My research, published today 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.

Why is MDR-TB spreading in North Korea? Ironically, in the area of TB control, the North Korean Ministry of Public Health (MOPH) has followed the advice of international experts to the letter. In 1998, the MOPH asked for help from the World Health Organization to rebuild its TB control program. In 2010, the Global Fund to Fight AIDS, Tuberculosis and Malaria pledged $41 million over five years to strengthen these efforts. Two respected UN agencies, UNICEF and WHO, are responsible for the implementation of the Global Fund project along with the MOPH. Yet this project is so poorly designed that it’s become part of the problem it was intended to solve.

In the Global Fund project, 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. The strategy essentially bets that there are no drug-resistant TB patients in North Korea, or at least that the numbers are so few that the public health impact is insignificant.

This is a dangerous bet. Drug-resistant tuberculosis is a man-made disease, created when TB is treated incorrectly. Treating drug-resistant TB with ineffective regimens provokes the TB to become even more resistant. 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.

When I first started working as a global health doctor 13 years ago, I met Peruvian MDR-TB patients who described their frustration at being treated over and over with the same first-line TB drugs. But that was when WHO was worried that MDR-TB was too complicated to treat in poor countries. Since then, the Peru national TB program has become a leader in MDR-TB treatment, and WHO now pushes countries to diagnose and treat it more aggressively. Mario Raviglione, Director of WHO’s Global TB Programme, recently described treating drug-resistant TB with ineffective drugs as "complete nonsense," adding, "It is silly to use drugs that there is proven high resistance to, thinking they will work."

It is shocking to see North Korean patients just like the ones I saw in Peru 13 years ago, taking the same first-line TB drugs for the second, third or fourth time. Each time they take these ineffective regimens they desperately hope that the result will be different.

It does not have to be this way.

Treatment of MDR-TB is expensive, but it is more expensive not to treat. It is an airborne, contagious disease, and treatment is the only way to prevent transmission. But the high cost of MDR-TB drugs impedes access to effective treatment in countries like North Korea. The Global Fund was created precisely so that poor countries would have access to treatment for complicated diseases, and it has a long track record of funding MDR-TB treatment programs in other countries. But so far it has provided treatment for only 50 MDR-TB patients in North Korea, not anywhere close to what is required to impact public health.