Tackling tuberculosis means looking beyond the disease: experts meet to address its broader causes

Cases of multidrug- and extensively drug-resistant tuberculosis (M/XDR-TB) are rising in the WHO European Region. Every year, around 81 000 people are estimated to fall sick with MDR-TB in the Region but, owing to limited access to diagnosis, only 29 000 were diagnosed in 2010. While 7500 cases of XDR-TB are estimated to occur annually in the Region, only 212 were detected in 2010, owing to limited diagnostic capacity.

Prevention, diagnosis, treatment and care

TB can affect anyone, but it is most often seen among young adults in the eastern part of the Region and among migrants and elderly people in the western countries. TB is particularly linked to social determinants of health such as migration, imprisonment and social marginalization.

Even with effective testing and diagnostic systems in place, people in these groups are often outside the health system, and their health problems difficult to diagnose. Yet diagnosis is only the first step. Treatment for TB, particularly M/XDR-TB, is lengthy, complicated and expensive. Providing uninterrupted treatment and care remains a challenge for the health systems in many countries. People without access to a social safety net must often choose between following treatment to get well or working to support their families.

Not completing treatment often means that people will fall ill again. Over the last five years, treatment success rates for new and previously treated TB cases in the European Region have continued to fall: from 72% and 50% in 2005 to 69% and 48% in 2010, respectively. While the treatment success rate for MDR-TB patients was 56% in 2010, the target rates for new pulmonary TB cases and MDR-TB cases are 85% and 75%, respectively.

“I was admitted to the TB sanatorium in 2007. I was there for three months and got better. I went home, did the treatment … . I wasn’t allowed to work, to smoke, to sit in the sun. But I had no other income; I had to raise my children, so I went back to work. I have this fear in my heart that I’m never going to get better. The pills, there are a lot of them, and they are very strong. They give you headaches, stomach aches, and make you feel like throwing up. I’m upset, because I have two children. Here, if you don’t work, you starve to death. There are 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.”

– Iulian, XDR-TB patient from a village in Dambovita, Romania, who died on 5 May 2012, aged 42

European response

In response to this alarming situation, WHO/Europe developed a Consolidated Action Plan to Prevent and Combat Multidrug- and Extensively Drug-Resistant Tuberculosis 2011–2015; it aims to break the vicious cycle of inadequate TB diagnosis, treatment and care, leading to rising M/XDR-TB cases. The Region’s Member States fully endorsed the Action Plan in September 2011. It emphasizes:

  • addressing the determinants of and the underlying risk factors contributing to the emergence and spread of M/XDR-TB; and
  • strengthening the health system’s response: providing accessible, affordable and acceptable services using patient-centred approaches.

Since the endorsement of the regional Action Plan, several countries have adopted national plans on M/XDR-TB in line with it. Many countries have increased access to treatment for MDR-TB from less than 50% in 2010 to above 80%. Nevertheless, many patients still go undiagnosed, or receive no or inadequate treatment. Access to treatment with quality-assured second-line drugs, particularly for marginalized groups, is a major public-health and human-rights concern in many countries in the Region.

At the eleventh meeting of managers of national TB programmes, held in London, United Kingdom on 2–3 July 2012, WHO/Europe staff and national and international experts are discussing achievements at the national level and solutions to challenges in implementing the Consolidated Action Plan.

What is M/XDR-TB?

MDR-TB is resistant to two of the most potent first-line anti-TB drugs. It is a man-made phenomenon that emerges as a result of inadequate treatment and/or poor airborne infection control in health care facilities and other settings where people congregate. XDR-TB is a form of MDR-TB that is resistant to the most important first- and second-line drugs, and has very limited chances for cure.