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Time to act: Save 120 000 lives and US$ 12 billion by 2015 with…The Consolidated Action Plan to Prevent and Combat Multidrug- and Extensively Drug-resistant Tuberculosis in the WHO European Region 2011–2015

➤ “Europe has been at the forefront of tuberculosis prevention and control for centuries. However, the emergence of multidrug-resistant tuberculosis (MDR-TB) is now hindering our efforts. The European Region has the highest rate of multidrug-resistant TB in the world, which speaks of the failure of health systems to treat TB effectively. People living with HIV, migrants, prisoners and other vulnerable populations are at most risk, but TB can infect anyone. Despite the availability of new diagnostic techniques, only one third of estimated MDR-TB cases are diagnosed and only two thirds of those are reported as receiving adequate treatment. Our Region has the lowest treatment success rate of pulmonary TB patients and this contributes to the further spread of MDR-TB. We cannot let this continue.” Zsuzsanna Jakab, WHO Regional Director for Europe

➤ “My name is Paul and I live in London. I have been HIV-positive for all my adult life. Whilst in hospital I became infected with MDR-TB. At first I didn’t know for three months there was a problem. As time went by I started to feel weak, to lose weight and I developed a cough and some slight chest pain. I never thought that it could be something like TB. I, like many others, thought that the disease had been eradicated years ago and was no longer a problem. How wrong I was!” Paul Thorn, United Kingdom, ex MDR-TB patient, TB survival project

➤ “I was admitted to the TB sanatorium in 2007. I was there for three months and got better. I went home, did the treatment … I wasn’t allowed to work, to smoke, to sit in the sun. But I had no other income; I had to raise my children, so I went back to work. I have this fear in my heart that I’m never going to get better. The pills, there are a lot of them, and they are very strong. They give you headaches, stomach aches, and make you feel like throwing up. I’m upset, because I have two children. Here, if you don’t work, you starve to death. There are two options: you take the TB pills and get better but starve, or you work and have to come back to the sanatorium. So it’s a lose-lose situation.” Iulian, MDR-TB patient from a village in Dambovita, Romania

Full implementation of the Action Plan will prevent 263 000 cases of M/XDR-TB and save about US$ 12 billion for Member States in the WHO European Region.

Expected achievements ➤➤ 225 000 MDR-TB patients diagnosed

➤➤ 127 000 MDR-TB patients treated successfully

➤➤ 250 000 MDR-TB and 13 000 XDR-TB cases averted

➤➤ 120 000 lives and US$ 5 billion saved directly through treatment of M/XDR-TB cases

➤➤ US$ 7 billion of additional savings by averting M/XDR-TB cases

“The decision-makers in governments should pay proper attention to TB/MDR-TB/HIV-TB because with each year that passes it becomes more and more difficult to combat the epidemics effectively. ACTION should be taken HERE and NOW.”

Elena Sukhova, Current TB-HIV co-infected patient, NGO volunteer, Ukraine

For further information, please visit the following websites: WHO Regional Office for Europe: www.euro.who.int/tuberculosisStop TB Partnership: www.stoptb.orgThe TB Europe Coalition: www.tbcoalition.eu or contact tuberculosis@euro.who.int

© World Health Organization 2011

Alarming facts about MDR-TB in the WHO European Region

THE ACTION PLAN aims to contain the spread of drug-resistant tuberculosis by achieving universal access to prevention, diagnosis and treatment of M/XDR-TB in all Member States of the WHO European Region by 2015.

THE ACTION PLAN emphasizes improving the treatment outcomes of TB patients and hence preventing the further emergence of MDR-TB. A target has, therefore, been carefully selected to decrease the proportion of MDR-TB among previously treated patients.

THE ACTION PLAN takes into account new diagnostic techniques and patient-centred models of care and tailored services for specific populations such as migrants, drug addicts or prisoners.

THE ACTION PLAN includes budgets, targets and timelines and six strategic directions, such as collaboration on more effective drugs, vaccines and testing, and seven areas of intervention, such as expanding country capacity to scale up management of drug-resistant TB, including advocacy, partnership and policy guidance.

Financing Implementation of the plan will cost an estimated US$ 5 billion. Most of the resources needed are expected to be provided by Member States but a funding gap will remain. The Global Fund to Fight AIDS, Tuberculosis and Malaria, the European Commission and other international agencies will have an essential role to play in filling this gap.

Major targets for end 20151. To decrease by 20% the proportion of MDR-

TB cases among previously treated patients.

2. To diagnose at least 85% of all estimated MDR-TB patients.

3. To successfully treat at least 75% of all notified MDR-TB patients.

➤➤ An estimated 81 000 of the 440 000 MDR-TB cases in the world occur in the WHO European Region (almost 20% of cases worldwide).

➤➤ Less than one third of MDR-TB cases are diagnosed throughout the Region because of limited access to diagnosis.

➤➤ 15 of the 27 countries with the highest burden of MDR-TB are in the European Region.

What is TB? ➤➤ TB is a contagious disease that is spread through the air.

➤➤ TB can infect any part of the body, but most often it attacks the lungs.

➤➤ TB can be cured within 6–9 months with proper treatment ... but untreated it can kill.

➤➤ Left untreated, a person with infectious TB can spread the germs to about 10–15 people every year.

➤➤ TB is the leading cause of death among people living with HIV.

What is drug-resistant TB? ➤➤ Drug-resistant TB (DR-TB) is a man-made phenomenon, caused by inconsistent or incorrect

monitoring and treatment of TB.

➤➤ Multidrug-resistant TB (MDR-TB) is a form of the disease where TB strains are resistant to the two most potent antibiotics (isoniazid and rifampicin). MDR-TB takes longer to treat than susceptible TB and can only be cured with second-line drugs, which are more expensive and have more side-effects than normal TB treatment.

➤➤ Extensively drug-resistant TB (XDR-TB) can develop when people can’t or don’t take all their treatment with these second-line drugs. XDR-TB is extremely difficult to treat and often impossible to cure.

➤➤ Both MDR-TB and XDR-TB can spread from person to person.

➤➤ Although TB strains are changing and becoming more and more lethal, no new drugs or vaccines have been developed over the past few decades.

➤➤ Recently, a new method of rapid diagnosis of TB and of rifampicin resistance has been approved by WHO. This new technology needs to be introduced quickly.

“Improving and scaling up access to drug-resistant TB diagnosis is one of the most essential weapons in the battle against the MDR-TB epidemic. Georgia achieved universal access to MDR-TB diagnosis and treatment in 2007 and 2009, respectively, due to strong political commitment from the Government, support from international donors and the collaborative efforts of all actors. The MDR-TB Action Plan has been prepared in Region-wide consultation with experts, patients and communities suffering from the disease. We hope that this new Plan will help other countries in the Region to scale up and reach universal access to diagnosis and treatment of drug-resistant TB.” Veriko Mirtskhulava, National Center for TB and Lung Diseases, Georgia

“Partnership, coordination and engagement of national and international organizations, including civil society and affected communities, in all national planning, assessment, monitoring and evaluation processes, is key to fully implementing the recommendations and activities of the Plan.”

Dr Lucica Ditiu, Executive Secretary, Stop TB Partnership

Photo: Maxim Dodniuk