Drug Resistant tuberculosis: responding to the Antimicrobial Resistance Review
On May 19th 2015, Lord O’Neill presented the recommendations of the Antimicrobial Resistance (AMR) Review1 to the British Government. With good reason, the AMR Review included a special focus on drug resistant (DR) Tuberculosis. Drug resistant TB kills more people annually than any other drug resistant pathogen - 200 000 deaths are a consequence of drug resistant disease.2 By 2050, it is estimated that 2.59 million people will die from MDR TB and cost the global economy as much as $16.7 trillion.3
The review emphasizes the pressing need for better diagnostics, projecting that with investment in molecular assays, such as next generation sequencing, 52 000 deaths/year from DR TB could be averted within six years. To address the need for new effective anti-TB drugs the report lays out a series of policy proposals to create investment in drug development for DR TB. These proposals include strengthening grant funding for TB research, introducing market entry awards for developers who develop successful new drugs and coupling anti-TB drug development with development of antibiotics for infections other than TB. The potential impact of implementing this bold raft of proposals are profound: the combination of introducing both new diagnostics and new, effective treatments for DR TB would together save 100 000 lives annually after six years. Over a decade, 770 000 lives would be saved by these combined interventions. The changes could radically shift the trajectory of the epidemic and offer reasons for optimism.
However, the success of the AMR Review to turn the tide of DR TB is predicated on whether governments are motivated to make it a policy priority. Chains of accountability at national and supranational levels must be instituted to keep both the science and the implementation on track. Furthermore, while the AMR Review focuses on the need for biomedical interventions, it lacks any focus on the complex social determinants to TB. To be effective, delivering biomedical innovations must go hand in hand with strategies to address risk factors for DR TB such as malnutrition, overcrowding and weak health systems.
Drug resistant TB is evidence of a new form of regression: we have taken the curable and made it nearly incurable. Frailties in TB control programs, especially in the poorest countries of the world, delays in early diagnosis and lack of effective treatment options are all part of the problem. Lord O’Neil’s report identifies concrete solutions to the challenges of the weak pipeline of new anti-tuberculous drugs and increasing availability of new rapid diagnostics. Acting on these solutions has the potential to avert millions of deaths and save trillions of dollars. It is the very least that should be done. International collaboration for real action via the World Health Assembly, G7, G20 and the UN is needed to deliver these policy proposals and turn discussions on AMR into action. Failure to respond to the challenges of DR-TB will be a failure to address one of the greatest challenges of global health.4
1. Review on Antimicrobial Resistance. London2016:84.
2. Global Tuberculosis Report. Geneva: World Health Organization;2015.
3. The Price of a Pandemic: Counting the cost of MDR-TB. In: Tuberculosis A-PPGoG, ed2015.
4. Upshur R, Singh J, Ford N. Apocalypse or redemption: responding to extensively drug-resistant tuberculosis. Bulletin of the World Health Organization. Jun 2009;87(6):481-483.
Competing interests: No competing interests