Is plan for drug-resistant TB delayed amid cost concerns, while cost of delay goes unnoticed?

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Recent history of White House proposed cuts to tuberculosis programming and research raise questions on status of Administration plan for MDR-TB 

A Huffington Post article last week described the individual impact, the economic damage and the global threat of drug-resistant tuberculosis in stark and efficient terms, starting with the case of one woman in the U.S., a teacher and grandmother whose illness took more than a year to confirm. In one of the more propitious countries on earth to detect and then find and complete treatment for the disease, her ordeal, which continues two years after she first noticed her symptoms, remains harrowing, including as it does months of isolation, painful injections and debilitating side effects, some permanent. It is no bargain either; the two years or more that treating her illness requires, at a minimum cost of about $100,000 can consume a health department’s budget, decimating money for support services needed in the process, while suspending patients’ income-earning capacity. In the process, with side effects that include psychosis, the treatment is so torturous, the article notes, that it can render its recipients suicidal. It still is better than the alternatives, which include the continued spread of drug-resistant infections, the development of even harder to treat extensively drug-resistant (or XDR) TB, and death from a treatable, curable disease.

It is why a physician quoted in the article says he would rather be infected with HIV, a disease that remains incurable, but which effective treatment developed and improved over the last two decades has rendered controllable in terms of both individual health and transmission risks, while efforts to address drug-resistant tuberculosis lagged.

It’s a good thing, the article notes, that a plan to take on drug-resistant TB is finally under consideration, albeit leaving those eagerly awaiting it also wondering if it will be backed with a budget that can turn it into reality.

The plan, promised by the White House as part of a larger response to drug-resistant infections that Administration officials released last March, has yet to be announced. More than four months have passed since  a gathering of tuberculosis community advocates, responders, planners, and other involved parties — including from the pharmaceutical industry — were given a glimpse by administration officials of plan details, which were said to include promotion of universal treatment of multidrug-resistant tuberculosis — starting with treatment for 360,000 people — accelerated basic research, and strengthened capacity to combat the disease in this country. With the deadline for the plan to be submitted to White House then more than two months away, the release of those outlines sounded promising. Now, more than a month after the plan was set to be completed, and with the World Health Organization’s annual report on the global TB epidemic set to be released this week, the status of the plan remains a question.

TB response advocates and providers hope to see a plan that includes specific goals for research and programming outcomes, and that is supported by a proposal for adequate funding in the administration’s next budget said Christine Lubinski, director of the Infectious Disease Society of America’s Center for Global Health Policy, which produces this blog.

“Current tools and strategies are leaving the majority of patients with drug-resistant tuberculosis undiagnosed and untreated, and allow the spread of an often deadly infection,” Lubinski said. But, she noted, with no word on the plan’s release, concerns include whether it has been stalled at the White House because of reluctance to commit the resources it requires.

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