Drug resistant TB is spreading worldwide

BMJ 1999; 319 doi: (Published 06 November 1999) Cite this as: BMJ 1999;319:1220
  1. Janice Hopkins Tanne
  1. New York

    Tuberculosis that is resistant both to the standard, four drug regimen and to expensive second line drugs has now been found in 104 countries, according to a report released last week in New York.

    The report, drawn up by Harvard Medical School and financier George Soros's Open Society Institute, estimates that it may cost up to $1bn (£625m) to fight tuberculosis worldwide.

    “We were surprised that multidrug resistant tuberculosis was reported so widely. Nowhere was it going away,” said Dr Paul Farmer, professor of social medicine at Harvard and lead author of the report.

    “Hot spots”—areas with high rates of drug resistant tuberculosis—are found in the countries of the former Soviet Union, India, China, the Dominican Republic, and the Ivory Coast.

    World Health Organisation (WHO) officials said in the report: “Tuberculosis control is being neglected in most countries worldwide, and … MDR-TB [multidrug resistant tuberculosis] is a manifestation of this global neglect.

    It clearly shows the effects on tuberculosis control of the dismantling of public health services, compounded by a generalised socioeconomic crisis in Eastern Europe and the former Soviet Union. In the Russian Federation … tuberculosis cases have almost tripled in less than 10 years.”

    Dr Farmer said: “This epidemic is only briefly local. It will not remain within borders. Forty two per cent of the Russian problem is in prisons. Prison bars and national borders are inadequate to stop transmission.”

    General Vladimir Yalunin, head of the Russian prison service, said: “About 100000 people confined within the Russian prison system have been diagnosed with active tuberculosis. About 40000 of them have multidrug resistant tuberculosis. Every year the penal system of Russia releases 30000 people into the community with active tuberculosis—about 12000 of them with multidrug resistant tuberculosis.”

    In the report, WHO officials committed the organisation to rapidly expanding the treatment strategy known as DOTS (directly observed therapy, short course) and addressing the emerging threat of multidrug resistant tuberculosis by giving expensive second line drugs to patients with drug resistant tuberculosis.

    The Global Impact of Drug-Resistant Tuberculosis, is on the internet at

    Embedded Image

    “A patient receives treatment for tuberculosis in Russia, one of the [00d2]hot spots” for drug resistant strains.


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