More investment in research needed to control tuberculosis

By Ari Probandari, MD

World Tuberculosis (TB) Day, observed March 24 each year, calls attention to the disease as one of the world’s oldest and deadliest. The date commemorates the 1882 announcement by Dr. Robert Koch that he had discovered the cause of the highly infectious disease:  the tubercle bacillus. Under the theme, “Unite to End TB,” advocacy groups are intensifying efforts to reach the World Health Organization’s (WHO) goal to eliminate the disease by 2030.

Although it is highly curable, TB remains an epidemic in much of the world, killing or maiming an average one-and-a-half million people annually. International nonprofits, health workers, TB survivors, and advocates to draw attention to the need for increased funding for research and more effective public policy to end the disease.

These needs exist here in Indonesia. With an estimated 6,800 new cases every year, we are 1 of 27 multidrug-resistant TB high burden countries worldwide. In 2016, the WHO estimated the overall number of cases here at just over one million.

Treating TB is increasingly complex because many of the basic drugs are ineffective in at least 16 percent of cases. The problem is made worse when patients receive improper treatment — such as the wrong type of drugs or inadequate duration of treatment — or patients stop treatment before it is completed. All of this is likely to contribute to drug resistance.

Normally, TB treatment includes a combination of drugs for six months. Drug-resistant TB, however, requires four times that amount and includes more unpleasant side effects. The lengthy treatment means extended time away from work and overall loss of productivity. This creates a difficult cycle where people drop out before the treatment is completed — one of the primary causes of drug-resistant TB.

The World Bank estimates that about four million people will die from drug-resistant TB by 2050 if better treatments are not developed. Indonesia will lose US $869 billion to this problem. The cost of health care for drug-resistant TB will be higher, as will be the overall loss of productivity.

Currently, only about 32 percent of the estimated number of people with tuberculosis are engaged in the healthcare system. The rest are “missing,” and they can transmit the disease in the community. While the missing cases may seek treatment, the quality of care they receive is unknown.

Just this month, the Indonesian Ministry of Health mandated that all healthcare providers report all tuberculosis cases to the national control program. This will provide better opportunity to track people with TB and to provide the proper treatment they need.

While this new initiative is a step in the right direction, there is the additional need for faster and more accurate diagnosis of TB and more effective treatment regimes. This should mean shorter treatment duration so fewer people drop out and, thus, less opportunity for drug-resistance to develop. The more we know about the disease, the better able we will be to optimize actions to address it. This simply means more investigation into the causes and effects of the disease.

As a middle-income country with a GDP of US $861.934 billion per year (based on World Bank data in 2015), Indonesia has the capacity to do more to fund TB research. It is up to the government to increase national funding and strengthen collaboration with international agencies for the benefit of the nation.

Conducting research is the daily business of higher education institutions and public policy organizations. I am calling as well on higher education entities to invest more time and resources in research on TB. The prevalence and impact of the disease suggest that it should be included in the national research agenda.

The network of researchers and implementers should be established at the national, provincial, and district levels to ensure the highest levels of participation and engagement in the kind of useful research effort required to take to control and ultimately end TB.

Dr. Ari Probandari is a physician, researcher, member of the Indonesian National TB Expert Committee, and manager of She recently participated in a TB advocacy program sponsored by ACTION, in Paris, France.