Speech about the Facts and eradication of TB

Facts About Tuberculosis

With the global eradication of smallpox, and the imminent eradication of polio, tuberculosis, malaria and infection with the Human Immunodeficiency Virus (HIV) are major causes of sickness and death in many countries of the world. These diseases affect largely people living in conditions of extreme poverty. In the last 20 years, some 20 million people have died as a result of being infected with HIV. HIV infected people do not die of the infection, but succumb to HIV-related diseases. The most common of these secondary diseases is Tuberculosis.

The Impact of Tuberculosis

The annual incidence of Tuberculosis is 9 million and mortality is 2 million. Of these staggering figures, Africa bears the brunt of the disease. Of the 22 poorest countries in the world, 18 are in Africa. Africa has 14% of the world's population, and yet it has 30% of the global Tuberculosis population and 80% of its HIV infected population.

In spite of the fact that Tuberculosis exists largely in southern countries, there is no reason for complacency in countries of Europe and North America. Large scale migrations and travel will continue to pose a challenge to the eventual eradication of the disease. For instance, the annual incidence in the United Kingdom, which was approximately 7000 until 2005, has increased to 9000 in 2006.

More concerning is the fact that migrants from Eastern European countries may have a higher incidence of drug resistant Tuberculosis, whereas those from Africa may have associated HIV infection which predisposes them to acquire Tuberculosis.

Tuberculosis is a curable disease. The treatment cost is approximately 5p a day for 6 months. Yet this curable disease continues to ravage populations in countries of the southern hemisphere where the vast majority of these populations, despite living in countries rich in natural resources, subsist on less than one dollar a day. Further, the highest mortality is among men aged between 15 and 40 years. These people, who could be gainfully employed and contributing to the wealth of their families and country, are, instead, contributing to the drain on the resources of their families and country.

The current incidence and prevalence of Tuberculosis is severely straining the capacity of some National Tuberculosis Control Programmes (NTCPs) to successfully administer the WHO recommended standard 6-month regimen. Furthermore, it inhibits the attainment of the United Nations Millennium Development Goals (MDGs) of arresting the incidence of Tuberculosis by 2015 and the Stop TB Partnership's goal of eradication Tuberculosis by 2050.

The standard treatment of Tuberculosis is a cocktail of drugs for 6 months. This treatment has high cure rates if taken for the total duration. It is universally agreed that, if Tuberculosis is to be eradicated through treatment, then treatment duration will have to be reduced substantially in order to improve compliance from both the patients and the treatment services. However, to be able to reduce duration further will require the development of new and more potent drugs. There has been no new drug development for Tuberculosis for 50 years.

In recent years several pharmaceutical companies have begun to test new compounds for Tuberculosis. However, the estimated development of a new anti-tuberculosis drug, from discovery to marketing, is, at least, 20 years at an estimated cost of one billion dollars for each drug. Since tuberculosis is treated by several drugs, these costs cannot be met by a single organisation.

The potential for currently used drugs to reduce treatment duration has not been fully explored even though there is evidence that duration can be reduced by increasing the dose of some of these drugs. And, although it will not be possible to reduce treatment to below 3 months, a 50% reduction in duration would have a significant beneficial impact on the patients' lives and on the NTCPs.

Since the discovery of streptomycin in 1944, clinical trials have played a pivotal role in the improvements in treatment of the disease as well as the reduction of treatment from 2 years to 6 months.

All treatment advances for Tuberculosis, such as the establishment of domiciliary treatment, as well as the reduction of treatment duration, have been made through carefully and rigorously conducted clinical trials.

Such clinical trials will continue to have a pivotal role in defining treatment schemes which will further reduce treatment duration, improve compliance and reduce the burden of administration for the NTCPs.

World Without TB aims to achieve a reduction in treatment duration through clinical trials of currently used drugs. This will be done through a series of rigorously conducted trials to test whether an increase in the dose can be safely achieved and whether this increase can lead to a reduction in treatment duration from the current 6 months to 3 months.

World Without Tuberculosis, however, needs your support to make our Vision a reality.