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Imagine an infectious disease emerges that affects more than half a million people in a single year across the globe…

Only about 1 in 3 people with this condition are diagnosed and 1 in 4 are treated.

It is airborne, and each person carrying the disease could infect up to 10-15 other people in a single year if they are not treated.

The disease is resistant to commonly-used antibiotics. Even with treatment, almost half of people who catch it die.

It is predicted to cost the global economy approximately $17 trillion USD over the next 35 years if it is not dealt with.

2

Investing in ending DR-TB presents an opportunity to promote universal health coverage, support health systems, address

antimicrobial resistance, increase global health security and drive sustainable development.

Now is the time to invest in drug-resistant tuberculosis

This story may sound like science fiction, but it exists today – this is the reality of drug-resistant tuberculosis (DR-TB). Yet despite the worrying figures, many people are not aware of the threat it poses, and that funding to successfully combat it is wholly inadequate.

This disease not only takes a devastating toll on human life and individual well-being, but analysis from the Economist Intelligence Unit (EIU) suggests that the DR-TB deaths occurring in a single year cost the global economy at least $14 billion in future GDP loss.1

Recognised as a serious global health threat, DR-TB is already predicted to be on track to become the most prevalent form of TB in some countries if we fail to make bold commitments and take swift action.2,3 However, with larger and more effective investment in the right tools and approaches, we can end this epidemic.

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Successful DR-TB management often requires social protection mechanisms such as cash transfers, insurance schemes, or welfare support to mitigate economic loss and address needs such as housing, nutrition and transportation - but these are not always in place. Providing these social protections can increase the likelihood that patients complete treatment and can achieve economic stability for themselves and their households.

DR-TB and the WorkplaceIn addition to households and communities, workplaces are settings where DR-TB can be transmitted, particularly if working conditions are poor. DR-TB also has a serious impact on workplace productivity and overall workforce stability due to long, challenging treatment among patients. It also often requires other economically productive family members to become their caregivers.10

“What is at the back of the minds of everyone working on TB, is that the person who develops DR-TB is not going to be you and I, not the ones who can afford it, not the ones

who can find ways to pay for it, but the ones who cannot figure out where their next meal is going to come from.”

In a 2013 survey of people with MDR-TB in Ethiopia, 72% reported losing their job and 79% reported income loss as a result of the disease.11

Treating a case of DR-TB can be 8 to 25 times more expensive than drug-

sensitive TB.7

Adequate nutrition and transportation can be the highest

costs to patients associated with DR-TB treatment.8

DR-TB can lead to further lung problems that pose continued

disability and financial burden after treatment.9

In addition to mitigating GDP loss, investing in DR-TB supports poverty alleviation and societal well-being

While DR-TB is a risk for everyone, it tends to impact more vulnerable groups in their most productive years, magnifying the economic impact of this disease. A combination of income loss, along with costs associated with treatment, can lead to catastrophic costs for the patient’s household and economic instability that can last well beyond the period of treatment.

Employers in both the private and public sector are important stakeholders in effective DR-TB control, and can contribute to appropriate screening, referral, and adherence support, addressing stigma and ensuring people with all forms of TB are protected against job loss.12

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UHC ensures all people can access the care they need without suffering financial hardship paying for it.

“Tackling TB and DR-TB must be at the heart of any global action against AMR.”16

Investing in all forms of TB can also result in significant returns on investmentAccording to a UK Parliamentary Group, DR-TB could cost the global economy $16.7 trillion overall between 2015 and 2050 if resistance rates are allowed to grow.13

Closing the estimated $67 billion funding gap needed for TB programmes and R&D for new tools in 2016-2020 could achieve:14

By creating fiscal space for investment in DR-TB as part of a wider TB programme, stakeholders are better able to contain the economic burden of this disease in the longer term.

Addressing DR-TB also demonstrates good stewardship of resources and careResources that go toward developing effective and comprehensive treatment of DR-TB can also strengthen health systems, help countries move toward universal health care (UHC), address antimicrobial resistance (AMR) and improve overall global health security.

8.4 million fewer TB

cases

1.4 million fewer TB

deaths

$181 billion in productivity

gains

$5.3 billionreduction in

treatment costs

$27-85return per

dollar invested

Enlarging the coverage for people su ering from DR-TB15

Extend to notcovered

Population: who is covered

Reduce costsharing andfees

Includeotherservices

Services: whichservices areprovided and atwhat quality

Current pooled funds

Direct costs:proportion of the costs covered

DR-TB

Other causes

DR-TB accounts for nearly a third of all AMR deaths16

Addressing DR-TB with approaches that support stewardship, accessibility, and a�ordability provides an important blueprint for tackling wider AMR.

