Upon first describing my research—on tuberculosis (TB) control in China—I’m generally met with glassy stares or feigned interest. When people ARE instantly captured, I get the feeling that much of it comes out of an anxious hypochondria that’s more about themselves than anything that I have to say. A bit of an exaggeration, okay, but to be sure: TB is not the “sexiest” of research topics.
And that’s part of the point of my work.
Did you know that approximately 30% of the world’s population is already infected with the TB bacillus? Or, that TB is seventh on the list of top causes of morality worldwide, at 1.4 million deaths (4.3% of all deaths)? Or, that 8.7 people fell ill with TB in 2011?
On March 24th, the global health community celebrates World TB Day in order to draw attention to the on-going efforts to prevent and control the disease. The day was selected to commemorate Robert Koch’s announcement that he had found the infectious agent that causes TB way back in 1882. This year’s theme is “Stop TB in My Lifetime,” mirroring the target of lowering the appearance of TB to less than one per million population by 2050 (this rate currently stands at 125 per 100,000 population).
It’s not the first time public health experts had foretold of the end of “the Captain of All these Men of Death.” In 1891, after nearly a decade of working in seclusion, Koch re-emerged with a vaccine, the inefficacy of which overshadowed his work until his death in 1910 despite winning the Nobel Prize (1905). When the TB vaccine BCG was introduced in 1921, it was met with controversy, and moreover, after more than fifty years in use was found to be ineffective for conferring immunity into adulthood. In the late 1940s, many again proclaimed the end TB given the discovery of efficacious chemotherapies and the establishment of the World Health Organization (WHO). Almost seventy years on, well, I refer the reader to paragraph two.
There is reason to be optimistic about the present situation. In October 2011, the WHO reported that after peaking at nine million in 2005, the number of people with TB had actually fallen for the first time in human history (The New York Times coverage of this momentous event was two sentences comprised of 38 words). At the end of last year, the US Food and Drug Administration (FDA) approved Sirturo (bedaquiline), the first new anti-TB drug to come out since the 1970s. Further, a host of the new rapid diagnostic technologies have been rolled out over the past several years, with more in the final stages of development.
Challenges remain despite these advancements. People living with HIV/AIDS are particularly vulnerable to TB infection, and TB causes a quarter of HIV-related deaths. The inappropriate use of anti-TB drugs has led to widespread drug-resistance, with multi-, extensively, and now “totally” drug resistant strains being increasingly detected (Belarus has the highest reported rates, with one-third of newly diagnosed cases being multi-drug resistant). And of course, there’s the money issue: the WHO and the Global Fund to Fight HIV, TB, and Malaria (a major coordinator of global health funds) have identified an annual funding gap of USD 1.6 billion at the international level, with much more needed from countries themselves.
Part of the problem of TB is that the disease breeds best within the fault lines created by political and economic structures. Canada is illustrative of this point. In 2010, only 1,577 total cases of TB were reported, the lowest number since the Canada began collecting statistics in 1924, and much below the global level. Moreover, most of the cases (66%) were among foreign-born individuals, meaning they most likely had been infected before their arrival. In country, however, First Nations amounted for the largest burden at 21% of cases. Nunavut alone reported 101 cases, for an incidence rate of 304 per 100,000 population (compared to the national rate of 4.6 per 100,000). That’s about the same incidence as Papua New Guinea, an island nation with a per capita GDP of just over USD 2,500.
In an era of neoliberalism, information overload, and weekly “Run for [Insert Disease/Disorder Here],” it’s not difficult to see that some diseases take center stage, while others proliferate in the shadows engendered by indifference. Stopping TB in our lifetime is within reach. At home and abroad, doing so will require renewed attention and efforts, especially in those places that are often overlooked.