title: Drug-resistant tuberculosis: time for visionary political leadership.
abstract: Two decades ago, WHO declared tuberculosis a global emergency, and invested in the highly cost-effective directly observed treatment short-course programme to control the epidemic. At that time, most strains of Mycobacterium tuberculosis were susceptible to first-line tuberculosis drugs, and drug resistance was not a major issue. However, in 2013, tuberculosis remains a major public health concern worldwide, with prevalence of multidrug-resistant (MDR) tuberculosis rising. WHO estimates roughly 630 000 cases of MDR tuberculosis worldwide, with great variation in the frequency of MDR tuberculosis between countries. In the past 8 years, extensively drug-resistant (XDR) tuberculosis has emerged, and has been reported in 84 countries, heralding the possibility of virtually untreatable tuberculosis. Increased population movement, the continuing HIV pandemic, and the rise in MDR tuberculosis pose formidable challenges to the global control of tuberculosis. We provide an overview of the global burden of drug-resistant disease; discuss the social, health service, management, and control issues that fuel and sustain the epidemic; and suggest specific recommendations for important next steps. Visionary political leadership is needed to curb the rise of MDR and XDR tuberculosis worldwide, through sustained funding and the implementation of global and regional action plans.
authors.affiliation: Centre for Infectious Disease Epidemiology, Department of Infection and Population Health, University College London, London, UK.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Abubakar
authors.forename: Matteo
authors.initials: M
authors.lastname: Zignol
authors.forename: Dennis
authors.initials: D
authors.lastname: Falzon
authors.forename: Mario
authors.initials: M
authors.lastname: Raviglione
authors.forename: Lucica
authors.initials: L
authors.lastname: Ditiu
authors.forename: Susan
authors.initials: S
authors.lastname: Masham
authors.forename: Ifedayo
authors.initials: I
authors.lastname: Adetifa
authors.forename: Nathan
authors.initials: N
authors.lastname: Ford
authors.forename: Helen
authors.initials: H
authors.lastname: Cox
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Lawn
authors.forename: Ben J
authors.initials: BJ
authors.lastname: Marais
authors.forename: Timothy D
authors.initials: TD
authors.lastname: McHugh
authors.forename: Peter
authors.initials: P
authors.lastname: Mwaba
authors.forename: Matthew
authors.initials: M
authors.lastname: Bates
authors.forename: Marc
authors.initials: M
authors.lastname: Lipman
authors.forename: Lynn
authors.initials: L
authors.lastname: Zijenah
authors.forename: Simon
authors.initials: S
authors.lastname: Logan
authors.forename: Ruth
authors.initials: R
authors.lastname: McNerney
authors.forename: Adam
authors.initials: A
authors.lastname: Zumla
authors.forename: Krishna
authors.initials: K
authors.lastname: Sarda
authors.forename: Payam
authors.initials: P
authors.lastname: Nahid
authors.forename: Michael
authors.initials: M
authors.lastname: Hoelscher
authors.forename: Michel
authors.initials: M
authors.lastname: Pletschette
authors.forename: Ziad A
authors.initials: ZA
authors.lastname: Memish
authors.forename: Peter
authors.initials: P
authors.lastname: Kim
authors.forename: Richard
authors.initials: R
authors.lastname: Hafner
authors.forename: Stewart
authors.initials: S
authors.lastname: Cole
authors.forename: Giovanni Battista
authors.initials: GB
authors.lastname: Migliori
authors.forename: Markus
authors.initials: M
authors.lastname: Maeurer
authors.forename: Marco
authors.initials: M
authors.lastname: Schito
authors.forename: Alimuddin
authors.initials: A
authors.lastname: Zumla
mesh_terms: D000995:Antitubercular Agents / Q000627:therapeutic use; D014943:Global Health; D006801:Humans; D009169:Mycobacterium tuberculosis / Q000187:drug effects* / Q000302:isolation & purification*; D015995:Prevalence; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy* / Q000453:epidemiology*; D014944:World Health Organization
chemical_list: D000995:Antitubercular Agents