6

New Delhi

Kolkata(Calcutta)

Chennai(Madras)

Bengalooru(Bangalore)

Hyderabad

Indore

Mumbai(Bombay)

Number of DR-TB* patientsnotified in 2017

*Rifampicin-resistant and MDR-TB.

0 10,0005,000

Political commitments at the highest levels of government to

ending the disease

Scaling up the most effective diagnostics, treatments, and

programs

Expanding universal health coverage and social protection

schemes

152%

242%

275%

As one of the world’s strongest and largest economies, India must quickly scale up actions to mitigate DR-TB’s significant economic and societal burden.

Spotlight on IndiaIndia has the highest rates of DR-TB in the world with nearly 200,000 new cases and over 68,000 deaths estimated in 2017.17

Modelling suggests that if funding and management of TB in India remains unchanged, more TB cases will be drug-resistant than drug-sensitive by 2032, and nearly 85% of MDR-TB cases will be caused by people passing DR-TB on (rather than the TB bacteria they carry developing resistance), compared to just 15% in 2012.3 In addition, by 2032 there will be an estimated:3

EIU analyses found that DR-TB deaths in 2016 alone were estimated to reduce the future Indian GDP by more than $6 billion – the biggest impact in any single country.1 This dwarfs the $580 million that was budgeted for addressing TB in India in 2018.17

For individuals and families, it has also been estimated that MDR-TB will result in catastrophic costs for more than 22 million households in India alone by 2035.18

increase in new cases of MDR-TB

increase in untreated MDR-TB cases

increase in the risk of MDR-TB infection

India is taking important steps to end this epidemic:19

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Given the increasing threat of DR-TB and a clear positive case for investment, multi-stakeholder action is needed to ensure that:

Funding gaps for DR-TB programme implementation and research and development are swiftly addressed at the global and national level

The most effective and comprehensive care is being provided, including ensuring that infrastructure required to deliver it is present

All patients and their families are protected against catastrophic costs

Accurate, accessible and robust data exists to inform efforts and guide effective investment

Leaders are empowered with the right resources and are held accountable at the national and local levels

Translating the Economic Case to Action

DR-TBstakeholders20

Multi-lateral and

multi-sector partnerships Governments,

including Ministers of Health and

Finance

Global suppliers

Advocacy and community-based

organisations

Professional organisations and technical partners

Funding agencies

Non-governmental organisations

Private sector

Public-private partnerships

Academic, research, and

training institutions

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To register your interest email us at drugresistantTB@eiu.com

References1. Economist Intelligence Unit Analysis. 2019. 2. Mehra M et al. Int J Tuberc Lung Dis 2013; 17(9): 1186-1194.3. Law S et al. Lancet Public Health 2017; 2: e47-55.4. WHO. Drug-Resistant TB: Global Situation. 2019.5. IHME. Global Burden of Disease. 2016.6. Kirgia J & Muthuri R. Infect Dis Poverty 2016; 5(1): 43.7. Marks S et al. Emerg Infect Dis 2014; 20(5): 812-821.8. Tiemersma E et al. USAID Summary Report. 2014.9. Chakaya J et al. J Clin Tuberc Other Mycobact Dis 2016; 3: 10-12.10. Bernatas J. TB in the Workplace and Beyond [presentation], 2018.11. van den Hof S et al. BMC Infect Dis 2016; 16(1): 470.12. WHO Stop TB. Guidelines for Workplace TB Control Activities. 2003.13. UK All-Party Parliamentary Group on Global TB. The Price of a Pandemic: Counting the cost of MDR-TB. 2015. 14. Stop TB Partnership. Global Plan to End TB. 2015.15. Boerma T et al. PLoS Med 2014; 11(9): e1001731.16. O’Neill. The Review on Antimicrobial Resistance. 2016.17. WHO. Tuberculosis Data. 2018.18. Verguet S et al. Lancet Glob Health 2017; 5(11): e1123-e1132.19. Ministry of Health and Welfare, Government of India. India TB Report 2018.20. WHO Stop TB Partnership. Engaging Stakeholders for Retooling TB Control. 2008.

Phase 3: A final report that captures the economic case for tackling DR-TB and charts a path forward for elimination.

Phase 2: Global advisory board of key stakeholders to stimulate dialogue and capture new ideas.

Phase 1: Review of literature, data analysis, and expert interviews to capture existing knowledge.

The EIU is taking on DR-TB with an independent research program that explores the burden, economic impact, health security implications, and other key issues. This document is a snapshot of preliminary findings as we enter phase 3 of the project; the final report, inclusive of a full description of our methodology and final analyses, is expected to be launched in March 2019.

What the EIU is doing to invigorate the fight against DR-TB

Image - © Kateryna Kon/Shutterstock