Harvard Med. School report warns of world health threat

October 27, 1999

New York---October 28, 1999-- Deadly strains of drug resistant tuberculosis are spreading rapidly and threaten to spiral out of control, according to "The Global Impact of Drug Resistant Tuberculosis", a report released today by Harvard Medical School's Program on Infectious Disease and Social Change and the Open Society Institute. The World Health Organization first sounded the TB alarm six years ago--labeling the airborne bacteria a "global emergency." But with the increasing prevalence of drug resistant strains of the disease, the epidemic has taken a chilling new direction.

In Russia, Estonia and other hotspots around the world cases of multidrug-resistant tuberculosis (MDR-TB) are reaching unprecedented levels. While TB and MDR-TB have traditionally been viewed as a scourge of the poor, the report traces the spread of MDR-TB to Western Europe and North America. The study, commissioned by philanthropist George Soros's Open Society Institute, documents drug-resistant TB in more than 100 countries.

"The rapid rise of multidrug-resistant tuberculosis is a public-health catastrophe of the first order," says the report's lead author Dr. Paul Farmer, an associate professor of social medicine at Harvard Medical School. "MDR-TB is a man-made problem. When patients stop taking or don't take enough of the right medications, they develop resistance to the drugs, and then spread new drug-resistant strains of the bacteria."

Immediate action and a massive infusion of new resources are urgently needed to bring this problem under control. While the report outlines an effective approach to the exploding epidemic, it also points out that without at least $1 billion in new funding for TB treatment in the immediate future, MDR-TB will spread to all corners of the earth.

"If new money isn't made available immediately the epidemic may become virtually impossible to contain," said Dr. Farmer. "It is only a matter of time before MDR-TB becomes a serious threat in the developed world, and the cost of controlling it will be exponentially greater." While the treatment method recommended by the World Health Organization (Directly Observed Therapy Shortcourseùor "DOTS") has been effective in controlling traditional TB, the new drug resistant strains require greater efforts to combat.

The report recommends the immediate implementation of the WHO's standard DOTS program so that all TB patients receive appropriate treatment. In areas where MDR-TB is already a problem, the report calls for the rapid implementation of the "DOTS-Plus" approach, under close WHO supervision. DOTS and DOTS-plus involve intensive monitoring and record keeping of patients' treatmentùconfirming that it is carried out correctly and completely.

The report also highlights the need for new drugs. "As with all antibiotics, anti-tuberculosis drugs are at risk of becoming obsolete if they are not managed with great care," says report co-author Dr. Jim Kim. "Direct observation of each dose, will help prevent the emergence of more drug-resistance. But new drugs must be developed."

The report will be presented at a meeting called by the Open Society Institute. The meeting will be attended by representatives of the US government, European, Canadian and Japanese goverments as well as George Soros and WHO Director General Gro Harlem Brundtland. At the meeting officials will discuss possible responses to this rising health emergency. Prior to the meeting, the report's authors will be available for comment at the Open Society Institute at 11:30 a.m., 400 West 59th Street New York, NY 10019, 4th floor. The report and related photographs can be downloaded from the internet at www.soros.org/tb .
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Open Society Institute

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