The Fight against TB: The Forgotten Battle

This post was written by Nicole Cho, Global Health Council (GHC) Intern.

A nurse at the National Institute of Diseases of Chest and Hospital is checking out the medicine for a patient. Dhaka, Bangladesh. Tuberculosis (TB) is a worldwide public health problem. The incident of TB is much higher in developing countries such as Bangladesh. The World Health Organization estimates that approximately 570000 people are currently suffering from TB disease in Bangladesh. Every year more than 300,000 people develop TB and 66,000 TB-related deaths occur in Bangladesh. Every day patients get admitted in TB Hospital (NIDCH) National Institute of Diseases of the Chest and Hospital in Dhaka and sometimes they have to wait a long time for a bed to become available. Across the country, every day, nearly 50 patients come to meet the doctors in this hospital. Drug-resistant TB (DR-TB) is increasingly spreading from person to person in places around the world, with some countries reporting up to 35% of new TB cases as multi-drug resistant (MDR-TB). Extensively drug-resistant TB (XDR-TB) has now been reported in 100 countries, accounting for an estimated 9% of all MDR-TB cases. Globally, access to proper treatment is drastically low: only one person in five with MDR-TB receives treatment; the rest are left to die, increasing the risk to their families and communities and fuelling the epidemic.

Tuberculosis (TB), the bacterial infection that mainly infects the lungs and is believed to have caused more deaths than famines and wars combined, is often seen as an ailment of the past. This conception seems true because sanitariums for consumption are no longer in practice and drugs are now available to treat the infection; however, TB has not been eradicated and it may be worse than ever before.

Before medication for TB was discovered, it was commonplace practice to force patients into respiratory isolation, so the disease could be contained. This method was used because of stigma, the highly transmittable nature of the active illness, and the belief that fresh air would help cure the illness. However, after extensive research on the disease and the discovery of antibiotics for TB, the practice of quarantine was no longer necessary.

Antibiotics enabled afflicted patients to be cured by consuming oral agents to inhibit Mycobacterium tuberculosis, the bacteria that causes infection. Sadly, this innovation and joyous victory against the disease was short lived because the illness resurged in the 1980s due to the HIV/AIDS epidemic and the development of resistance to treatment in certain strains of the bacteria. Resistance to antibiotics has become a dangerous public health threat because Mycobacterium tuberculosis is not only resistant to just one antibiotic, but to multiple, leading to Multi-Drug Resistant (MDR) TB and Extensively Drug Resistant (XDR) TB. With a lack of funding and awareness, tuberculosis could become extremely difficult to treat and fatal.

According to the World Health Organization, TB is among the top 10 causes of death worldwide and causes more deaths than HIV/AIDS and Malaria. Furthermore, the Centers for Disease Control and Prevention reports that one-third of the world’s population is afflicted with TB and this number is slowly increasing.

The prevalence and negative impact of TB are especially growing in communities that lack access to quality healthcare, and in highly susceptible groups, such as the immuno-compromised and those who live in poverty. How have we forgotten about something that afflicts a third of our population and is a leading cause of death?

With a growing number of life-threatening diseases and a lack of funding, advocates for TB research have to fight for resources and support. Unfortunately, donors and governments are reluctant to give aid to what they believe is an outdated and treatable illness, when there are diseases, like Zika or Ebola, to worry about. Furthermore, as TB does not afflict as many Americans as other diseases do, we tend to forget about all the other global citizens who are suffering from the infection. Moreover, since the bacteria tends to infect people in low-income countries, there is little incentive for pharmaceutical companies to research new prevention and treatment methods. So what happens if we continue with this trend and ignore tuberculosis?

 

Devoid of new attention or funds to the cause, many people will be negatively affected. Without new, fast acting treatment, tuberculosis could take longer to cure and treatment could fail. Medical expenses would rise, people would miss days of work, and quality of life would greatly decline. Sick people in low-income countries would have a harder time accessing effective combination drug therapies and others would become infected with MDR-TB. Local public health departments could go bankrupt, trying to treat and study XDR-TB cases. This calamity can be avoided if more attention is brought to this cause.

To increase support for this cause and win the battle, we must initiate discussion, disseminate knowledge, and reduce prejudice toward those with the disease. The burden for the fight for research and new technology cannot be solely placed on those who are afflicted by TB; rather, it requires a community effort, the global community, because TB is a threat to all, even those in the United States.