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TB emergency

Drug-resistant forms of the disease are widespread, and time and money to fight it are short.

February 28, 2008

In the early stages of the AIDS epidemic, most Americans were aware of the arrival of a horrible new disease that was spreading rapidly. But they weren't particularly afraid, because the victims were mostly outside the mainstream: homosexuals, drug users and Haitians. By the time Middle America did get scared -- when movie stars and heterosexuals and people they knew began dying -- HIV had already gone global.

With drug-resistant tuberculosis, there is still time to prevent such a hideous outcome. But perhaps not much.

A new survey by the World Health Organization shows that drug-resistant tuberculosis is even more widespread than had been feared -- on average, it's present in 5% of new TB cases. That's 500,000 drug-resistant cases a year. If most Americans aren't concerned by this, it's because they don't yet understand that drug-resistant tuberculosis is no longer a disease that threatens mainly HIV and AIDS patients and the Third World poor. It threatens us all. Worldwide, only 8% of TB cases occur in HIV/AIDS patients.

Tuberculosis is an airborne disease that can be transmitted by a cough or a sneeze -- much easier to spread than HIV. The multiple-drug resistant, or MDR, strains can usually be cured by a two-year course of antibiotics, which can cost $1,500 to $15,000, compared with $20 to cure ordinary TB. In parts of the former Soviet Union and China, more than one-fifth of all new TB cases are MDR. The extremely drug-resistant, or XDR, strains, which the WHO identified in 45 countries, are essentially incurable.

Dr. Mario Raviglione, director of the WHO's "Stop TB" program, estimates that new antibiotics capable of conquering the XDR strains may be developed by 2012 -- if we're lucky. But they probably won't be on the market until about 2015. Meanwhile, the drug-resistant strains will inevitably spread, Raviglione said.

Even after the panic last year caused by Andrew Speaker, the jet-setting honeymooner found to have MDR TB, funding to stop the disease has lagged. The WHO, which gets its money from United Nations member states, estimates it needs $4.8 billion for global TB control. But despite increases in funding from the U.S., Britain and private donors, it still faces a $2.5-billion shortfall. That's about what the United States is spending in Iraq every nine days, though the problem can't and shouldn't be solved by the U.S. alone. Oil-rich Russia and relatively affluent China can certainly afford to treat their own infected populations, and they must be exhorted to contribute more to the global fight against this awful disease.

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