By Claudiu Ciprian Tanasescu - 28th March 2013
Not only does TB cause stigmatisation for patients, it causes illness and death, and if not properly treated leads to very high costs for society
Claudiu Ciprian Tanasescu
Tuberculosis is a growing concern that requires coordinated member state, EU and worldwide action, writes Claudiu Ciprian Tanasescu.
Iulian, a former Romanian tuberculosis (TB) patient, who died from the disease last spring, said, “When you have TB you have two options: you take the TB pills and get better, but starve, or you work and have to come back to the sanatorium. So, it’s a lose-lose situation. It’s a disease where people in society stay away from you, because they know you are sick.”
Unfortunately, TB has several other facets. Not only does TB cause stigmatisation for patients, it causes illness and death, and if not properly treated leads to very high costs for society. In the EU alone the fight against TB costs €15m per week and €750m per year in medical costs.
This cross-border health threat kills 1.4 million people each year worldwide and seven people per hour in the European region, representing the second leading cause of death from an infectious disease.
In 2011, 8.7 million people were infected with TB worldwide. The global burden of TB still remains high, but most worrying is the growing number of drug resistant (DR) TB cases, some of which are now being transmitted directly from person to person. Multi drug resistant (MDR) TB and extensively resistant TB are much more costly and difficult to treat. Curing an MDR TB case can be 100 times more expensive than a ‘normal’ TB case.
If we provide more than €750m per year for the disease, over 90 per cent of MDR TB patients will be detected and provided with adequate treatment by 2016. If not, progress will scale back and we will witness an increase in all forms of TB.
A clear signal for immediate action in the EU should be given by the five EU member states (Romania, Bulgaria, Estonia, Lithuania and Latvia) that are among the top 28 MDR TB high burden countries worldwide, registering a very low treatment success rate. Romania’s treatment success, for example, is much below that of Kazakhstan, or even the Democratic Republic of Congo.
Political commitment and financial support from decision makers are key if we are to control this major public health threat. Countries need to put in place strategic action plans to fight TB in order to save money and improve the state of health of the population.
To attain a better control of TB we have to make investments in research and development into new tools – effective vaccines for all populations, new medicines, early and appropriate treatments, cost effective diagnostic methods and resistance detection tools – and to dispose of fully funded national TB programmes. Personally, I see four major steps towards achieving these above mentioned objectives.
First, at the EU level, the commission should back up, both financially and politically, the implementation of the World Health Organisaton (WHO) action plan on DR TB for the period 2011-2015. If implemented correctly it will save 120,000 lives and €2.92bn in the short term. It is not just the European commission, but individual countries who have to take a stance to the growing TB threat and increase the domestic funding allocated to this problem.
Second, the commission and EU member states should commit the necessary resources to the 2013 replenishment of the global fund to fight Aids, TB and malaria. The global fund alone provides 80 per cent of the international funding for TB. WHO estimates that 118 low and middle income countries will face a funding gap of at least €0.92bn per year for TB for 2014-2016.
Third, awareness has to be raised not only among decision makers but also among the general public. For this reason the public-private partnerships and the engagement of community groups should grow in importance, providing the tools necessary for the NGOs to reach populations otherwise out of reach by governmental programmes.
Fourth, the commission should address the roughly €750m funding gap in R&D for TB by significantly increasing its funding for health research and particularly poverty related diseases in the next research framework programme.
If action is not taken now we might lose control over a major health problem. Not dealing properly with TB translates in an increase of antimicrobial resistance and growing national costs for health. WHO estimates a rise of up to two million DR TB cases up to 2015. For this reason, urgent action from the EU and endemic countries worldwide is needed to cope with this growing, cross-border health threat.
Claudiu Ciprian Tanasescu is a member of parliament's environment, public health and food safety committee