments, industry, civil society and scientists across the G20 nations.

The old adage that an ounce of prevention is worth a pound of cure could not ring more true. As G20 leaders discuss austerity measures in Europe, perhaps they should also consider austerity measures to address the annual loss of more than $300 billion from a disease that with the right investments today would pay long-term dividends in lives saved, productivity gains and ultimately make advances toward economic and moral solvency for at least six of the G20 countries bearing the biggest cost to their economies.

 

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