Russia is among the 22 countries in the world with the highest rate of tuberculosis. The U.S. Agency for International Development (USAID) says that after years of decline during the Soviet era, the incidence of TB more than doubled in the 1990s. That has slowed since 2000, but doctors warn there is a growing number of cases of a drug-resistant form of TB that could eventually lead to the development of a new, incurable virus. Anya Ardayeva reports from Moscow.
Ninety percent of patients at Moscow's Central Tuberculosis Research Institute are suffering from the drug-resistant form of TB.
Irina Vasilyeva, the head of the institute's therapeutic department, outlines the problem. "I think this is the consequences of the ‘90s, when the entire healthcare system collapsed, the society was lost, everything that had been achieved was lost, patients were left to themselves, the disease developed and there were many patients left who were not cured completely, who continued living in the society and contaminating people around them. Now we are seeing the consequences of the collapse of the state, and of the social and economic problems.”
Multidrug-resistant TB is tuberculosis that is resistant to the two medicines most commonly used to treat it. That makes it harder to treat. Doctors say that many patients with drug-sensitive TB need to take their antibiotics daily for several months, but they stop when they start to feel better. And so the disease mutates, it becomes resistant to traditional antibiotic treatment. TB still has a terrible stigma attached to it in Russia and the public tries to ignore it.
Meet Alexei. He is a 24-year-old student who tested positive for TB after he came to the hospital for a hernia surgery. He says he was immediately fired from his job, and stopped telling people about the disease.
After two years of treatment, Alexei says he is amazed by how little Russians know about TB. "People are afraid of AIDS and the sexually-transmitted diseases and are protecting themselves with condoms. But no one thinks about diseases like TB, although they are so widespread. People need to be informed about them. Everyone is trying to hide it. But it's not right.”
Another patient, Natalya, has been under treatment for a multi-drug-resistant form of TB for the last five years. She says the disease has ruined her life. She is 33 years old with a disability pension that is the equivalent of about $90 a month.
"I can't even imagine where I got it,” she says. “It's such a thing -- one sneezes, another catches it. It could have been on a trolleybus, on transport, anywhere. How did it change my life? I am a pensioner now, with 2500 rubles of monthly income. This is how it has changed. I can't find a job. Who will hire me after I have been retired for five years? What job will I be doing?"
The World Health Organization says drug-resistant TB is a hundred times more expensive to treat than the ordinary form of the disease, and the Russian state's supplies of the right medicines are often scarce. Failing to contain the spread of multi-drug-resistant TB could lead to an additional threat: the emergence of a new, almost untreatable, form of TB.
Irina Vasilyeva of Moscow's Central Tuberculosis Research Institute says, "There will be a new form of the disease that will be resistible to nearly all anti-TB medication. This can lead to very grave consequences. The tuberculosis bacillus will become resistible to any medication. And from the start it will be impossible to cure such patients. We will get back to the situation of pre-anti-bacterial epoch when there were no antibiotics and no anti-tuberculosis medicines. We will be back to what it was a hundred years ago."
The Red Cross estimates some 70 people die in Russia from tuberculosis every day. Veronika Agapova, the main TB specialist at the Russian Red Cross in Moscow, says the other problem in combating the spread of TB is Russia's ineffective system of monitoring the people infected with the disease.
"Even if the medicine is there, it doesn't always reach the patients because they do not always take them and there's no clear system of controlling those patients," says Agapova.
In the 1990s, the Moscow Center for Prison Reform said that prisons and labor camps became incubators for multi-drug-resistant TB in Russia. And health officials say the level of TB incidence in prisons is still high. Yet no one knows exactly how many people in this country are infected or how many are being properly treated. Doctors like Irina Vasilyeva says that is a time bomb waiting to explode.