Patricia W. Finn, MD
It’s no accident that I am writing this column a week after World TB Day, which is celebrated on March 24, the day in 1882 when Dr. Robert Koch discovered the cause of tuberculosis. Marking World TB Day is important, but it is equally important to remain focused on tuberculosis and the terrible toll it takes on humankind after the special events have concluded.
Consider these facts from the World Health Organization:
- TB is second only to HIV/AIDS as the greatest killer worldwide due to a single infectious agent.
- In 2012, 8.6 million people fell ill with TB and 1.3 million died from TB.
- TB is the third-leading cause of death for women of reproductive age globally.
- Of the 9 million people who will become sick with TB this year, 3 million will receive no treatment.
A study conducted by researchers at Brigham and Women’s Hospital’s Division of Global Health Equity and published in the Lancet last week found that as many as a million children become sick each year with TB–twice the previous estimate–and as many as 32,000 of those infections are drug resistant.
And this is a disease that is both preventable and curable.
The most formidable barrier to TB’s eradication is apathy. Apathy on the part of those of us who live in affluent countries where TB is much less of a problem. Apathy on the part of our political and civic leaders. And, yes, apathy on the part of the science and health community.
Despite TB’s devastation, it is not a global health priority, and here in United States, federal funding for TB control—essential also for global TB control—has been cut back to levels reached almost a decade ago.
As a result, there will likely be more outbreaks of TB, more cases of drug-resistant TB, and more of those most vulnerable—the poor, the malnourished, those with compromised immune systems, those with diabetes and kidney disease, migrants and miners, and smokers, among others—are likely to die.
It does not have to be this way. And if any group of people can explain why, it’s the members of the American Thoracic Society. TB is what brought us together more than a century ago, and today we’re called upon to redouble our efforts to eliminate TB. It should be a special concern of the Society as it focuses increased attention on issues of health equality.
Many members are involved in research for new diagnostic tools, drugs, and vaccines, while others work on helping governments and public health departments in the U.S. and around the world develop protocols for dealing with outbreaks.
Those efforts deserve to be recognized, and the resulting discoveries disseminated widely. Our founding members wisely saw that advances occur faster when information is shared freely.
But those of us who aren’t involved in TB research or control programs have a much bigger role to play in defeating this epidemic rather than simply incorporating the latest knowledge into our practices. It’s up to every one of us to educate our politicians, business leaders, philanthropic communities, the media, and our fellow citizens about the threat that TB poses.
It’s a message that I believe will resonate strongly in both human terms and in economic ones.
Around the world, someone dies of TB every 20 seconds. Although some people are more likely to become ill, no one is immune to this disease, and the threat of drug-resistant TB hangs over all of us. Left unchecked, the bacterium could evolve faster than our treatments, leaving even those with the best access to medicine vulnerable.
And the cost of an inadequate response to the epidemic speaks for itself. According to the WHO, TB treatment costs about $2,000 (U.S.) a patient, but rises up to $250,000 for a patient with drug-resistant TB. Treatment for XDR-TB can cost up to $1 million in the U.S., and there is no guarantee of survival. This is truly a case where the world cannot afford to be complacent.
This is why I urge you to write your government representatives and educate your fellow citizens. There are helpful resources for both efforts on the ATS website. Though geared towards the U.S., they can be easily adapted by members working in other countries.
This is especially important now that World TB Day is over. If we can sustain this campaign, I am convinced that we will change the funding dynamics and achieve something that even our founders dared not dream: a world with no TB deaths.
