China fights tuberculosis

Drug-resistant
tuberculosis, far more expensive to treat, emerges when patients fail to follow
treatment regimes and take substandard drugs or stop treatment too early.

Liu
Zhongwu, a stonecutter working in southern China, for example, stopped taking
his TB medication midway through a standard six-month course in 2007 because it
was too costly.

“Even
though one or two drugs were free, I had to pay 500 yuan ($73) a month for
other drugs (to reduce side effects) and the side effects were bad, I suffered
terrible gastric pain and had to stop work, I didn’t even have energy to
walk,” said Liu.

It
is precisely this sort of behaviour that health experts are trying to stop
because if the TB bacteria is not fully eliminated, it can mutate, resurge
later and become resistant to the small arsenal of drugs that can fight the
disease.

China
has 4.5 million TB cases currently; and each year 1.4 million people fall ill
with the disease. TB killed 160,000 people in China in 2008, according to the
World Health Organisation.

TB
killed 1.8 million people across the world in 2008, or a person every 20
seconds. It is not only a scourge in poor countries but also in the west, where
it has flared anew in the last 20 years because of AIDS, which weakens the
immune system.

Drug-resistant strain

TB
is also a big drain on China’s health budget because of a high incidence of
people with a drug-resistant strain of the disease, which is a lot harder and
more expensive to treat.

In
such cases, patients need to take drugs for up to two years and the worst type
of TB, for which there is no cure, kills one out of every two patients.

“If
there are more drug-resistant cases, the cost of TB treatment will rise by a
lot, that’s for sure. With drug resistance, we can’t use first-line drugs and
other drugs cost a lot more,” said Lin Yan, director of the China office
of the non-profit International Union Against TB and Lung Disease.

“When
these patients infect others, the others will get drug-resistant TB. That
increases the cost of treating that person and increases the chances of him not
recovering.”

Regular
TB costs 1,000 yuan to treat in China but drug-resistant TB ranges from 100,000
to 300,000 yuan per person, said Zhong Qiu of China’s TB Expert Consultative
Committee.

China
ranks second in the world with 112,000 drug-resistant TB cases in 2007, after
India with 131,000. Russia has 43,000 cases, while South Africa has 16,000 and
Bangladesh 15,000.

China
spent $225m on tackling TB in 2008, up from $98m in 2002, according to WHO.
These figures do not take into account what patients pay out of their pockets,
typically between 47 and 62 percent of their hospital bills.

Drug-resistant
TB made up 27.8 percent of all TB cases in China in 2000 versus five percent in
advanced countries.

“There
are many reasons for China’s drug-resistant TB problem. Patients stop taking
drugs when they feel better, maybe after a month. Some have no money for drugs
if the treatment is not free and they don’t even know this is a serious
disease,” said Lin.

“Some
are so afraid of stigma they don’t see a doctor, they just buy drugs over the
counter.”

Ignorance, poverty, stigma

TB
affects mostly poor people, who typically live in places where healthcare is
not easily accessible. Many patients pay not only for treatment but also
transportation, and any chronic, long-term disease can bankrupt entire
families.

Li
Jiachuen, 45, quickly ran out of money and had to borrow from relatives and
friends after he was diagnosed with TB.

“I
don’t take drugs now. I don’t even have money to pay off my 20,000 yuan debt. I
spent thousands of yuan on diagnosis and treatment and even more on
transportation,” Li said.

WHO
recommends all TB treatment be free because the disease is a public health
threat.

But
in China, diagnosis and treatment is only free in specialist TB outpatient
clinics. General hospitals, which have been self-financing since the 1990s,
impose charges.

“TB
is a political problem because it is infectious. It has societal impact, it is
a threat to public health … free treatment is very important,” said
Zhong, who also heads the Anti-TB Research Institute in China’s southern
Guangdong province.

The
world’s only TB vaccine is 100 years old and there has been no new TB drug for
more than 40 years. But the resurgence of TB due to AIDS has forced the West
back into TB research in the last 20 years and a string of experimental drugs
and vaccines are now in the pipeline.

Chinese
scientists are working on a new class of TB drugs based on an old drug called
clofazimine, used in the past to treat leprosy, said Ann Ginsberg, chief
medical officer of the TB Alliance, a US-based non-profit scientific group that
pulls together partners to develop new TB drugs.

“They
(scientists) found a very promising lead compound and we hope within the next
six months … it will come into formal pre-clinical development and get the
formal animal and non human studies that are required to convince the regulators
it can go onto people,” said Ginsberg.