Aisling Irwin reports on the Tuberculosis 2000 conference at the Royal Society of Medicine. The growing scourge of tuberculosis, could be eliminated worldwide if doctors and governments were to act immediately, before drug resistance takes hold, TB experts heard in London last week.
And the elimination could cost as little as $10 per person, according to Donald Enarson of the International Union Against Tuberculosis and Lung Disease. But if we do not exploit this small window of time, drug resistance will take hold and cures will cost 10,000 times more per person, he said.
Warnings that TB is becoming a worldwide epidemic have been circulating for several years. The World Health Organisation predicted last month that the disease will kill 30 million people over the next decade. And the developed world is not safe. Alarmingly high pockets of TB have developed among the homeless. Last year a study of hostel-frequenters in London's Tower Hamlets found that two per cent of them had TB. In sub-Saharan Africa the incidence in 1990 was 260 per 100,000. Asia has the biggest problem, with 70 per cent of cases reported worldwide in 1993 coming from south east Asia and the western Pacific region.
One of the main fears about TB is drug resistance. TB can be treated with several drugs, and different TB bacteria are resistant to different drugs. The best treatment now is with a combination of drugs - this is because if you treat with just one drug a few TB bacteria will survive in the body, the disease will recur, and the patient will infect other people with the resistant strain.
Doctors say that the problem of resistance to individual drugs is so acute that it is better not to treat a patient at all than to treat them with individual drugs. But disturbing reports are now emerging of patients resistant even to the recommended cocktail of drugs.
Professor Enarson, who is director of scientific affairs at the union based in Paris, said that even the most recent of the drugs that make up this cocktail was developed as long ago as 1965. "We have no new medications and I know of no new ones in the pipeline. We're now sowing the seeds which will make the ultimate elimination more unlikely."
But Professor Enarson told the meeting, held at the Royal Society of Medicine: "It's still not too late to do the right things. This is still a disease we can get rid of."
He said that the cost of treating one person had already been reduced from $45 to $18 by competitive bidding. Further changes could cut this to $10. With four million new cases a year predicted he says that even the poorest countries could find the money for treatment.
Paul Ormerod, chair of the Joint Tuberculosis Committee, said: "It could potentially be eliminated. It's much more soluble than HIV."
Kenneth Citron, past president of the British Thoracic Society, was less optimistic, saying it could be eliminated in developed countries but around the world, elimination was "doubtful". "But it could be vastly reduced," he said.
Several speakers gave evidence that TB could be kept under control in developed countries. The incidence in North America has dropped for the third year running, by 6.2 per cent, according to figures released last week.