BEIJING -- Countries must fight a "potentially explosive" rise in hard-to-treat strains of tuberculosis with stronger health care systems and better drugs and tests for infections, the World Health Organization's chief said Wednesday.
One of the world's oldest and deadliest infectious diseases, TB has mutated into hardier forms that withstand some of the most commonly used medicines. Left unchecked, people with drug-resistant TB could spread the disease to others, creating a widespread epidemic in the highly mobile global economy.
WHO Director-General Margaret Chan told health ministers and senior officials from 27 countries worst-affected by the new drug-resistant strains of TB that they must make dramatic improvements in detecting infections and build stronger health care systems.
"Call it what you may a time bomb or a powder keg," Chan said at the opening of a three-day meeting on drug-resistant TB in Beijing. "Any way you look at it, this is a potentially explosive situation."
In a spur to action, software magnate Bill Gates' foundation and the Chinese government announced a $33 million project to test new ways to diagnose drug-resistant TB, new treatments and better ways to track patients.
The disease is caused by germs that spread when a person with active TB coughs, sneezes or speaks. It's ancient and treatable but now has evolved into stronger forms: multidrug-resistant TB, which does not respond to two top drugs, and extensively drug-resistant TB, which is virtually untreatable.
The problem has been partly blamed on health care systems that lose track of patients who do not complete their courses of treatment, allowing the TB bacteria to develop resistance to normally potent medicines.
Chan said less than 5 percent of estimated cases of drug-resistant TB were being detected and fewer than 3 percent were being treated according to WHO standards.
Even when detected, those infected with multidrug-resistant TB have to switch to more potent and expensive medicines, posing a problem for many countries with underfunded health care systems.
In 2007, 1.75 million people died of tuberculosis. Of the more than 9 million people around the world who contract the disease every year, about 500,000 get multi-drug resistant TB. The WHO estimates that 150,000 people die of drug-resistant TB every year worldwide.
Nearly a quarter of those who contract the drug-resistant strains are in China, where legions of rural migrants face an inadequate health care system.
It is also a problem in India, where rural health care is often poor and there is little control over the sale of anti-TB drugs; Russia, which faces a shortage of qualified medical staff and drugs; and South Africa, where the disease thrives amid an AIDS epidemic that has weakened the immune systems of people with HIV.
"I urge you to make the right policy decisions with appropriate urgency," Chan said to the officials. "At a time of economic downturn, the world simply cannot afford to let a threat of this magnitude, complexity and cost spiral out of control."
Countries attending the meeting are expected to start drawing up five-year national plans to prevent and control the spread of drug-resistant TB.
The Bill & Melinda Gates Foundation chose to fund the TB project in China because, Bill Gates said, the scale of the problem is great and the government has the ability to set an example for the world.
"Because of its skill, its scale, its TB burden, its love of innovation, and its political commitment to public health, China is a perfect laboratory for large-scale testing of new tools and delivery techniques to fight TB," Gates said at a news conference.
The project will initially cover 20 million people in six provinces and then be expanded to 100 million people over five years, Gates said.
Medecins Sans Frontieres, also known as Doctors Without Borders, welcomed the Gates project but said China should not neglect other drug-resistant TB sufferers in the country who are not covered by the program.
"It's a big pilot project but the question is what happens to all the other patients who need treatment now and what will be provided to them while this project is ongoing in the next five years," said MSF's Tido von Schoen-Angerer.
TB is usually treated in six months with a $20 cocktail of four antibiotics, but its drug-resistant form takes up to two years to fight. Chan said the cost of treating drug-resistant TB can be as much as 200 times higher than normal TB.
Detecting drug-resistant TB quickly improves the chances a patient will survive and lowers the risk that the disease mutates further into an even more drug-resistant form of the disease.