UNGA should address TB and antimicrobial resistance together
Drug-resistant tuberculosis, which is spread through air and responsible for a large number of deaths, is part of antimicrobial resistance efforts. The United Nations General Assembly can pave the way by calling for integrating efforts to address both.
Blog post on Devex by Nick Herbert, Dr. Lucica Ditiu and Austin Arinze Obiefuna, 15 May 2024
Tuberculosis is among the world’s most devastating infectious diseases, and the World Health Organization has described the spread of its drug-resistant forms as a global health crisis. As the United Nations General Assembly hosts a multistakeholder hearing on May 15 in the lead-up to September’s high-level meeting on antimicrobial resistance, it should take steps to integrate TB as a key strategy in the global response to AMR.
As it stands, drug-resistant TB, or DR-TB, is a leading cause of death among AMR infections globally. In 2022, at least 410,000 people across the world developed multidrug resistant TB, which is a severe form of DR-TB, resulting in 160,000 deaths. TB also has a “one health” dimension, as zoonotic TB affects animals and can be transmitted to humans. An estimated 140,000 people develop zoonotic TB annually, and the bacteria causing this form of TB is naturally resistant to an antibiotic commonly used in TB treatment.
The stakeholder hearing presents a crucial opportunity for U.N. member states to reaffirm countries’ commitment to combating AMR. It is equally critical that the General Assembly addresses DR-TB as a priority within the AMR agenda.
The intersection between TB and AMR
TB and its drug-resistant forms are prime examples of the intersection between AMR and infectious diseases. The spread of multidrug-resistant TB and even more dangerous extensively drug-resistant TBs has exacerbated both the TB pandemic and AMR crisis.
Only 2 in 5 people with DR-TB start treatment, according to WHO estimates, leaving a large number of people untreated. Untreated DR-TB spreads through the airborne route and mortality is upwards of 50%. Most TB drug resistance will emerge when a person with TB receives inadequate, substandard, or incomplete treatment. Where people with TB lack access to people-centered care and adequate nutritional, psychosocial, or mental health support, the risks are greater that treatment will be interrupted, and new resistance will emerge.
Preventing drug resistance in TB is also a priority among mobile populations such as refugees, internally displaced people, and migrant workers, where breakdowns in the continuum of care can lead to treatment interruptions. Even the wealthiest countries that are close to eliminating TB are impacted, especially from a financial perspective, when small numbers of people become sick with DR-TB.
Because of a lack of action, DR-TB has spread to the point where most people with resistant forms of TB acquired it through airborne transmission. In addition to the overall burden of TB globally, the ongoing spread of DR-TB combined with shortfalls in investment to develop new TB treatment regimens makes TB a global health security risk.
Key asks for UNGA
It is crucial to address TB and AMR together, and UNGA can pave the way by supporting critical interventions. The following are actions the assembly should endorse.
1. Include TB as a tracer indicator in global and national AMR strategies. This is critical as progress on TB and TB research and development are key indicators of progress on AMR and necessary to guard against the development of drug-resistant strains.
2. Mobilize $22 billion in annual funding for the global TB response by 2027, plus $5 billion in annual investment in TB R&D, as agreed in the 2023 U.N. political declaration of the high-level meeting on the fight against TB.
3. Prioritize vaccine development as a critical strategy in addressing AMR; ensure regulatory frameworks support streamlined development and authorization of drugs and vaccines against AMR infections; and support R&D on human immunology. Member states should embrace artificial intelligence strategies for tracking AMR and identifying viable vaccine targets for AMR.
4. Include TB services as essential elements of national and global universal health coverage strategies and efforts to address AMR, to ensure uninterrupted diagnosis, prevention, treatment, affordable and quality-assured antibiotics, surveillance, and research-related activities. Supporting a one health approach is critical.
5. Commit to providing treatment for up to 45 million people with TB between 2023 and 2027, including up to 4.5 million children and up to 1.5 million people with drug-resistant tuberculosis, as agreed in the 2023 U.N. political declaration on TB elimination.
6. Advocate and commit resources for an AMR response that is human rights-based, gender transformative, stigma-free, and people-centered. This ensures communities, affected people, and key and vulnerable populations are at the center of the AMR response, with resources allocated to support their engagement in AMR programs.
7. An independent panel on evidence for action on AMR should be constituted expediently, with a similar approach as was done for the Intergovernmental Panel on Climate Change. Such a panel as well as any accountability and/or follow-up mechanisms established by the high-level meeting on AMR in September should include TB.
A more robust effort against TB and AMR is crucial to the achievement of the Sustainable Development Goals. Because of its spread and airborne nature, DR-TB is a key driver of AMR globally, making it essential for the TB response to be integrated into the AMR agenda. At its upcoming high-level meeting on AMR, UNGA has a critical opportunity to advance a coordinated response to TB and AMR at the national level.
Read the original blog post here. To read more about the link between TB and AMR read this report.