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Four years ago, I’m not sure that I knew tuberculosis still existed. Hadn’t we eradicated it along with diseases like smallpox years prior? For an American teenager like me, tuberculosis likely fell somewhere between cholera and dysentery on the list of diseases that might ruin your pixelated game of Oregon Trail. I don’t know if this speaks more to my ignorance as an 18-year-old college freshman or to the absence of global health coverage in the local media, but it’s nonetheless embarrassing now.
Tuberculosis, TB as it is frequently known, is of course with us to this day and while it primarily plagues those in low- or middle-income nations, the bacterium can be found essentially everywhere. It’s easy to look at the statistics for tuberculosis in the United States alone and see TB as a declining disease, one that affects fewer and fewer people each year. 2012 marked the 20th consecutive year of decline in TB incidence nationally and the first year that the number of new cases fell below 10,000 since we started keeping records in the 1950s. Even globally, the total number of new TB cases has begun to shown a decline. However, every single minute of every single day of the year, 3 people on average die from this treatable disease. Tuberculosis is clearly a continual global threat with an estimated 8.7 million new cases and 1.4 million deaths per year from the pathogen.
Public health experts, news anchors, and politicians love to use statistics like these to scare people into taking action. I don’t think they work. How many times have you heard that a child dies every minute from malaria? That HIV is the number one killer of so many people in the “developing world?” That nearly a third of the world’s population is infected with Mycobacterium tuberculosis (yes, you read that right, about 2 billion people have TB bacteria in their body). These numbers, though they do represent an enormous burden of disease globally, seem to fail to elicit the necessary response to effectively curb the spread of these diseases.
This makes me retrospect on how I became passionate about stopping TB in the first place. Though I tend to view myself as a “numbers person,” I don’t think any of these calculations inspired me to switch from a career in mechanical engineering to one in public health. Looking back, the likely source of this switch, the spark if you will, was reading Tracy Kidder’s Mountains Beyond Mountains, a tale of the now-famous Dr. Paul Farmer and his quest to cure the world of preventable and treatable diseases like TB. Hearing the stories of Haitians, Russian prisoners, and others dying of treatable diseases was much harder to ignore.
So today, while the global incidence might be decreasing, we can’t ignore the dramatic rise in multi drug-resistant tuberculosis (MDR-TB). We can’t ignore the fact that TB is the number one killer of people with HIV. We can’t ignore the fact that over 95% of tuberculosis deaths occur in low- and middle-income countries.We can’t ignore TB.
With that said, it is equally important to remember that we can’t give up hope. This is a treatabledisease after all. It is possible to see the elimination of TB in our lifetime. We recently saw the approval of the first new TB drug in over 40 years! The GeneXpert, a diagnostic tool heralded as a game changer, was rolled out in several countries in the past year. More drugs are in the approval process that could help treat resistant strains of the disease. There are 37 different vaccine candidates in research and testing at this point. There is hope.
But the fact remains that TB is one of the leading causes of death globally. Drug resistant strains continue to rise in number and these are the cases that are extremely expensive and difficult to treat. The disease will not go away on its own. Without increased support, it is likely that it will get worse, possibly much worse. However, with a global partnership and increased attention paid to this plague of the poor, we could possibly see an end to this disease in our lifetime.
For more information about TB and MDR-TB specifically, check out the post I wrote for last year’s World TB Day that went into much more detail about controlling drug resistant strains.