Via The Tyee, an article that first appeared in Policy Options: Think Tuberculosis Is a Thing of the Past in Canada? Think Again. Excerpt:
Tuberculosis kills more people than any other infectious disease on the planet. Nevertheless, TB is not high on the lists of health concerns of most Canadians. While it cut a wide swath through the population a century ago, rising standards of living drove a decline in the incidence of the disease in the first half of the 20th century. Drugs developed in the 1940s and 1950s offered an effective cure for the cases at the time.
Unfortunately, the success of those drugs has led to a complacency that is preventing us from taking the necessary measures against this disease. Tuberculosis is still a real threat for many Canadians, particularly the homeless and Indigenous people who have not experienced improvements in nutrition and housing, as well as people from countries where TB remains widespread. Complacency is also creating unnecessary barriers to addressing the emerging threat of drug-resistant tuberculosis.
In Canada, as elsewhere, an increasing proportion of TB cases are now multidrug-resistant or extensively drug-resistant. This is a serious public health concern. Drug resistance arises when patients receive inadequate treatment, leaving the patient uncured and the disease more resilient. There is mounting evidence that drug-resistant TB can spread readily from person to person; rather than an individual developing drug resistance over time, a previously uninfected individual could have extensively drug-resistant TB from the beginning. Thus, reliable and uninterrupted access to TB treatment is crucial for curing the sick, but it is also of utmost importance for protecting the community from infection and preventing the emergence of further drug resistance.
As drug resistance increases, the tools available to combat it correspondingly decrease. Unfortunately, complacency around TB is also the reason few innovative treatments are being developed. Unlike treatment for drug-sensitive TB, which is almost always 100 per cent effective when carried out properly, treating drug-resistant TB is considerably more difficult. And treatment for extensively drug-resistant TB can take up to two years and involves a set of increasingly unpleasant drugs that have side effects ranging from nausea to permanent hearing loss. As well, successful cure is not guaranteed.
Compounding the issue in Canada is the fact that there are barriers to accessing the existing treatments. The chapter on drug resistance in the current Canadian Tuberculosis Standards contains a table listing 11 second-line TB drugs. All 11 appear on the World Health Organization’s Model List of Essential Medicines, medicines every health system should have access to. As a footnote to the table notes, however, only five of these 11 are approved to be sold in Canada.