TB, which cannot be cured with conventional drugs, is spreading in Eastern Europe. So far, strategies to fight the disease have shown little success because it is closely linked to poverty and exclusion.
Two years ago, most addicts in Eastern Europe died from a overdose or committed suicide; today, more and more of them are dying from multi-resistant tuberculosis (TB).
“The leading cause of death for people we treat is TB," says Daria Ocheret, who has worked with addicts in the Lithuanian capital Vilnius for 10 years. "And most of the time, it is multi-resistant tuberculosis.”
For many people, TB is a disease that was eradicated in the last century. But the fact is the disease has returned and is more dangerous than ever. Multi-drug resistant TB complicates the treatment of patients worldwide.
The past several years has seen the rise of strains that are resistant not only to conventional antibiotics but nearly to all medicines. The World Health Organization (WHO) estimates that more than 400,000 people are suffering from multi- or extremely-resistant TB.
Former Soviet states at high-risk
The former Soviet Union is especially at risk in Europe. Around 80,000 people with resistance to conventional TB medicines live in former Soviet states – a fifth of all cases worldwide, according to the WHO. A total of 15 European countries are considered high-risk, including Russia, Ukraine, Belarus, Bulgaria, and Moldavia as well as the Baltic states.
Germanyis interested in the situation in these countries, according to Barbara Hauer, an infections disease expert at the country's disease prevention and control authority Robert Koch Institute.
“We have to wait and see how the developments in other countries affect Germany in the long term,” she says. “The rates are at a low-level, but we need to keep an eye on the number of cases.
Hauer estimates that Germany has around 50 cases a year.
Normally, TB patients receive four to five antibiotics, which they have to take for six months. Resistance develops when patients don't take their medicine or the treatment ends earlier. Up to 17 tablets can be required to treat resistant TB, which can lead to deafness. And the costs can exceed normal TB treatment by more than a hundred times. If multi-resistant TB is not treated properly, there is a danger of extremely resistant strains.
That's why it's necessary to carefully monitor current and former patients, according to Andrei Dadu from WHO's European office.
But the actual number of known cases of resistant TB is "still at a very low level," he says, adding that "if we don't find the number of infected people, others could get infected."
Dadu believes more money should be invested in diagnostic techniques in high-risk countries.
Last year, the WHO allocated more than $400 million (309 million euros) alone for countries in Europe at risk of TB. The money is to be used, among other things, for producing diagnosis equipment designed to identify strains within an hour through DNA analysis. By 2015, the WHO budget could rise to almost $2 billion. The Global Fund to Fight AIDS, Tuberculosis and Malaria has set aside a similar amount of money.
Despite the funding, less than a third of suspected cases of multi-drug resistant TB are found and only two-thirds of the discovered cases are treated adequately. Plenty of necessary infrastructure is also lacking, such as hospital beds and labs, in addition to diagnostic equipment.
Lack of understanding
There is often a lack of understanding for TB in society, such as a willingness to accept HIV-positive prisoners and drug addicts, according Daria Ocheret.
“Almost every person who died from TB in Russia over the past 10 years was HIV positive and addicted to drugs,” she says.
There is a simple reason, she adds, why these people have not been diagnosed or treated – drugs are illegal and addicts fear being sent to prison or a long stay in the hospital without drugs or substitutes, as is the case in Russia.
“A lot of them leave," Ocheret says. "Or they are thrown out after being caught with drugs. So they stop the treatment and increase the chances of developing and spreading multi-resistant TB.”
The solution, she believes, would be to link help for addicts to TB treatment. Those who receive anti-addiction drug methadone must also be given TB drugs regularly.
But a joint proposal of initiatives for drug prevention has failed, partly due to the public health structures in Ukraine, Russia, and Belarus. And the WHO argues Central Asian countries like Azerbaijan and Kazakhstan lack a political will to take action.
At the end of this year, the Global Funds wants to base the allocation of funds on a country's TB burden and the average per capita income.