*Original published in BMJ Group blogs
Despite being considered as a disease of the past, tuberculosis (TB) kills seven people in Europe every hour and, worryingly, rates of multi-drug resistant TB (MDR-TB) in the region are the highest in the world. With 81,000 MDR-TB cases in 2010 alone, the European region accounts for nearly 20% of the global burden.
In 2011 one country, Romania, accounted for 29% of all TB cases in the European Union, and evidence from the country’s leading NGO working on TB has highlighted a huge imbalance in treatment in the country. At the moment, a select number of drug resistant patients in Romania have access to an uninterrupted supply of second line drugs used to treat drug resistance thanks to a grant from the Global Fund to fight AIDS, TB, and Malaria, and consequently these patients have a 70% treatment success rate.
While this grant from the Global Fund is able to provide patients with the international standard of care for treating drug resistant TB, the funds are limited and most patients with drug-resistant TB are prescribed substandard medication and face drug stock outs. As a result, these patients only have a 20% treatment success rate.
The MDR-TB treatment course covered by the Global Fund is in such short supply as to necessitate the establishment of a commission of doctors to decide who should have access to medicines. Faced with the difficult choice of deciding whose survival chances will be vastly improved and whose won’t be, the commission ultimately chooses younger, better educated, and economically more well off patients—namely those who have the best chances of being cured.
Romania joined the EU in 2007, meaning it has fulfilled EU accession criteria, including ensuring “stable institutions guaranteeing democracy, the rule of law, human rights and respect for and protection of minorities.” However, evidence brought to light in a new reportreleased recently outlining the effect funding shortages will have on HIV and TB, including drug resistant TB, in the European region suggests that Romania does not have the institutional capacity to ensure its citizens have the basic right to health. The country relies on grants from the Global Fund to fight AIDS, TB, and Malaria, which look set to end in 2013.
The imbalance in access to treatment leaves Romania lagging far behind countries like the Democratic Republic of Congo and South Africa in terms of treatment success rates (WHO, Global TB Report, 2011). Adding to the poor treatment outcomes within the Romanian health system, many patients receive no welfare benefits while sick and as a consequence face financial hardship as they have to miss work during treatment.
Underfunding HIV and TB programmes in the European region will inevitably contribute to increasing rates of disease and drug resistance. This will cost lives and cause an enormous drain on the European region’s economy due to increased treatment costs and lost productivity. For example, WHO Europe estimates that if immediate steps are not taken to address drug resistant TB in the European region, the economic loss to the region will be US$ 12 billion within five years.
In 2011 the WHO adopted “The consolidated action plan to prevent and combat multidrug and extensively drug resistant tuberculosis in the WHO European Region 2011 – 2015,” and it is now time for the EU to respond accordingly. Health experts have long since been calling for a global health programme for action that duly prioritises HIV and TB and provides a framework for effectively addressing the twin epidemic in eastern Europe and central Asia.
The EU has been dragging its feet, but with rates of MDR-TB rising and a funding crisis looming, it seems ever more important that such a programme is developed. In Europe, commitment to the Global Fund must not falter now. Board members should ensure that middle income countries with epidemics among key populations can access critical Global Fund contributions and the EU and its member states must continue to provide the resources the Fund requires to meet demand. Unless such support is given, countries like Romania will continue to fall further down the league tables in terms of treatment for this curable disease.