Preventing the Untreatable: Why Drug-resistant Tuberculosis Must Be Prevented
Division of Global Public Health, University of San Diego School of Medicine; Refugee Health Assessment Program; and Utopia Scientific, United States
There were more than 9 million new cases of tuberculosis (TB) worldwide in 2009 (WHO, 2010). It takes at least six months of daily drug therapy to treat just one case of TB, thus the global TB burden represents more than 4 million person-years of treatment from the 2009 cases alone. While this represents an almost incomprehensible drain on public health resources, evidence of decreasing TB incidence over the last few years suggests that it is at least possible to impact this disease on a global scale. For more than a quarter million of these new TB cases, however, treatment will be unsuccessful due to the drug-resistant nature of their infections, and they will join the ranks of almost 2 million people who die of TB each year. Most countries outside of North America and Europe do not routinely test TB patients for drug resistance, nor do they have access to the correct drugs for drug-resistant TB; accordingly, fewer than 10% of the patients with drug-resistant TB worldwide receive appropriate treatment (WHO, 2011). While it is critical to build the global capacity to diagnose and treat drug-resistant TB patients appropriately, it is clear that for many low-income, high-burden countries, preventing the development of drug-resistant TB should be the primary means of tackling this problem.