Great. Thank you very much, Mr. Chair. Thank you, committee members, for this opportunity to speak on World TB Day.
My background is that I'm a medical doctor, originally from St. Catharines, Ontario. I've been working for over 10 years internationally with Médecins Sans Frontières, or Doctors Without Borders, so mainly in southern Africa but also in China and India. I helped to support a TB-HIV project operated by MSF in Ukraine as well.
I'd like to show a number of images to you and just talk around these images. The first is of a person who's actually sneezing. You can see when a person sneezes that hundreds, even thousands of little droplets come out. The same thing happens when someone coughs. If a person happens to have active TB disease, amongst these droplets will be some of the TB germs. The point is that TB is an airborne disease. These droplets, some of them tend to be suspended in the air not just for seconds, not for minutes, but sometimes for hours. So if the ventilation is not very good, if someone had been coughing in this room even before we all arrived and the ventilation wasn't good, some of the droplets would still be floating in the air.
The point again is that TB is an airborne disease. It's a public health threat in every single country around the world, so anybody who travels, anybody who spends time in a room with other people or where other people have been is at risk to inhale this TB germ.
It's important to distinguish between drug-sensitive and drug-resistant TB. So again, MDR stands for a multi-drug-resistant TB. It refers to a TB germ that's resistant against at least two of the more common and powerful drugs we would normally use to cure TB. So some of the differences between drug-sensitive and drug-resistant TB are that drug-sensitive TB can be diagnosed using the microscopy test that Helen referred to, so a relatively simple procedure looking under a microscope; whereas MDR-TB requires a higher-level lab. In a resource-limited setting such as a number of places MSF supports, this lab doesn't necessarily exist, so it's more difficult to make a diagnosis of drug-resistant TB.
Again, TB can be cured. It normally takes around six months for drug-sensitive TB, but it can take 20 months or more for MDR-TB. The number of drugs to cure drug-sensitive TB is four, commonly in a fixed dose combination, so an easy to take regime for drug-sensitive TB. But this number increases to six drugs including a daily injection to cure MDR-TB.
The side effects of using drugs to treat drug-sensitive TB, although they are possible, we don't tend to see them as much. Whereas with MDR-TB, the possible side effects become probable. The cost to cure one case of drug-sensitive TB is less than $100. For MDR-TB, it's over $5,000 just to cure one single case.
This is an image from the clinic that Helen visited in Mumbai. It's a woman who has active TB. She happens to have drug-resistant TB, and the second image is the number of pills that she has to take every single day, in addition to this injection. This image shows that drug-resistant TB takes up to two years to cure. It's quite a long and involved process involving again lots of pills and the possibility of side effects, sometimes quite severe, ranging from hearing loss to intractable nausea and vomiting, to mental health issues, to kidney issues and liver issues.
It's a difficult regimen to take. You can probably understand that when people start to feel better in terms of the TB symptoms they often want to stop this treatment early, the problem being that it doesn't cure the TB and the symptoms will come back again in time.
One of the most important issues is that most of the people—81%—with drug-resistant TB either are not diagnosed in the first place or are diagnosed and don't receive effective treatment. Of the 19% who do, only half are cured, so this difficult treatment regimen that I've described—up to two years—is actually only successful in curing people about half the time. You can see that most of the people with drug-resistant TB are never cured. When somebody is not cured, they tend to go on with their daily activities. They are going to work with a cough, travelling on public transport, and exposing other people to the drug-resistant TB germ.
Shown on this page is a website that MSF has helped to set up. It's called “Test Me, Treat Me”. It's a drug-resistant TB manifesto. The woman you see shown is from South Africa. Her name is Phumeza. She has a story similar to that of the patient in Mumbai that Helen described. She had TB. She did not receive the correct treatment the first time around. Her drug-resistant TB turned into XDR-TB, which refers to a drug-resistant TB that's even more resistant than MDR. She took the treatment. She was eventually cured, but in the process she developed profound hearing loss. She worked together with her health care provider to tell her story. Together, they created this manifesto that talks about all of the difficulties and the need for better treatment.
I would ask committee members, if you have time, to take a look at this website, and if you agree with what's presented there, actually sign this manifesto, which is all of us creating a voice for urgent change.
Again, the issues include difficulty in diagnosing drug-resistant TB. Even if the drug-resistant TB is diagnosed properly, many people don't actually get treated properly. When people don't get treated properly, they continue to cough these drug-resistant TB germs in communities around the world. Also again, this is a public health threat that is not going away. It's getting worse over time, not better. We need to work together, including investing more in research and development, to create a better, more realistic treatment regimen that can be scaled up, so that we can take that number of less than 20% who need the treatment and increase it to closer to 100%, such that people around the world who need the treatment actually get it.
Thank you.