New figures published by the UK All Party Parliamentary Group on Global TB (APPG TB) reveal the alarming costs of a resurgent TB pandemic if drug resistance is left un-tackled: Over the next 35 years, 75 million people will lose their lives to multi drug-resistant TB (MDR-TB); and, by 2050 the airborne infection could cost the global economy $US 16.7 trillion – the equivalent of the entire current economic output of the European Union.
By 2050, if it is left un-tackled, MDR-TB could be responsible for 0.63 per cent reduction of annual global GDP and could claim an extra 2.59 million lives annually.
These cost projections were originally produced for the independent review on Anti-Microbial Resistance chaired by Jim O’Neill and are now published as part of a report by the APPG TB examining the global challenge of MDR-TB and some potential solutions to tackle the disease. The report proposes six key interventions that donor countries must take to tackle the pandemic: an R&D challenge fund, targeted investments in basic research, additional support for existing pipelines of new products, operational research, an increase in TB bilateral programs, and the recognition of TB as a central pillar of the global anti-microbial resistance (AMR) crisis.
The cost projections are based on a scenario where an additional forty per cent of all cases are resistant to first-line drugs leading to a doubling of the infection rate.
Andrew George MP (Liberal Democrat – St Ives), co-chairman of the APPG TB said: “Too often we dismiss projections as mathematical exercises with little relation to the real world, but already a number of countries have seen a rapid increase in drug-resistant TB, with devastating impact on public health.”
TB is the world’s second deadliest infectious disease, killing 1.5 million people every year, and is the only major drug-resistant infection spread through the air. The World Health Organisation’s post-2015 strategy projects the elimination of TB as a public health threat over the next twenty years but is contingent on rapid reductions in rates of the disease that are not being currently attained. The projections in this report highlight the danger not just that already ambitious targets for TB reduction could fail to be met, but that the number of lives claimed by the disease could actually increase as a result of drug-resistance.
Chairman of the independent review on AMR, Jim O’Neill said: “These figures show us in no uncertain terms that the rising global burden of MDR-TB and other drug-resistant infections will come at a human and economic cost which the global community simply cannot afford to ignore. I welcome the report’s contribution to raising awareness of this emerging global crisis, and I am glad that policy-makers in the UK and internationally are increasingly recognising the need for coordinated action to kick-start the development of vital new life-saving antibiotics.”
MDR-TB has undoubtedly spread due to the inadequacy of treatment. Since 1967, no new drugs have entered the standard TB treatment regimen, and only two new anti-TB drugs have been developed and approved by the European Medicines Agency since it was created in 1995. Treatment for drug-resistant TB can take up to two years, and is so complex, expensive, and toxic that less than half of people successfully complete treatment.
“We need better tools to deal with this new threat, but since TB primarily affects the poorest and most vulnerable in society there is little commercial incentive to develop new drugs,” said Nick Herbert MP (Conservative – Arundel and South Downs), co-chairman of the APPG TB. “It will require significant, globally coordinated action to address this market failure, which is why the Prime Minister’s leadership on AMR has been so important."
The response to TB is further hampered by the lack of an effective vaccine. The only existing TB vaccine, BCG, protects some children from severe forms of TB, but is unreliable in preventing TB in the lung, which is the most common form of the disease.
“There is a great deal of complacency surrounding tuberculosis,” said Virendra Sharma MP (Labour, Ealing Southall), co-chairman of the APPG TB. “People think the disease has been defeated, but it hasn’t. Parts of London have TB rates higher than sub-Saharan Africa, and many people have the mistaken belief that the BCG vaccine will protect them. These figures highlight that we are at a tipping point: if we focus our efforts and resources we could eliminate the disease within a generation, but if we don’t we will face catastrophic human and economic costs.”