Multidrug-resistant tuberculosis (TB) is caused by bacteria resistant to isoniazid and rifampicin, the two most effective first-line anti-TB drugs, originally developed and introduced in the 1950 and 1960s. Since 2008, the Forum on Drug Discovery, Development, and Translation of the Institute of Medicine has hosted or co-hosted six domestic and international workshops addressing the global crisis of drug-resistant TB, with special attention to the BRICS countries - Brazil, Russia, India, China, and South Africa.

The Global Crisis of Drug-Resistant Tuberculosis and Leadership of China and the BRICS is the summary of a workshop convened to address the current status of drug-resistant TB globally and in China. This report considers lessons learned from high burden countries; highlights global challenges to controlling the spread of drug-resistant strains; and discusses innovative strategies to advance and harmonize local and international efforts to prevent and treat drug-resistant TB. Additionally, the report examines the problem of MDR TB and emergent TB strains that are potentially untreatable with drugs available and considers the critical leadership role of the BRICS countries in addressing the threats and opportunities in drug-resistant TB.

Contents

• THE NATIONAL ACADEMIES
• PLANNING COMMITTEE FOR THE WORKSHOP ON THE GLOBAL CRISIS OF DRUG-RESISTANT TUBERCULOSIS AND THE LEADERSHIP OF THE BRICS COUNTRIES: CHALLENGES AND OPPORTUNITIES
• FORUM ON DRUG DISCOVERY, DEVELOPMENT, AND TRANSLATION
• Reviewers
• Acronyms
• 1. Introduction and Overview of the Workshop
  • WORKSHOP CHAIR'S KEY MESSAGES
  • THE BEIJING WORKSHOP
  • ORGANIZATION OF THE REPORT
• 2. The Challenges and Opportunities for the BRICS Countries to Lead
  • OVERALL ROLE OF THE BRICS COUNTRIES
  • BRAZIL
  • SOUTH AFRICA
  • INDIA
  • RUSSIA
  • CHINA
• 3. Catching Up with the Microbe
  • MDR TB IN NEW YORK CITY
  • COMMUNITY-BASED CARE
  • THE NEED FOR RESOURCES
• 4. Drug-Resistant TB in China
  • MANAGEMENT OF MDR TB IN CHINA
  • 2007 NATIONAL SURVEY OF DRUG RESISTANCE IN CHINA
  • THE DIAGNOSIS AND TREATMENT OF MDR TB IN HOSPITALS
  • MDR AND XDR TB CHEMOTHERAPY IN CHINA
  • DRUG-RESISTANT TB AND HIV IN CHINA
  • MDR TB AND DIABETES
• 5. Experiences with MDR TB in Other Countries
  • MDR TB IN THE RUSSIAN FEDERATION
  • COMMUNITY-BASED CARE IN SOUTH AFRICA
  • DIRECT COLLABORATION IN CAMBODIA AND ETHIOPIA
• 6. Drug-Resistant Tuberculosis in Pediatric Populations
  • CHILDREN AS SENTINELS FOR TRANSMISSION AND POLICY RESPONSE
  • PEDIATRIC DRUG-RESISTANT TB IN CHINA
  • DRUG-RESISTANT TB MENINGITIS IN CHILDREN
  • PEDIATRIC MDR AND XDR TB IN THE RUSSIAN FEDERATION AND OTHER COUNTRIES OF THE FORMER SOVIET UNION
• 7. Global Perspectives on Transmission and Infection Control
  • THE VALUE OF GENOTYPE MAPPING
  • INFECTION CONTROL CHALLENGES FOR HEALTH CARE WORKERS IN CHINA
  • INFECTION CONTROL CHALLENGES FOR HEALTH CARE WORKERS IN SOUTH AFRICA
  • INSTITUTIONAL INFECTION CONTROL IN RUSSIA
  • STOPPING TRANSMISSION IN INSTITUTIONAL AND COMMUNITY SETTINGS
• 8. Rapid Diagnostic Technologies: Status and Limitations
  • GAPS IN DRUG SUSCEPTIBILITY TESTING IN SOUTH AFRICA
  • DIAGNOSTIC TESTS IN CHINA
  • THE GENETIC DIVERSITY OF DRUG-RESISTANT TB
• 9. Addressing Diagnosis and Treatment Across the Spectrum of Drug Resistance
  • THE SPECTRUM OF MDR AND XDR TB
  • THE NEED FOR A PARADIGM SHIFT IN THE TREATMENT OF THE SPECTRUM OF DRUG-RESISTANT TB
  • MDR, XDR, AND UNTREATABLE TB IN AFRICA
  • MDR, XDR, AND UNTREATABLE TB FROM A LABORATORY PERSPECTIVE
  • TOTALLY DRUG-RESISTANT TB IN INDIA: LESSONS AND OPPORTUNITIES FROM A CLINICAL PERSPECTIVE
  • TB TERMINOLOGY AND ADVOCACY NEEDS
• 10. Developing and Strengthening the Drug Supply Chain for Drug-Resistant TB
  • OVERCOMING BARRIERS IN THE GLOBAL SUPPLY CHAIN
  • A SYSTEMS PERSPECTIVE ON THE GLOBAL SUPPLY CHAIN
  • INFORMATION IN THE GLOBAL SUPPLY CHAIN
  • LAUNCHING NEW ANTI-TB DRUGS
• 11. Embracing a New Vision for Research
  • CREATING A SYNERGY OF DISCOVERY AND DELIVERY OF CARE
  • NEW TOOLS TO FACILITATE TB RESEARCH
  • TBRESIST: A GLOBAL CONSORTIUM FOR WHOLE-GENOME SEQUENCING OF DRUG-RESISTANT TB
  • META-ANALYSIS
• 12. What Will Be Required to Achieve Zero Deaths from TB
  • WHY HAS CONTROLLING TB BEEN SO DIFFICULT
  • HOW CAN PROGRESS BE RADICALLY IMPROVED
  • THE ROLE OF THE BRICS COUNTRIES
• 13. Creating an Evidence-Based Blueprint for Action
  • ADDRESSING DRUG-RESISTANT TB IN CHILDREN
  • ADOPTING GENOMIC TOOLS TO MAP THE EPIDEMIC OF DRUG-RESISTANT TB AND ADDRESS DIAGNOSTIC CHALLENGES
  • BLOCKING TRANSMISSION OF DRUG-RESISTANT TB
  • REFORMING DRUG DISTRIBUTION AND ASSURING DRUG QUALITY
  • INCREASING THE VISIBILITY OF DRUG-RESISTANT TB
• References
• APPENDIXES
  • Appendix A Workshop Agenda
  • Appendix B Participant Biographies

