From this Plos article by Jerome Amir Sing, Ross Upshur and Nesri Padayatchi entitled 'XDR in South Africa: No Time for Denial or Complacency' :
"On September 1, 2006 the World Health Organization (WHO) announced that a deadly new strain of extensively drug-resistant tuberculosis (XDR-TB) had been detected in Tugela Ferry, a rural town in the South African province of KwaZulu-Natal (KZN), the epicentre of South Africa's HIV/AIDS epidemic. Of the 544 patients studied in the area in 2005, 221 had multi-drug resistant tuberculosis (MDR-TB) that is, mycobacterium tuberculosis that is resistant to at least rifampicin and isoniazid. O fthese 221 cases, 53 were identified as XDR-TB i.e. MDR-TB pluse resistance to at least 3 of the 6 classess of second-line agents. This reportedly represents almost one sixth of all known XDR-TB cases reported world-wide. Of the 53, 44 were tested for HIV and all were HIV infected.".
Thus XDR-TB is "now considered endemic to KZN; with 30 new cases reported each month.".
"(D)iagnosed cases of XDR-TB likely represent a small proportion of the true extent of the problem.
"WHO urged a response to the outbreak akin to the recent global efforts to control SARS and Bird Flu.".
Is XDR-TB then just the latest evidence of the inadequate response of the 'global community' to the global tuberculosis crisis? Well despite the the fact that TB has been and was declared a global health emergency in 1993, there are those who are asserting just that.
From a recent issue of The Lancet:
"Mario Raviglione, Director of StopTB at the WHO, said the local, national and international response to the spread of XDR tuberculosis was too little too late. 'This is an absolute emergency', he told The Lancet. "It is the most urgent thing I have seen in my 15 years of working in tuberculosis: a highly resistant strain that is now killing HIV-positive people and is spreading very rapidly ... Nobody is moving fast enough.'. an appeal for $US 95 million made last October in Paris has met little response, he said.".
"In fact (the Plos article again), "it could be said that the emergence of MDR-TB itself is evidence of the systemic failiure of the Global Community to tackle a curable disease.".
Tuberculois, is 'recognized as a disease that preys upon social disadvantage', and what we are talking about here in another step along the road to 'nightmare scenario' that many have feared - namely a virtually untreatable TB, a global health disaster of unimaginable consequences and implications. And this is certainly what we were alludingg to in our initial essay when we discussed how a failiure to deal with such public health issues on a justice/moral/humanitarian level can inevitably push them towards becoming a public security issue. And this is indeed what is happening with regards to XDR-TB and the tough measures that are now being considered. And it is certainly the issue that has underlined the whole response to the Andrew Speaker story.
Again, the Plos article:
"Is there a role for involuntary detention?
"The successful containment of TB, MDR-TB, and XDR-TB in South Africa carries human rights and ethical implications. And important question that we must come to terms with is the extent to which judicially sanctioned restrictuve measures should be employed to control what could develop into a lethal global pandemic.
"Current WHO guidelines recognize that this strategy is not feasible in resource-constrained environments. WHO recommends that persons with MDR-TB voluntarily refrain from mixing with the general public and from those susceptible to infection, while they are infectious and in ambulatroy care. The document is silent on what steps to take should voluntary measures fail.
"The failiure rests upon us all. We should begin to contemplate the response when we move to the predictable next: completely drug resisitant tuberculosis.".
Wel.. Let the contemplation begin.
And let me take this moment to emphasize the words 'resource deprived enivronments' as a note for many future posts where we will attempt to break down the complete story with regards to the resources available to fight tuberculosis 'versus' the resources deemed necessary.
And for those interested (like myself) who may not know what tuberculosis is , and how it is treated and thus what MDR-TB, and XDR-TB are - a good primer might be the Wikipedia version, or one could consult the WHO fact sheet on tuberculosis.
The great Stephanie Nolen breaks down the storyof Tony Moll the South African doctor who first discovered the problem of XDR-TB in 'the rural town in the low hills of KwZulu-Natal province. 'A problem that some public health experts say may be the worst threat to humanity in the past half-century.'. But it will cost you $4.95. Canadian.
AND FURTHER STILL:
This just in: the WHO has now released its Global MDR-TB and XDR-TB
response Plan. Here is the Press Release. And here is The Plan . And here is The Fact Sheet for The Plan. I haven't had time to read these yet. But I will be definitely getting to them in the near future.