A New Defense in the Fight Against Tuberculosis

TUBERCULOSIS (TB) is man’s oldest infectious killer, and it remains such a serious health threat that the World Health Organization (WHO) compares it to a time bomb. “We are in a race against time,” warns a WHO report on TB. If man fails to defuse this bomb, he may one day face a drug-resistant disease that “spreads through the air, yet is virtually as incurable as AIDS.” The time has come, urges WHO, to wake up to TB’s devastating potential. “Everyone who breathes air, from Wall Street to the Great Wall . . . , needs to worry about this risk.”

An overstatement? Hardly. Just imagine how wide-awake the world would be if a disease threatened to rage out of control and erase the entire population of, say, Canada in ten years! Though this sounds like fiction, the threat is real. Worldwide, TB kills more people than AIDS, malaria, and tropical diseases combined: 8,000 persons each day. Some 20 million people now suffer from active TB, and some 30 million could die from it in the next ten years—a number larger than the population of Canada.—See the box “TB’s Global Grip,” on page 22.

Why on the Rise—AGAIN?

The cure for tuberculosis (TB) was discovered more than four decades ago. Since then, over 120 million people have died of TB, and nearly 3 million more people will die this year. Why are so many people still dying from TB when there is a cure? For three main reasons: neglect, HIV/AIDS, and multidrug-resistant TB.

Neglect. The eyes of the world are focused on such infectious diseases as AIDS and Ebola. In 1995, however, for every person who died of Ebola, 12,000 died of TB. In fact, TB is so common in developing countries that people there have come to view the disease as a fact of life. Meanwhile, in the richer countries, TB has been allowed to spread even while effective medicines to cure it sit on the shelves. This global neglect has proved to be a fatal mistake. While the world’s concern about TB was weakening, the TB bacilli were growing stronger. Today they attack more people in more countries than ever before in human history.

HIV⁄AIDS. TB is a traveling companion of HIV and AIDS. When people become infected with HIV—which lowers their immunity—they are 30 times more likely to develop TB. No wonder that the current worldwide HIV epidemic has caused an increase in the number of TB patients as well! It is estimated that 266,000 HIV-positive people died from TB in 1997. “These are the men and women,” says Peter Piot, director of the Joint United Nations Programme on HIV/AIDS, “who didn’t benefit from the inexpensive anti-TB medicines they needed to cure their tuberculosis.”

Multidrug-Resistant TB. “Superbugs,” immune to man’s antibiotic arsenal, are the stuff of science fiction, but in the case of TB, they are rapidly becoming a fact. More than 50 million people may already be infected with multidrug-resistant (MDR) TB. Patients who stop taking their medicines after a few weeks because they feel better, because the drug supplies run out, or because the disease carries a social stigma do not kill all TB bacilli in their body. In one Asian country, for instance, 2 out of every 3 TB patients drop out of treatment early. When they become sick again, the disease may be harder to treat because the surviving bacteria fight back and triumph over every available anti-TB medicine. As a result, the patients end up with a type of TB that is incurable—for them and for whomever they may infect. And once this deadly MDR genie is out of the bottle , we are left with the grim question, Will man be able to put it back?

[Box on page 22]

TB’s Global Grip

The tuberculosis (TB) epidemic is growing more sizable, more expensive, and more deadly by the year. Reports gathered by the World Health Organization trace the spread of this silent killer. Here are some examples: “Pakistan has been losing the war against tuberculosis.” “Tuberculosis has returned to Thailand with a vengeance.” “Today, tuberculosis ranks among the leading causes of illness and death in Brazil.” “Tuberculosis has maintained a tenacious grip on Mexico’s people.” In Russia “the incidence of TB is rising sharply.” In Ethiopia “tuberculosis rages throughout the country.” “South Africa has one of the highest recorded incidence rates of TB in the world.”

Although 95 out of every 100 TB patients live in the world’s poorer countries, TB is tightening its grip on rich countries as well. The United States saw a sharp rise in reported TB cases during the early 1990’s. U.S. journalist Valery Gartseff notes that TB “has once more returned to haunt Americans.” Likewise, Dr. Jaap Broekmans, director of the Royal Netherlands TB Association, said recently that the TB epidemic has “begun to worsen in Eastern Europe and parts of Western Europe.” Not surprisingly, the journal Science, of August 22, 1997, states that “tuberculosis continues to be a major health threat.”