Mandy is ACTION's Senior Associate for tuberculosis.
I used to think if I ignored something long enough, it would go away. That annoying toothache, that crying child on the airplane, that unpaid library charge from 1997—they could all disappear with time and a little patience. In the end, it was easier to look the other direction.
This is exactly what the world is doing with tuberculosis (TB). We’ve become complacent with a disease that kills 1.5 million people each year. The disease has been around for centuries, and is responsible for killing more people than any other disease in the history of humankind.
This is intolerable, and it’s not working.
Microbes don’t just disappear — they constantly evolve, finding new ways to infect people and evade the drugs made to kill them. It’s estimated (and these estimates are considered low) that about 5% of the 9 million TB cases around the globe are multi drug-resistant TB (MDR-TB) meaning they do not respond to at least two of the first-line drugs used to treat it.
New projections published today by the UK All-Party Parliamentary Group on Global TB show that, by 2050, MDR-TB could account for one-quarter of all drug-resistant infections at a potential cost of $16.7 dollars to the global economy. These estimations were produced for an independent Review of Antimicrobial Resistance launched last year by British Prime Minister David Cameron and led by economist Jim O’Neill.
The nightmarish scenarios they present are certainly intolerable, but not inevitable.
As a global community, we’ve placed minimal effort in curbing the spread of TB. Instead we’ve created a superbug.
If we want to beat TB, we need to do better. Smallpox shows us that with effective tools and a well-resourced strategy it’s possible to wipe out a disease.
First and foremost, we must invest in new drugs to fight TB.
Since the discovery of antibiotics, minimal effort has been made to develop new tools to fight TB. With TB no longer considered a health threat in high-income countries, investment in research and development all but halted due to lack of commercial incentives. Public funders did not step in to fill the gap. As a result, TB R&D has been starved of funding and no new first-line TB drugs have been developed since 1967. Yes, people who get sick with TB today are largely treated with the same medication used in 1967.
These medications are woefully inadequate. Most people have trouble completing a seven-day course of antibiotics; yet treating TB takes a minimum of six months. As you can imagine, many people don’t finish the full six months of treatment because they feel better and stop taking the medication, or many patients lack access to a continual supply of drugs. This allows the bacteria to mutate into drug-resistant forms. MDR-TB is the only drug-resistant disease that spreads person to person through the air.
Donors and implementing countries must partner with the private sector and provide the resources needed to develop improved drugs, diagnostics, and vaccines.
While these new tools are urgently needed, there is more we can do with the tools we already have. Currently, one in three people with TB are missed by health systems. This could be improved if TB Programs become more proactive by screening the household contacts of all people with active TB disease and providing adequate treatment and care. This type of active case finding is resource intensive. Unfortunately, National TB Programs are drastically underfunded at a rate of $2 billion per year. Affected country governments and political leaders need to increase financial and political commitments to fight this disease that has plagued our world for centuries.
Additionally, new and current donors need to step up support for the Global Fund to Fight AIDS, Tuberculosis, and Malaria, which has helped diagnose and treat 12.3 million people. While Global Fund achievements are historic, progress in the fight against TB is at risk without increased investment. Currently, the Global Fund has $241 million in quality TB projects that are unfunded due to lack of resources.
It’s time to stop turning our backs on TB. If we continue to let this ancient bacteria outsmart us, the toll of human suffering, burden on our health care systems, and cost to the global economy will only continue to multiply.