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Global Health Agencies Must Do More To Combat Drug-Resistant TB In North Korea

“Tuberculosis has long been recognized as one of the biggest public health problems in North Korea, but there is a disturbing new development: much of the TB in North Korea is resistant to regular antibiotics,” K.J. Seung, deputy director for the Partners In Health project in Lesotho and a physician in the division of global health equity at Brigham and Women’s Hospital in Boston, writes in an Atlantic opinion piece. Noting “[t]he most serious strains of drug-resistant TB, called ‘multidrug-resistant,’ or MDR-TB, don’t respond to treatment with first-line TB drugs,” he states, “For North Korean patients, MDR-TB is basically a death sentence.” Seung continues, “Until now, there has never been any clear scientific evidence that drug-resistant TB is a serious problem in North Korea, mainly because North Korea does not yet have a laboratory with the capacity to do this sort of research.” However, the doctors that work “in the TB sanatoria that dot the North Korean countryside … have been quite open about the fact that they have patients who are not being cured with regular TB drugs,” he notes.

“My research, published [Tuesday] in PLOS Medicine, analyzed sputum samples from more than 200 of these patients and found that the North Korean doctors were indeed correct — 87 percent were proven to have MDR-TB,” Seung writes. He examines why MDR-TB is spreading in North Korea, highlighting a program funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria and run by UNICEF and the WHO, through which “all North Korean TB patients are treated blindly with first-line drugs without first being tested to see if they’re infected with resistant strains.” However, “[t]reating drug-resistant TB with ineffective regimens provokes the TB to become even more resistant,” he writes, adding, “From a public health point of view, bad treatment is worse than no treatment at all, because it can quickly make the problem of drug-resistant TB worse.” He concludes, “In this difficult political climate, the Global Fund, UNICEF and WHO should be applauded for their intention to improve TB control in North Korea. But with TB, good intentions are not enough, and can be dangerous. Only the correct public health strategy can defeat it” (7/30).