GENEVA -- Western Europeans, unless they are old enough to remember the first half of the 20th century, tend to think of tuberculosis as a disease of the dim past: the illness that felled opera heroines and prompted long stays in sanatoria. In reality, a massive epidemic is raging right now in the eastern portion of our continent.
In Eastern Europe each year, about 400,000 people become sick with TB and nearly 50,000 people die from the disease. In nine European countries -- including Russia and several former Soviet republics -- case rates doubled between 1990 and 2005. The problem is compounded by the steeply rising prevalence of HIV, especially in Russia and Ukraine, which makes people far more susceptible to developing active tuberculosis.
More disquieting, the region has the highest rates of multi-drug-resistant TB (MDR-TB) in the world. The European Centre for Disease Prevention and Control estimates that between 18% and 20% of known TB patients in the Baltic states have MDR-TB, which means the bacteria are resistant to the two most potent "first-line" TB drugs (isoniazid and rifampicin). Of the 20 countries in the world with the highest rates of MDR-TB, 14 are in Europe, including Estonia, Latvia and Lithuania. This is a result of poor TB-control practices and a high percentage of people dropping out of treatment.
MDR-TB is man-made. In some cases, people become infected with this strain by being treated with first-line TB drugs improperly. Or they may catch it directly from someone else who has an undetected, infectious case of the drug-resistant strain. If MDR-TB cases are not detected or managed properly with second-line drugs, patients can develop extensively drug-resistant tuberculosis, or XDR-TB. This strain is even worse than MDR-TB, since it is resistant to even more treatments. Virtually untreatable strains of XDR-TB have recently emerged in Eastern Europe.
If these drug-resistant strains are left to proliferate in the eastern part of the continent, the threat to public health in Western European countries will intensify. The European Commission is encouraging EU member states to develop national plans to address the TB threat. It is in all our interests that this comprehensive approach is replicated in countries in Eastern Europe. These plans should focus first and foremost on access to quality diagnosis and treatment, while also addressing special regional challenges such as TB/HIV co-infection and high TB rates in prisons. Infectious diseases that are spread through the air, such as tuberculosis, know no borders.
Besides the danger it poses to public health, TB is also an economic drain on Europe. Tuberculosis generally strikes people between the ages of 15 and 54, their most economically productive years. According to the European Lung Foundation, treating the disease costs some €2.1 billion annually in the EU. That figure does not include the substantial costs associated with lost work and premature deaths.
Treating TB promptly prevents the spread of the disease and reduces poverty. My organization's Global Plan to Stop TB (2006-2015) estimates that $9.2 billion is needed to fight TB in Eastern Europe over the next decade. All European countries need to take on their fair share, and promptly.
There has not been a new drug specifically developed to treat tuberculosis in nearly 40 years. This is unacceptable, especially given the looming threat of increasingly drug-resistant strains of TB. For diagnosis, we still must rely on examining sputum (matter coughed up from the lungs) by microscopy. New tools are desperately needed, especially for detection of drug-resistant TB. Western European research institutions and companies -- which have the expertise and the means to engage in the vital research needed to fill this gap -- should be taking the lead to stem this growing crisis.
Dr. Espinal is executive secretary of the Stop TB Partnership.