Calling for Zero TB Deaths

Posted on September 6, 2012 by

Health center in Peru, Ministry of Health. Photo by Julie Rosenberg Talbot. 2002

Health center in Peru, Ministry of Health. Photo by Julie Rosenberg Talbot. 2002

We know how to treat multidrug-resistant tuberculosis—and have for decades—yet barely 0.5 percent of newly diagnosed patients worldwide receive appropriate treatment, write Drs. Salmaan Keshavjee and Paul Farmer in the latest issue of The New England Journal of Medicine.




Effective counselling and support is essential for all forms of TB in order to give the best possible chance of successful treatment. Gini Williams, Nurse, in GHDonline

In “Tuberculosis, Drug Resistance, and the History of Medicine,” they argue that shifts in tuberculosis policy have played a key role in the inadequate response to this disease. Keshavjee is a physician in the Division of Global Health Equity at Brigham and Women’s Hospital, and was a moderator of the MDR-TB Treatment & Prevention community on Farmer, co-founder of Partners In Health, is chief of the division.

As tuberculosis was brought under control in the United States and other wealthy countries, funding for research and implementation programs elsewhere dried up.

“The U.S. response to the outbreaks of MDR tuberculosis in New York City and elsewhere was bold and comprehensive; it was designed to halt the epidemic,” write Keshavjee and Farmer. “A similar response has not yet been attempted in low- and middle-income countries. Instead, selective primary health care and ‘cost-effectiveness’ have shaped an anemic response to the ongoing global pandemic.”

Tuberculosis kills almost 2 million people every year.

“We want to encourage the international tuberculosis community to redouble its efforts to battle this disease, including adopting a goal of zero tuberculosis deaths,” said Keshavjee in a statement from Brigham and Women’s Hospital. “That means proactively looking for those who are already sick, ensuring they are rapidly diagnosed and putting them on appropriate treatment. It also means treating those with latent infection and implementing infection control measures that can stop the spread of the disease. This is the approach we’ve used in the United States and Western Europe, and it needs to become the global standard of care.”

This post was first published in the Partners In Health blog.

2 thoughts on “Calling for Zero TB Deaths

  1. Prasanta Poudyal

    I,Prasanta Poudyal, MBBS final year student from Maharajgunj Medical Campus, Institute of Medicine, TUTH,Kathmandu,Nepal, would like to congratulate Paul Farmer and Keshavjee for addressing the important issues in MDR-TB.
    TB burden in Nepal
    45% of total population are infected with TB 40,000 people get TB every year 20,000 new sputum positive cases every year 5000-7000 people die each year from TB in Nepal.
    TB is one of the most widespread infectious diseases in Nepal, and poses a serious threat to the health Currently, nearly 80,000 people have TB in Nepal, with more than 40,000 new cases arising every year. About half of these are infectious (sputum smear-positive TB) cases, which continues the chain of transmission. Over 200,000 people will develop TB during the next five years, a number equivalent to the population of a densely populated hill district of the country. The majority of TB patients belong to the economically active age groups of 15–45 years. Without appropriate TB treatment, nearly 94,992 people will die of TB in Nepal over the next five years.

    Tuberculosis Control Programme was launched by Government of Nepal almost six decades ago. In 1937 ‘Tokha Sanatorium’ situated on the north of Kathmandu city was established. The Central Chest Clinic (CCC) came into existence in 1951 with the facility of diagnosis and treatment services for the TB patients on domiciliary basis. Similarly, in 1965, TB Control Programme was systematically organized with tripartite agreement between Government of Nepal, WHO and UNICEF. Since then TB Control Programme started on a nation wide basis offering preventive measures such as BCG vaccination, case-findings and distribution of drugs. Later Central Chest Clinic and TB Control Programme were amalgamated into one centre as National Tuberculosis Centre. As a result the National Tuberculosis Centre in Thimi, Bhaktapur at the central level and Regional Tuberculosis Centre (RTC) at the regional level in Pokhara were established in 1989 with the cooperation of Japan International Cooperation Agency.

    But the undone part is the inclusion of medical students in addressing the burden of the disease. Medical students in our country have least opportunity to work in research field and programmes conducted to address the burden. However, from our side, we have been constantly tried our best by celebrating World TB day programme and holding lectures on the topics to address the issue. Recently , a group of medical students, Prasanta Poudyal, Aditya Kumar, Shikar More, Paras Khakurel even presented the scientific journal on “Burden of MDR/XDR TB in Nepal and the role of medical students-a qualitative study” in the East Asian Medical Students Conference in Singapore in 2012 organized by Asian Medical Students Association International. We were not even supported by the funding.(Since Nepal falls under a low middle income countries,there are few research universities and above all almost nil funding research opportunities even in the most prestigious institute of the country.)So, by one way we were not encouraged rather discouraged to continue our works further.
    I therefore, suggest that ,to address such disease, not only the policy makers, doctors and grass-hood level health workers be involved in curative services only but also medical students should be encouraged to conduct research activities, help them participate and present in international conference to share and present the scientific research paper and also not underestimate the role of medical students in helping reduce the burden of the disease.
    We ,group of medical students are also working in collaboration of Univesities Allied for essential medicines(UAEM),established in 2001, which has also been encouraging to conduct research activities as well as programmes to address Neglected Disease like Tuberculosis all over the world with the objective of increasing understanding of neglected diseases, the research gap and the role of universities amongst students, faculty, administrators and the general public.
    It also focuses on student empowerment.
    So, finally i would like to request Global Health Project Delivery at Harvard University to help us in our efforts to battle this disease and adopt a adopt a goal of zero tuberculosis deaths.

  2. Editor

    Hi Prasanta,

    Thanks for sharing your thoughts from Nepal, and your work with the student group and UAEM. Are you a member of our TB communities on You could connect there with lots of TB professionals, students, and policy makers. We also organize virtual expert panels and could envision one on “Students and the fight against TB” for example if you’d like to organize with us. If you are interest, join GHDonline and contact us

    Best, Sophie

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