Professor Nazir Ismail

So globally, the total number of drug-resistant TB is close to half a million people, which is about 5% of the global burden.

Obviously, the challenge there is that we only detect or probably detect globally about half of those.

So the other half are totally missed.

So we just need to appreciate that.

But it's supremely transformed in the past decade, decade and a half.

With new rapid molecular diagnostics, which provide rapid results for TB and drug resistance.

We're even talking of, at least South Africa has already started implementing a next generation sequencing for diagnosing drug-resistant TB.

But in terms of success rate, so for MDR-TB, we're like 50%.

With the introduction of bedaquiline, they're now climbing more towards 60, 70%.

But with the new regimen, I think the evidence is still accumulating, but it's probably definitely above 80%.

So I think it's been quite an amazing journey over the past decade.

But that's not to say that we don't have problems ahead.

The scary thing for the current BPAL regimen, particularly for bedaquiline, which is sort of the cornerstone of this current regimen and many other alternative regimens that are being recommended by WHO now, they all include bedaquiline as a core drug.

But the concerning thing has been the evidence that we had shown initially in South Africa with podactyl resistance already approaching 3% to 4% at the early stages, and now emerging evidence in the Western Cape in South Africa and in Mozambique with resistance rates now reaching 10% or more.

And the key thing there is this is a very new drug.

It's not even 10 years in use and we're already sitting at 10% resistance.

So that is the concern that with the scale up, I mean, it's been a revolution, so there's a huge interest and interest.

excitement in implementing these new drugs.

So, you know, it's been proven historically and nothing's going to change again is that, as you said, the more we use it, we're more likely to lose those drugs in time.

No country in the world, whether it's an upper income country or low income country, there's never enough money.