Rapporteurs: Steve Olson, Rebecca A. English, and Anne B. Claiborne.

This activity was supported by contracts between the National Academy of Sciences and Department of Health and Human Services (HHSN26300023 [Under Base #HHSN263201200074I] and Contract No. N01-OD-4-2139 TO #276; HHSF22301026T [Under Base #HHSF223200810020I]), AbbVie Inc., American Diabetes Association, American Society for Microbiology, Amgen Inc., Association of American Medical Colleges, AstraZeneca, Bristol-Myers Squibb, Burroughs Wellcome Fund, CDC Foundation, Celtic Therapeutics, LLLP, Critical Path Institute, Doris Duke Charitable Foundation, Eli Lilly & Co. Foundation, Eli Lilly and Company, FasterCures, Fondation Mérieux, Friends of Cancer Research, GlaxoSmithKline, Johnson & Johnson, March of Dimes Foundation, Merck & Co., Inc., Novartis Pharmaceuticals Corporation, Pfizer Inc., and Sanofi. The views presented in this publication do not necessarily reflect the views of the organizations or agencies that provided support for the activity.

Suggested citation:

IOM (Institute of Medicine). 2014. The Global Crisis of Drug-Resistant Tuberculosis and Leadership of China and the BRICS: Challenges and Opportunities: Summary of a Joint Workshop. Washington, DC: The National Academies Press.

NOTICE: The workshop that is the subject of this workshop summary was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.