WSJournal. Five Developing Nations Join to Fight Drug-Resistant TB
NEW DELHI—For the first time, five emerging-market nations with extensive infectious-disease problems—Brazil, Russia, India, China and South Africa—have agreed to work together to fight an epidemic of drug resistance in tuberculosis.
The pact is the latest indication that the world is awakening to the threat of drug-resistant TB, a killer that claims hundreds of thousands of lives annually and which is threatening to become all but incurable, in some instances, with current treatments. The agreement comes as the World Health Organization and other global health experts are acknowledging that the scope of the problem is far beyond what they had foreseen.
Agreements like these are only a first step, as it can take years for nations to tame outbreaks of drug-resistant TB strains. "These countries and their governments can and should do more," said Paul Farmer, the physician-activist who co-founded Partners in Health, a Boston nonprofit running health programs in developing countries. Dr. Farmer, who participated in a meeting on drug-resistant TB in Beijing last month where the new BRICS move was discussed, called the decision by the five nations a positive first step, but one that needs to be followed with specific actions.
Over the past year, The Wall Street Journal has chronicled the failure of India—home to 2.2 million of the world's 8.7 million TB patients—to address its own epidemic of drug-resistant TB. The Journal revealed that the WHO's own program for combating TB had the unintended consequence of allowing drug-resistant strains to worsen and spread.
Nearly 60% of the estimated 310,000 cases of multidrug-resistant TB in 2011 occurred in China, India, and Russia, according to the WHO, which has said that those countries must intensify their efforts in order for the global epidemic to be overcome. Multidrug-resistant TB is a form of the disease that doesn't respond to the two most powerful anti-TB medicines.
The communiqué by the five nations comes after a year of dire reports about the worsening of drug-resistant TB globally despite progress in reducing the incidence of regular TB. Early last year, an Indian physician reported seeing patients whose TB had become so resistant that it didn't respond to virtually any of the 12 top medicines used against the disease. In June, a research team in China reported its first national survey of drug resistance, finding that 10% of TB patients had multidrug-resistant strains.
With their flourishing economies and emerging middle classes, the five countries—often collectively referred to as the BRICS nations—are under growing pressure to use more of their own funds to address their health issues, rather than accept donations from wealthy developed nations such as the U.S. However, treating drug-resistant forms of the disease is much more costly and complicated than treating regular TB. For years, public-health experts feared that treating resistant strains would distract national health programs from fighting regular TB, which is far more prevalent.
The BRICS countries sealed their pact after their health ministers met last month in New Delhi as part of a new effort by the five to work more closely together to tackle health problems. The joint plan also calls for the group to cooperate in addressing malaria, mental disorders and tobacco control.
"When you consider the very large size of the populations of the BRICS and their large burden of drug-resistant TB, and the fact that they have agreed to collaborate and cooperate, I think it's going to make a huge difference," said Gail H. Cassell, a visiting professor in the department of global health and social medicine at Harvard Medical School and co-chair of the Beijing meeting, which was organized by the U.S. Institute of Medicine and the Chinese Academy of Sciences.
The pact could help to raise the profile of a disease that, unlike HIV/AIDS or malaria, has lacked visible leadership that delivers funding, said Rifat Atun, professor of international health management at Imperial College, London. The five countries have substantial expertise in dealing with drug-resistant tuberculosis, he said. "They have the potential to transform this issue from a low-attention subject to a G-20-agenda item," he said.
The BRICS countries plan to meet in coming months to develop a plan that will be presented at a January 2014 meeting of health ministers, officials said. India, for example, plans to share its experience in disease surveillance, said Jagdish Prasad, director general for health in India.
India's system is set up to quickly inform central health officers of an outbreak of serious contagious diseases, such as cholera. "Within a minute of a case being reported anywhere in India, we get informed of it in Delhi," he said.
Brazil, which has kept its prevalence of TB low for decades, would share its expertise in technology research and development, said Jarbas Barbosa da Silva Jr., Brazil's secretary of health surveillance. India and Brazil already have a technology transfer program, he said, citing a private Indian lab that is working with a Brazilian state lab to develop a combined form of four TB drugs. "We can leverage our research and know-how," he said.
South Africa could share lessons learned in its large-scale deployment of a new device known as GeneXpert, which can diagnose a common form of TB drug resistance in under two hours, said Norbert Ndjeka, who heads the South African health ministry's drug-resistant TB directorate. Deployment of more than 143 machines so far has helped officials detect cases of drug-resistant TB much sooner and get them on treatment, to cut down on undetected spread of the disease, he said.
