Wellness & Fitness

WHO’s deadly omission as tuberculosis marches on

tb

A medical worker at a mobile testing facilities for TB. FILE PHOTO | NMG

After an uproar over the omission of Tuberculosis from World Health Organisation’s (WHO) list of 12 pathogens that are resistant to antibiotics, the global health body is considering editing the list to include TB.

Speaking during the launch of Kenya’s national TB prevalence survey on March 24, 2017, WHO’s country representative Rudolf Eggers said the organisation was “updating the list.”

In February 27 this year, WHO published a list of microorganisms that are resistant to antibiotics and labelled them a threat to human health.

This was the first time that the global health body had identified antimicrobial resistance through particular pathogens that were ranked on severity.

There were criteria of what to include in the list of the 12: how deadly the infections they cause are; the length of time those who fall sick of the disease they caused stayed in hospital; whether they were resistant to existing antibiotics; how fast they moved from one person to another.

WHO also considered the ease—or lack thereof— of preventing them; whether they are preventable; the options of treatment available; and whether new antibiotics for those diseases were being developed.

The list was intended to encourage research and development (R&D) of new antibiotics in the midst of the gloom and dread of medicines continually losing their power to cure diseases. Researchers and public health specialists did not take it kindly that Mycobacterium tuberculosis (Mtb) was omitted from the list of 12 microorganisms that pose the greatest public health threats.

Mtb causes 1.8 million deaths globally and three in every 10 of these deaths are due to drug resistance globally.

In fact in 2015, WHO estimated that there were 480 000 new cases of multidrug-resistant TB (MDR-TB).

Dr Evans Amukoye, the Chief Research Officer at Kenya Medical Research Institute (KEMRI) said that the omission of Mtb from the list would affect funding, not just for the management of the disease but also on research and development.

“TB is a disease of the poor, so anything risking access to medication would harm the people”, he said.
He said that TB had even surpassed Malaria and HIV to become the greatest killer in the world, and he did not understand why WHO would omit it from the list.

His concerns were echoed by organisations such as TB Alliance which wrote to the WHO asking for the rectification of the list to include TB.

Hours after WHO published the list, the Stop TB Partnership wrote on their website that the list had “significant implications for the manner in which we will fight TB and drug resistant TB as it widely acknowledged the numerous gaps in implementation, research and innovation to rapidly detect, treat, and cure persons afflicted with drug resistant TB”.

Dr Amukoye described the resistance to TB in Kenya as “not very high”, at one per cent of the total cases.

Before the national survey, the figure would be slightly higher than 800 annually, a figure that shot up to about 1,400.

In its defence, WHO released a presser stating that TB remained a great concern for the organisation, and that the list was only meant to shift attention and focus to pathogens that had been ignored.

The scientists argued that despite WHO’s best intentions, the paper would influence policy making and governments would not get into the details of why TB was not included in the list.

Only 125,000 of the 480,000 cases— 20 per cent— of MDR were enrolled for treatment.

All over the world only 22 per cent of people resistant to TB drugs are detected.

Only 52 of the few that manage to get access to treatment are cured.

This leaves more than 580,000 cases of drug resistant TB annually and only about 64,000— estimated to be 11 per cent— are cured.

Even with these depressing statistics, money injected into research for TB has been declining.

The little that was left for developing new anti-TB drugs, Stop TB said, is almost depleted. This is partly because of low detection rate.

The Global Plan by Stop TB identified five areas that needed investment in —vaccines, drugs, basic science, diagnostics and operational research— areas that did not receive the monies required.

Dr Enos Masini of TB programme at the Ministry of Health said that while the Kenyan government had done a lot to ensure that the trajectory of the disease was declining, even the increased numbers needed more money.

It costs about Sh5,000 to Sh10,000 to take care of uncomplicated TB but about Sh2million to treat drug resistant TB.