World Tuberculosis (TB) Day on March 24, 2016, marks the 134-year anniversary of Dr. Robert Koch’s unprecedented discovery in 1882 of the TB bacillus—the cause of tuberculosis. Once considered to be hereditary or due to some mysterious environmental forces, tuberculosis was found to be a treatable disease caused by the bacterium M.tuberculosis. Koch’s breakthrough discovery opened the door to the development of medications that would decrease the incidence of the disease worldwide. The number of reported cases of TB in the United States—once the leading cause of death in the U.S.—has steadily decreased and was at an all-time low of 9,421 in 2014. However, despite this encouraging trend, TB remains of vital concern to the U.S. public health community.
The World Health Organization (WHO) estimates that more than 9 million people globally develop active TB every year. Of this number, approximately 3 million are either not diagnosed or not treated. More than 1.5 million people die of the disease annually.
More ominously, a global rise in multidrug-resistant tuberculosis (MDR-TB) has been noted. MDR-TB is resistant to the two major medications effective against the disease, Izoniazid and Rifampin. Extensively-drug resistant TB (XDR-TB), a rare type of MDR-TB, in addition to being resistant to Izoniazid and Rifampin, is resistant to virtually all of the medications used to treat the illness.
Drug resistance can occur when the drugs used to treat tuberculosis are misused or mismanaged. Examples include when people do not complete the full course of treatment; when the wrong treatment, the wrong dose, or the wrong length of time for taking the medication is prescribed; when an adequate supply of proper medication is not available; or when people have spent time with someone known to have drug-resistant TB.
Even though the occurrence of MDR-TB (91 cases) and XDR-TB (2 cases) reported in the U.S. in 2014 is relatively infrequent, there is a very real potential for the worldwide rise in these resistant forms of the disease to impact our population. Treatment comes at a significant price–it is very expensive, takes a long time to complete, disrupts lives, and has potentially life-threatening effects.
For these reasons, in December 2015, the White House proactively released “The National Plan for Combating Multidrug-Resistant Tuberculosis,” referred to as The National Action Plan. This plan, which is dependent on Congress for funding in legislating appropriations, identifies critical immediate actions the U.S. government will take over a 3-5 year period to contribute to the global fight against MDR-TB.
The National Action Plan is organized around three goals that aim to strengthen healthcare services, public health, and academic and industrial research through collaborative action by the U.S. government in partnership with individuals, organizations and other nations. The goals are:
- Strengthen Domestic Capacity to Combat MDR-TB – Ensure prompt detection, treatment, and follow-up of TB patients and their contacts.
- Improve International Capacity and Collaboration to Combat MDR-TB – Through strategic investments, broaden access to diagnosis and treatment by engaging providers from both the public and private sectors in affected communities.
- Accelerate Basic and Applied Research and Development to Combat MDR-TB – Support initiatives to develop rapid tests to diagnose TB, determine susceptibility to available drugs, and develop therapies and drug regimens that could cure TB and MDR-TB within weeks, making it easier for patients to complete therapy.
In addition to being subject to budgetary constraints and congressional appropriations, the success of the National Action Plan depends upon the sustained partnership, commitment and coordination among U.S. and global healthcare providers who detect, diagnose and treat MDR-TB; state and local public health departments; non-governmental organizations engaged in healthcare advocacy; private sector partners such as researchers, pharmaceutical manufacturers of vaccines, drugs and diagnostics; and community leaders.
Looking ahead from World TB Day 2016, and working together with these partners, the U.S. government, over the next 3-5 years, envisions making significant strides toward promoting a healthy global population and ensuring that MDR-TB does not become a threat to the health and well-being of U.S. citizens.