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Science

A world without tuberculosis?

The World Health Organization (WHO) has developed a new ambitious strategy to drastically reduce the number of tuberculosis cases worldwide – even eradicate it in some countries. A realistic target?

If it's up to the WHO, the number of tuberculosis (TB) deaths is to decrease by 95 percent over the next twenty years, the number of those contracting the disease by 90 percent. These are without doubt lofty targets. Serious efforts will have to be taken to get the infectious disease that's triggered by bacteria under control.

The World Health Organization's "End TB"-strategy has already failed to convince all the experts: "It's definitely not possible to eradicate the disease with this timeframe and I also doubt that tuberculosis will ever be purged from Earth completely," said tropical disease specialist August Stich. "It has existed for as long as homo sapiens. We have a few new drugs to fight it and have also achieved a breakthrough in diagnostics by introducing molecular-biological testing methods. But tuberculosis remains a huge problem."

The WHO experts are aware of this. But Mario Raviglione still considers the "End TB"-strategy to be rather realistic. "We have some new tools, for instance the quick molecular diagnostic test that was not available four, five years ago," Raviglione said. "For the first time we have two new drugs for the multi drug resistant form of TB, meaning the forms that resist the normal treatment of tuberculosis. And therefore there is some hope here - especially because there has also been investment in research, in the past ten, fifteen years - that we can actually accelerate TB's decline."

The Nobel Prize winning German doctor Robert Koch discovered tuberculosis in 1882

The Nobel Prize winning German doctor Robert Koch discovered tuberculosis in 1882

The danger of multi-resistant pathogens

Ahead of World Tuberculosis Day on March 24, the Robert-Koch-Institute announced there were 4,318 cases of tuberculosis in Germany in 2013. Statistics from previous years indicate the country hasn't really got very far in the fight against TB.

Stich sees three large problem areas. "The first problem are the resistant, multi-resistant or extensive-resistant tuberculosis strains, which are extremely difficult to treat," the expert said. "The second problem is that many patients are co-infected with HIV Aids. That makes treatment harder and increases the mortality rate. The third problem is the issue of access to more effective treatments."

The treatment of tuberculosis is laborious and time-consuming. Patients have to take four kinds of antibiotics for half a year. When doctors can't use certain drugs because the patient developed a resistance, it takes even longer and thus becomes more expensive.

Stich points out that only a fraction of the people who would actually need it have access to therapy. "Across the world there are 500,000 people suffering from multi-resistant tuberculosis," he said. "In 2013, Germany registered 100 of these cases."

A joint effort

To stop tuberculosis from spreading, it's important to nip the disease in the bud. To achieve this, doctors have to be able to diagnose TB as soon as possible. That's why the WHO is calling for perfecting the use of drugs and financial support for patients.

"The idea is that the responsible health ministries have to strengthen their national programs so that all the medications are provided once the patient is diagnosed," Raviglione said. "We have to make sure that a system is in place that allows diagnosis and treatment."

The ravaged lungs of a tuberculosis patient under the microscope

The ravaged lungs of a tuberculosis patient under the microscope

According to the WHO, more money needs to be invested in research and new therapy methods, like vaccinations and prophylaxis.

"We need shorter and more effective therapy or a vaccinewe can use," Raviglione said. "These are the tools that will eventually push the incidence of tuberculosis down."

International cooperation is one of the central points in the WHO's 20-year-plan. The costs are to be kept down so that patients from poorer families can also be treated.

"I think the fight against tuberculosis can be won by improving healthcare systems rather than through pharmaceutical research," Stich said. "If people everywhere had access to the necessary therapy, that would be a big step in the right direction."

That's exactly what the WHO's 20-year-plan hopes to achieve. It also aims to find a new vaccine by 2025. The one that's currently used is more than half a century old.

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