Several weeks ago, I visited the Central Tuberculosis Research Institute (CTRI) of the Russian Academy of Medical Sciences in Moscow. It plays a central role in Russia’s battle with tuberculosis (TB) as the country’s top TB treatment hospital, research center, and medical training facility. Russians with the most difficult multi-drug resistant (MDR) – TB and extensively drug-resistant (XDR) -TB are treated there. I was struck by the determination of the Russian doctors in the face of the continued threat of MDR-TB and XDR-TB and I am glad that USAID counts them as partners in our common fight.
As we commemorate World Tuberculosis Day on March 24, it is important for all of us to recognize that Eastern Europe and Eurasia continue to have the highest rates of MDR-TB and XDR-TB infections in the world. According to the World Health Organization (WHO), 12 countries have reported proportions of MDR-TB of 6% or more among new TB cases: all of these countries are in Eastern Europe and Eurasia. Five countries report MDR-TB proportions of 50% or more among previously treated cases: all of these countries are also in Eastern Europe and Central Asia. The WHO estimates that in Russia, 42.4% of previously treated TB cases are MDR-TB; in Azerbaijan, 55.8%; in Georgia, 27.4%; and in Ukraine, 44.3%.
In our interconnected planet where people constantly cross borders and millions of people fly every day, not only are U.S. citizens travelling abroad vulnerable to MDR and XDR-TB, but Americans from Georgia to Maine could face this threat at home. Therefore, we have a national security interest in stopping TB around the world and we need the grit of those dogged Russian doctors I met in Moscow.
Tuberculosis is curable but potentially deadly. It is spread through the air and is second only to HIV among infectious killers worldwide. Tuberculosis exacts an enormous personal and economic toll, often striking people in their most economically productive years. MDR-TB and XDR-TB are major risks to effective TB control. MDR-TB is resistant to the two most important first-line drugs used in the treatment of TB. XDR-TB is resistant to additional drugs. The usual six-month treatment with first-line TB drugs is not effective for MDR-TB and XDR-TB. The treatment for MDR-TB and XDR-TB is more expensive, less effective, with greater side effects, and it requires two years to complete—if that form of TB is treatable at all.
MDR-TB and XDR-TB arise due to a number of controllable factors, such as high patient treatment default rates, late diagnosis, irregular treatment, easy access to first and second line drugs in private sector pharmacies without prescription, and, in some cases, population displacement due to unrest. Therefore, it is possible to prevent and control MDR-TB and XDR-TB.
USAID missions through the Eastern Europe and Central Asian regions are working with host countries to combat MDR-TB and XDR-TB. There is hope. For example, USAID in Georgia supported the National TB Program and provided technical assistance to create DOTS spots—special TB outpatient centers located inside of the general urban outpatient clinics. As a result, in the capital city of Tbilisi, the clinics reduced treatment defaults from 23% in 2003 to 9% in 2008. With lowered treatment default rates, the risk of MDR and XDR-TB are lessened. With USAID-supported technical and financial assistance, MDR-TB reported cases decreased in the Balkans from 14.4% in 1996 to less than 9% in 2003. In Ukraine, USAID assisted implementation of laboratory quality control procedures in 8 regions, resulting in 92% of USAID-supported laboratories demonstrating high proficiency in laboratory-based TB diagnosis. These successes show that USAID support is yielding results and helping to control MDR and XDR-TB.
USAID is helping to save thousands of lives and showing the goodwill of the American people. Together with the people of Europe and Eurasia, we must continue to fight MDR and XDR-TB for their sake and our own national interest. Let us not lose focus, take decisive action and curb the spread of MDR-TB and XDR-TB. It is the right thing to do morally, economically, and for our national security.