In September, the Obama administration will unveil The National Action Plan to Combat Drug Resistant Tuberculosis (TB). I commend the administration for developing an action plan to address this preventable, air-borne disease. As a practicing physician who has been treating people with drug resistant TB for decades, I am cautiously optimistic that future patients will receive the safe and effective treatment regimens they need both for their own survival as well as to prevent spreading the disease in their families and communities.

For this plan to succeed it will require implementing ambitious goals to scale up treatment services for patients with drug-resistant both in the U.S. and globally using available diagnostics and treatment regimes as a first step. Let us not delude ourselves, however, because we will never treat our way out of the global drug-resistant TB pandemic using current weak and toxic treatment regimens. Success will require full implementation of an aggressive research agenda to rapidly develop new TB diagnostics, drugs and vaccines, a research agenda recommended by the Federal Tuberculosis Task Force in 1992 and 2009 but never implemented.


TB is the second leading global infectious disease killer, killing 1.5 million people annually, the number of fatalities equivalent to 10 wide-body airline crashes daily. It is the third leading cause of death for women of reproductive age. And in sub-Saharan Africa, it is the top cause of death for people living with HIV/AIDS. Only 10 percent of the estimated half-million persons with new cases of multidrug resistant TB (MDR-TB) each year are successfully treated. The vast majority of those affected by MDR-TB continue to spread the disease in their communities for several years before dying.

This ongoing spread of drug resistant TB is not a theoretical or potential global health threat, it represents a global public health emergency that we cannot afford to ignore. Here in the U.S., we currently have 4 cases of the most dangerous form of TB, extensively drug resistant (XDR) TB and additionally almost 100 cases of multi-drug resistant (MDR) TB. Treatment costs for XDR TB can be over $1 million and for MDR, between $100,000 – 300,000. The regimen is excessively long, requiring two years of daily therapy with mostly old antibiotics developed decades ago. MDR-TB treatment may be life-saving but can only be described as inhumane. A teacher who started treatment for MDR-TB in Denver required repeated hospitalizations to manage side-effects of recurrent vomiting and is facing challenges with returning to work due to drug-induced hearing loss that may be permanent.  Other common side effects include nerve damage, liver injury and life-threatening depression. I am tired of apologizing to my patients for being forced to use this harsh antiquated treatment regimen because we have failed to adequately fund research into developing new drugs and regimens, and the basic science that paves the way for these discoveries.

The president should work closely with Congress to ensure that the  Action Plan to Combat Multi-Drug Resistant TB is accompanied by the necessary funding required for agencies, including U.S. Agency for International Development (USAID), Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to implement the plan.  It is abundantly clear that the existing level of resources devoted to combating TB is insufficient.

Reves is a professor of Medicine and Public Health at the University of Colorado, Denver.