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. Last Updated: 07/27/2016

TB: Scarier than Nukes




The epidemic of multi-drug resistant, or MDR, tuberculosis sweeping through jails and penal colonies of the former Soviet Union has reached alarming proportions that justify adding this new scourge to the official list of calamities threatening the world after the collapse of communism -- along with the smuggling of nuclear material, the spread of organized crime and environmental pollution.


One out of every 10 of the 1.5 million inhabitants of the former Soviet Union's penal systems has active TB, for a total of 150,000 cases. About 12 percent of the inmates, roughly 18,000, are affected by TB strains resistant to treatment with commonly used first-line drugs. In some institutions, such as colony No. 33 in Mariinsk, Kemerovo region, or the Central prison in Baku, the multi-drug resistant rate reaches 40 percent. This is the worst incidence rate of MDR TB ever recorded.


The MDR TB epidemic is also spilling over into surrounding civilian communities. The World Health Organization names Latvia, Estonia and Russia among the 10 hot spots of MDR TB in the general populations.


Russia, thanks to its vast prison system, is the world's largest reservoir of the deadly disease. MDR TB is a man-made phenomenon. It is caused by misuse of antibiotics during treatment of regular TB, which consists of a daily ration of four drugs that must be taken for six months without interruption. This gives a nearly 100 percent chance of cure at the cost of about $100 per patient. However, if the regimen is interrupted, or the antibiotic cocktail is incomplete, a small fraction of TB bacteria evolve to tolerate the drugs. These mutants proliferate and resistance develops.


Substandard treatment, while temporarily reducing symptoms, thus converts a curable condition into a virtual death sentence for the patient, unless expensive second-line drugs and a sophisticated medical support system are available.


Even worse, before dying, each such patient will infect others with the deadly, drug-resistant strain. Thus, when the full set of drugs is not available, or the completion of treatment is not feasible, more lives are lost by substandard treatment than by no treatment at all.


Due to a chronic lack of funding, the ex-Soviet prison systems' TB drug requirements have been fulfilled by no more than 20 to 25 percent in the past several years.


Inmates and prison authorities do not generally understand the risks of MDR TB, but pressure to treat patients with whatever is available has mounted as the epidemic grows. As a result, tens of thousand of prisoners with regular, drug sensitive TB are undergoing substandard treatment -- thus generating thousands of new MDR TB cases every year.


Infectious diseases know no fences or borders, and it is only a matter of time before MDR TB of ex-Soviet origin knocks on the doors of Western European or American households. Treatment of a single such case in an American hospital often costs more than $200,000, with uncertain outcome. When a relatively small outbreak of MDR TB hit New York -- some 600 cases in the peak year of 1991 -- a near panic ensued and the city spent $1 billion in only four years to bring it under control.


Given tens of thousands of persons already infected in this epidemic, and its growth rate, in the age of mass international travel no city in the globe can be sure that a gulag strain does not suddenly turn up in its airport or mass transit system.


For these reasons, the TB situation is not simply an issue of medical or humanitarian concern. It should be the subject of very serious consideration by Western foreign policy and national security planners.


Fortunately, there is still a window of opportunity to bring the situation under control. A combination of urgent administrative and medical steps is required -- such as providing drugs, improving prison conditions, and stopping the irrational practice of generating the MDR TB scourge through improper use of antibiotics. Western leaders should pressure former Eastern bloc governments on this issue with the same zeal as they do with regard to control of decaying nuclear arsenals.


In Russia, the first step should be for the Health Ministry to abandon its archaic TB policy rooted in the pre-antibiotic era and accept the treatment guidelines of the World Health Organization -- something that the world medical community has been urging Russia to do for years.


However, pressure alone is not enough. In the current economic situation, local governments simply do not have the resources needed to combat TB even with the best organization. These resources can only come from foreign assistance to turn the existing epidemic around.


A one-time infusion of at least $100 million is needed to implement World Health Organization recommended treatment throughout the former Soviet Union in a manner which can then be sustained by local authorities.


Another one-time $150 million may be needed to treat those already infected with MDR TB in order to prevent those unfortunate patients from spreading MDR TB to others. If this money is not spent soon, in several years the cost of the epidemic to the world will be counted in billions, and indeed it may become unmanageable. Of all foreign bills that American, West European and Japanese taxpayers should be asked to pay, there is hardly a more urgent one -- for reasons of self-interest rather than charity.


Alex Goldfarb is the director of the Russian TB Project of New York's Public Health Research Institute, a $12 million program funded by George Soros. He contributed this comment to The Moscow Times.