Tuberculosis makes the G20 Declaration

On 7 & 8th July 2017, leaders of the G20 met in Hamburg, Germany, to address major global economic challenges and to contribute to prosperity and well-being.

Their Declaration, published on July 8, carries an important section on combatting antimicrobial resistance (AMR):

"AMR represents a growing threat to public health and economic growth. To tackle the spread of AMR in humans, animals and the environment, we aim to have implementation of our National Action Plans, based on a One-Health approach, well under way by the end of 2018.

We will promote the prudent use of antibiotics in all sectors and strive to restrict their use in veterinary medicine to therapeutic uses alone. Responsible and prudent use of antibiotics in food producing animals does not include the use for growth promotion in the absence of risk analysis. We underline that treatments should be available through prescription or the veterinary equivalent only. We will strengthen public awareness, infection prevention and control and improve the understanding of the issue of antimicrobials in the environment. 

We will promote access to affordable and quality antimicrobials, vaccines and diagnostics, including through efforts to preserve existing therapeutic options. We highlight the importance of fostering R&D, in particular for priority pathogens as identified by the WHO and tuberculosis.

We call for a new international R&D Collaboration Hub to maximise the impact of existing and new anti-microbial basic and clinical research initiatives as well as product development. We invite all interested countries and partners to join this new initiative. Concurrently, in collaboration with relevant experts including from the OECD and the WHO, we will further examine practical market incentive options."

I am pleased to see this Declaration. It is timely and welcome, because AMR is a major health threat, and it is estimated that by 2050, 10 million lives a year and a cumulative 100 trillion USD of economic output are at risk due to the rise of drug-resistant infections.

Drug-resistant tuberculosis (DR-TB) is a perfect example of the threat posed by AMR. It is much smarter and cheaper to prevent DR-TB than treat it. And prevention of DR-TB requires better access to drug-resistance testing, high-quality treatment, access to new TB drugs, infection control, and increased political commitment with financing. Unfortunately, high TB burden countries are yet to seriously address these priority actions to tackle DR-TB. In many countries, only a quarter of MDR-TB patients are detected, and not even half of all patients with DR-TB are on second-line drug therapy. 

A major reason behind poor TB control is the fact that TB is a low priority for many developing countries, and current TB budgets are insufficient to make progress in addressing DR-TB. Most National TB Programs in high burden countries are seriously under-funded, and, sadly, even emerging economies such as India are not spending enough on TB.

In this context, it may be more impactful for DR-TB control to be seen as one component of a comprehensive strategy to address AMR. While TB gets little attention, AMR is increasingly seen as a global health emergency and a security threat. Policy makers and donor agencies have prioritized AMR as a key issue for the global health security agenda, and the G20 declaration underscores this fact.

As I have argued previously, the door is wide open for the TB community to leverage this interest, and advocate for a well-funded, comprehensive AMR initiative that includes DR-TB as a key component. In fact, DR-TB could well be a pathfinder for successfully tackling AMR in low and middle income countries, and help make the case for greater investments. The TB community should therefore continue to advocate for including TB in the broader agenda to tackle AMR globally, and make sure DR-TB receives adequate funding and support. 

The upcoming Global Ministerial Conference on TB in Moscow in November 2017, and the UN General Assembly High Level Meeting on TB in 2018 are exciting opportunities to push this agenda forward.

Source: Nature Microbiology Community