"Tackling TB and DR-TB must be at the heart of any global action against Antimicrobial Resistance. The burden of TB is too great and the need for new treatment too urgent." ~ AMR Review.
The ground-breaking publication of Lord Jim O'Neill's global Review on Antimicrobial Resistance (AMR) is the wake-up call the world desperately needs. Have no doubts: the 'superbugs' that develop antimicrobial resistance are a threat of immense proportions and have a potential impact of 10 million deaths a year by 2050 as antibiotic efficacy dwindles. This report establishes the UK Government's global leadership on this issue and creates much needed momentum.
The recommendations of the review quite rightly identify tuberculosis (TB) as the cornerstone of the global AMR challenge. One of the world's oldest diseases, TB has claimed more lives than any other infectious disease in human history, and since 2015 TB has surpassed HIV as the world's deadliest. It is responsible for 1.5 million deaths annually.
Why TB is included in the AMR review is clear: over the last few decades TB has been quietly transforming itself into new strains of drug resistant TB (DR-TB). DR-TB causes an astounding 500 deaths a day and can't be cured with normal TB drugs.
Drug resistant TB has developed in part due to the lengthy treatment needed, as even standard TB requires six months to treat. This gets worse for drug resistant TB, taking as long as two years to treat with drugs that are stronger, but ultimately much worse. These are only effective in 50% of cases and often create terrible side effects such as deafness, blindness, nausea, and in extreme cases, psychosis. Such lengthy and difficult treatment means patients do not - or cannot - complete treatment, increasing the development of resistance.
Increasing drug resistance has dire consequences. The work of the Review has shown that TB has the potential to represent a quarter of anti-microbial resistance deaths by 2050, with an estimated 75 million additional people dying from TB over the next 35 years.
The economic impact of DR-TB could be just as devastating as the tremendous human cost, with a predicted economic cost of US$16.7 trillion. Putting that in context, it is roughly equivalent to the annual economic output of the European Union, including the UK.
Part of what drives those huge costs is the costs of the drugs themselves. Current DR-TB treatment is up to 450 times more expensive than standard TB treatment. A growing DR-TB epidemic will exponentially increase the burden on healthcare systems and national budgets. This cost will hit developing nations hardest and negatively impact the quality of life for some of the poorest and most marginalised around the world, but will not end there.
Diseases, particularly airborne ones such as TB, do not respect national borders. The impact on Europe will be significant, with DR-TB responsible for an additional 2.1 million deaths in the continent by 2050 at economic cost of US$1.1 trillion. Currently the WHO Europe region has the highest rates of DR-TB globally. London is particularly hard hit by the disease. It has the largest TB burden in Western Europe, with around 7 people developing symptoms every day.
As with many issues, waiting to act only prolongs the suffering and dramatically increases the costs. The AMR Review lays out key steps we must take now to prevent this, and fully funding the Review's recommendations is a logical and smart investment for UK that will pay enormous dividends both abroad and at home.
The development of a new generation of drugs to which resistance has not developed is crucial. It is astonishing that no new drugs have entered standard TB treatment in nearly 50 years, but by providing a major reward for developing new drugs and treatment regimens, the Review's recommendations could transform how we treat TB. Equally important are the recommendations on ensuring that all people around the world can afford and access any new treatments, as this is truly a global problem and TB is most likely to affect poor and marginalised people no matter how rich a country they live in.
If drug-resistance continues to grow on its current trajectory we could return to an era where treatment becomes practically impossible. The scale of the human and economic impact means we urgently need new tools to fight TB. We have to act, and we have to act now. Today world leaders are faced with a once-in-a-generation opportunity to forge a genuinely global response and lay the foundations for the elimination of this ancient disease once and for all.