Utah Valley Global Health Group

A blog about global health for those living in Utah Valley and their friends.

RESULTS, XDR-TB, and emergencies

Posted by chads on March 11, 2007

We had our monthly RESULTS meeting and teleconference on March 10. The thrust of the discussion was on obtaining funding for “extremely drug resistant tuberculosis”, or XDR-TB. The WHO explains:

MDR-TB (Multidrug Resistant TB) describes strains of tuberculosis that are resistant to at least the two main first-line TB drugs – isoniazid and rifampicin. XDR-TB, or Extensive Drug Resistant TB (also referred to as Extreme Drug Resistance) is MDR-TB that is also resistant to three or more of the six classes of second-line drugs.

The folks at RESULTS urge us to push our elected officials for additional funding for XDR-TB in the “Emergency Defense Supplemental”:

Please continue to urge Congress to support an emergency infusion of resources to help address the XDR-TB (extremely drug resistant TB) emergency. (The continuing resolution did not contain bilateral TB funding in it.) XDR-TB has a very high mortality rate, is especially deadly for those with HIV/AIDS, and threatens to undermine AIDS and TB treatment in southern Africa. The U.S. is also quickly facing the dangers of XDR-TB. When the president sent his Emergency Defense Supplemental request to Congress it contained monies for Avian Flu, which is a theoretical emergency. XDR TB is a REAL emergency.

I wholeheartedly agree with this plea for fundingwith a passion. Well, sorta. The need for a comprehensive response to tuberculosis is, in my mind, indisputable. And the public health crisis that barely treatable (and sometimes untreatable) XDR TB presents is unacceptable.

I have mixed feelings, however, about calling this an emergency. You see, public health officials and clinicians have known for many, many years that TB was becoming resistant to many drugs, and that it had the potential to become a public health emergency. XDR TB exists because of our failure to respond properly to TB; a failure to strengthen the health system. The WHO continues:

Resistance to anti-TB drugs in populations is a phenomenon that occurs primarily due to poorly managed TB care. Problems include incorrect drug prescribing practices by providers, poor quality drugs or erratic supply of drugs, and also patient non-adherence.

Screaming “emergency” is an effective fund-raising tool, though it more often that not comes in unpredictable spurts. It seems to me that such sporadic responses lead in the long term to corruption, dependence, and lack of preparedness for the next “emergency.” Those suffering from diseases like tuberculosis desperately need a health system that is strong, flexible, and promotes evidence-based health interventions.

So, I’ll support this Emergency Defense Supplemental funding for XDR-TB. Because something has to be done. But there has to be more of a focus on health systems strengthening.

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