An upswing in drug-resistant forms of tuberculosis is imposing an unprecedented health and financial burden on China.
About 4.5 million people in China have TB, and about 1.4 million are diagnosed with the disease each year. In 2008 mortality from TB reached 160,000, says the World Health Organization.
Drug-resistant forms of the disease place a particular burden on China. In absolute numbers, China's 112,000 cases of drug-resistant TB in 2007 were second only to India's 131,000. As a proportion of all TB cases in China, drug-resistant forms accounted for 27.8% versus 5% in developed nations.
"There are many reasons for China's drug-resistant TB problem," says Lin Yan, director of the China office of the International Union Against TB and Lung Disease, a nonprofit organization. "Patients stop taking drugs when they feel better, maybe after a month. Some have no money for drugs if the treatment is not free, and they don't even know this is a serious disease, Lin says. Stigma also deters people from seeking care.
The financial burden of China's TB problem is two-pronged. As the case in other parts of the world, tuberculosis in China disproportionately affects the poor. In addition, drug-resistant forms of the disease can be 100 to 300 times more expensive to treat in China than conventional TB, says Zhong Qui of China's TB Expert Consultative Committee.
In specialty TB outpatient clinics, diagnosis and treatment are free, while general hospitals have fees. In recognition of the public-health threat represented by TB, the World Health Organization recommends that care be provided at no charge to the patient.
"TB is a political problem because it is infectious. It has societal impact, it is a threat to public health...free treatment is very important," says Zhong, who also serves as head of the Anti-TB Research Institute in China's Guangdong province.
