Tuberculosis

Tuberculosis, the ancient scourge of humans, still takes about three million lives a year throughout the world. And less is spent doing something about applying known inexpensive drug cures to the afflicted than Westerners spend on anti-balding nostrums. Now, however, a more resistant strain of TB is spreading in one country after another, principally in the countries of the former Soviet Union. It is called Multi-drug resistant tuberculosis or MDR-TB.

A new report on MDR-TB in Russia by the Soros-backed Public Health Research Institute (PHRI) (455 First Avenue, New York, New York 10016) declares that the worst epidemic of MDR-TB ever recorded is coming out of the countries that made up the former Soviet Union, led by Russia.

In clear language, the Report states that “this epidemic is a direct threat to U.S. citizens, and that threat will worsen considerably if action is not taken soon.”

To bring this situation home, consider the MDR-TB outbreak in New York City that peaked in 1991 with 600 new cases. Back under the Reagan Administration, the physicians at the Centers for Disease Control asked for less than five million dollars to conduct better surveillance of what seemed then to be a small resurgence of TB in the U.S. Request denied said the Reaganites.

By the early Nineties, the government learned of the folly of that denial. Nearly one billion dollars was spent to re-establish TB control systems, build facilities and applied the widely

accepted Directly Observed Therapy (DOTS) treatment in the New York City area. MDR-TB cases totaled 2500 cases and was brought under control.

PHRI now estimates there are 30,000 active MDR-TB cases in the former Soviet Union or 50 times the peak number of cases in the New York City epidemic. The number of such cases is increasing 10-25% per year, and if Russian prisons release large numbers of sick prisoners, as is expected, they could infect tens of thousands of Russians simply through the air as they cough and cough.

PHRI Program Director, Alexander Goldfarb, Ph.D, writing recently in the Moscow Times, explains the situation: “Russia, thanks to its vast prison system, is the world’s largest reservoir of the deadly disease. MDR-TB is a man-made phenomenon. It is caused by misuse of antiĀ­biotics during treatment of regular TB, which consists of a daily ration of four drugs that must be taken for six months without interruption. This gives a nearly 100 percent chance of cure at the cost of about $100 per patient. However, if the regimen is interrupted, or the antibiotic cocktail is incomplete, a small fraction of TB bacteria evolve to tolerate the drugs. These mutants proliferate and resistance develops.

“Substandard treatment, while temporarily reducing symptoms, thus converts a curable condition into a virtual death sentence for the patient, unless expensive second-line drugs and a sophisticated medical support system are available.

“Even worse, before dying, each such patient will infect others with the deadly, drug-resistant strain. Thus, when the full set of drugs is not available, or the completion of treatment is not feasible, more lives are lost by substandard treatment than by no treatment at all.”

In case you wonder what all this has to do with your community, consider Dr. Goldfarb’s windup: “Infectious diseases know no fences or borders, and it is only a matter of time before MDR-TB of ex-Soviet origin knocks on the doors of Western European or American households. Treatment of a single such case in an American hospital often costs more than $200,000, with uncertain outcome.”

People trying to alert the world’s richest nations and their leaders to start paying serious attention to TB speak of this problem as one for foreign policy and national security officials. With increasing air travel (one Korean woman infected several passengers on a flight from Korea to the U.S.), mass transits and other crowded conditions, the airborne TB strain can move far away from its most nourishing climate which is mass poverty.

PHRI recommends that a one-time $100 million to implement World Health Organization’s DOTS therapy throughout the former Soviet Union and have it sustained by local clinics, and another one-time $150 million to treat MDR-TB patients and prevent the contagion to others will save many billions of dollars in the future and possibly a disastrous fatal epidemic.

The World Health Organization has successful experiences where a small sum can have these preventive effects in a number of countries from areas in China to Tanzania.

Every day, 8000 people die from TB and $4 billion is spent on military weapons worldwide. PHRI is sounding the alarm, along with Princeton Project 55’s TB Initiative. Is anyone listening who has power and the means to make the difference?

Well, the White House and the mass media (which neglected to report PHRI’s findings) are hardly listening. Large Foundations are not interested. The day will come when all of them will have to be interested, whether they like it or not.

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