WHO-led paper issued ahead of UN General Assembly high-level meeting on antimicrobial resistance
In the lead up to the UN General Assembly’s first-ever high-level meeting on antimicrobial resistance, The New England Journal of Medicine has published a historical article on global surveillance of drug-resistant tuberculosis (TB). The new paper led by World Health Organization (WHO) authors and key science leaders highlights the evolution and lessons learned in TB drug resistance surveillance and its implications in tackling the multidrug-resistant TB (MDR-TB) crisis.
“This article charts the progress made over two decades in our anti-TB drug resistance surveillance programme and its key role in the response to MDR-TB,” said Dr Mario Raviglione, Director of WHO’s Global TB Programme and one of the authors. “Our work with key scientific and public health partners has great relevance for current efforts to combat antimicrobial resistance in general and is a model for other infectious diseases.”
An overview of key achievements over 1994-2014 are outlined in the report, highlighting extraordinarily strengthened surveillance systems in most countries worldwide, as well as a better understanding of MDR-TB burden and trends. The data on anti-TB drug resistance were derived from continuous surveillance or periodic surveys in 153 countries, covering 96% of the world’s population and incident TB cases.
Despite the progress, the authors highlight three areas which need to be strengthened: more data on trends especially for many resource-limited countries (particularly in Africa); better capacity to detect hot-spot areas and outbreaks; and increased engagement of private health providers in surveys.
The paper also presents plans for further strengthening of surveillance efforts. “Surveillance of drug resistance in TB will significantly evolve in the next decade,” said Dr Matteo Zignol of WHO’s Global TB Programme and lead author of the publication. “Conventional phenotypic testing will ultimately be replaced by molecular technologies, including genome sequencing which have recently shown great potential for surveillance of drug resistance in resource-limited settings.”
In addition, mechanisms are being put in place to monitor resistance to new anti-TB drugs like bedaquiline and delamanid in patients with MDR-TB. This will be of paramount importance to preserve the effectiveness of these drugs.
In conclusion, the authors emphasize the importance of surveillance data in the development of an evidence-based response to the public health threat of MDR-TB. Better surveillance is a critical cornerstone of the WHO End TB Strategy as well as the WHO Global Action Plan on Antimicrobial Resistance.