This post is by the Global Center’s Rabita Aziz.
After graduating from the University of Mississippi in 2008, Max Woodliff backpacked through Southeast Asia with three friends. He came back to the United States in the fall, ready to begin a new chapter in his life as a graduate student. But the next chapter was anything but normal. For starters, he was quarantined and told he might die. The reason? He had contracted multidrug-resistant tuberculosis. That was the beginning of an 18-month ordeal that continues today.
“He’s endured what nobody should have to endure,” said Rep. Eliot Engel, D-N.Y., at a World TB Day briefing in the U.S. House of Representatives, entitled “Tuberculosis– Why U.S. Leadership on this Global Health Threat is Essential.” Rep. Engel joined with four other leading tuberculosis advocates to urge lawmakers to take aggressive action to combat and reverse the current trajectory of the disease, which claimed 1.8 million lives in 2008.
Woodliff described his horrific ordeal to raise awareness and to encourage lawmakers and civil society alike to take action against TB. “I was shocked I had contracted this disease that many American’s think doesn’t exist anymore,” he said. Woodliff became aware of his condition after taking a TB test required for admission into a teaching program. He left school when he was diagnosed with MDR-TB, after doctors found that his cultures were resistant to four TB drugs. He was placed into quarantine for one month at the National Jewish Hospital, where doctors told him he had a 25 percent chance of dying from the disease, which had not yet caused any physical symptoms.
He was placed on powerful antibiotics that wreaked havoc on his body; he compared the treatment to chemotherapy in its intensity. After being released from the hospital, he returned home to Jackson, where medical personnel came to his home twice a day to administer more drugs. One of these drugs produced serious psychological trauma, which he described as similar to schizophrenia. At one point in his treatment, he said he lost all sense of logic and reasoning for several days, an extremely frightening episode. Nearly two years later, Woodliff is still not done with his treatment. He urged lawmakers to put more effort into TB research and to develop new drugs that don’t have such dangerous side effects.
Rep. Engel used Woodliff’s story to emphasis the point that TB knows no borders and that we cannot isolate ourselves from this deadly threat. Rep. Engel, who sponsored the TB portion of the Lantos-Hyde Act, expressed disappointment at the Obama Administration’s failure to meet the authorized Lantos-Hyde funding levels for TB. He promised to fight for more funding to combat TB. Engel, who began his career representing the 17th district of New York during the TB epidemic that struck New York City in the late 1980s, noted that it takes only about $20 to treat a normal case of tuberculosis, but that price shoots up to nearly $500,000 to treat MDR-TB.
“With TB we know what needs to be done,” he said. “It is a disgrace that we don’t provide what is needed to control it.”
Dr. Randall Reves, medical director of the Denver Metro TB Program and the former Chair of Stop TB USA, echoed moderator Philip LoBue of the CDC, who stated that just treating one patient with MDR-TB in the United States can eat up one state’s entire TB budget. Dr. Reves discussed the urgent need to develop a shorter, more effective drug regimen. The current regimen requires patients to four drugs daily for six months, and that’s for drug-susceptible tuberculosis. For MDR-TB and XDR-TB, patients have to take more toxic and more expensive drugs for 18 to 24 months.
“We’re being forced to use TB treatments abandoned 50 years ago,” Dr. Reeves said. At the current rate of progress, he said, we will not reach the goal of TB eradication (now set for 2050) for another 100 years. Urgent action and fully funding are needed to address the situation, Dr. Reves said.
Diana Weil, the coordinator for policy and strategy at the World Health Organization’s Stop TB Department, highlighted the successes achieved by the WHO in combating TB while discussing the vital need for more to be done. The Directly Observed Treatment, Short-course (DOTS) method, pursued in over 184 countries, has resulted in 36 million TB cases treated and 9 million lives saved between 1995 and 2008. Weil said that although the global average rate of prevalence has fallen, cure rates are much lower in Africa and Eastern Europe. Global case detection has stagnated at around 60 percent. The emergence of MDR and XDR-TB has greatly impacted cure rates for TB. While 90 percent of regular TB patients are cured, the number goes down to 60 percent for MDR patients, and around 30 percent for XDR patients. Weil stated that the reversal of these numbers requires health systems strengthening, from laboratory strengthening, to greater infection control, to generally improving health systems, all of which will have a positive impact on other areas, such as maternal health. She also highlighted the importance of improving drug access for the sick in developing countries, citing that diagnostic capacities are advancing faster than treatment access.
Dr. Ann Ginsburg, chief medical officer for the Global Alliance for TB Drug Development, discussed how problematic it is to use antiquated tools to deal with modern strains of TB. For example, the diagnostic tool most widely used today, sputum-smear microscopy, was developed in the 1880s. The BCG vaccine, which is largely ineffective when administered to adults, was developed in the 1920s, while current first-line drugs were introduced between 1940 and 1970. Ginsburg emphasized that we need simpler, faster, safer, and better tolerated drugs that are also compatible with antiretroviral therapy, as HIV/TB co-infection is a deadly combination. Ginsburg would like to see treatment regimens shortened to two to four months, and eventually to 10 days. She said biologically, there is no reason why this cannot be achieved. All that’s needed is commitment from legislators for full support and funding, as there is currently a $6.2 billion funding gap over 10 years for TB elimination plans.
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