By: Moe Moore
Back in the first decades of the 20th century, tuberculosis (TB) was the leading cause of death in America. And it wasn’t even close: 280 out of every 100,000 New York City residents died from TB in 1900. My grandfather’s family lived in New York at that time and when he fell ill, he was sent to the White Mountains of New Hampshire for the “fresh air cure” and his baby sister, my great-aunt, went to an “open air” school, exposed to the elements all winter to avoid infection. We’ve made enormous strides in TB control and now, in the 21st century, the US has all but defeated TB. Between 2004 and 2013, an average of 16 New Yorkers died per year from TB, or 0.2 persons per 100,000. But that success has not been shared. Outside the United States, TB remains a leading cause of death.
Return of the Top Infectious Killer
We will remember 2020, 2021, and 2022 as the years of Covid-19, which has killed more than 6 million people and continues to take lives. However, as more people get vaccinated, and especially so in the Global South, we will hopefully see Covid-19 cases and deaths wane and, unfortunately, tuberculosis will reclaim its status as the “captain of death.” Tuberculosis has likely killed more humans than any other cause over the last four millennia. It has seen the end of the age of pharaohs, and the ends of the Greek, Roman, Mongol, Byzantine, British, and Ottoman empires. Today, approximately 10 million people are sickened by TB and 1.5 million people die from the disease every year. But it doesn’t have to be this way. TB is detectable, preventable, and treatable, even in its most complicated presentations. The end of the Tuberculosis Era is long overdue.
Molbio system installed at Government Medical College (GMC), Anantnag, Jammu & Kashmir, India (Photo by Molbio)
While the infectious agent for TB, Mycobacteria tuberculosis, was first identified in 1882, the first successful treatments were not identified until 1944; and within months of the introduction of those treatments, the first resistant strains of TB were identified. Since then, many other new treatments have been introduced and the standard treatment regimen, a multi-drug combination, has been in use for decades. The drug combination is intended to reduce the likelihood of resistance developing in an individual and take advantage of the different attributes of the chemicals. Nevertheless, multi-drug resistant tuberculosis and extensively drug resistant tuberculosis have become increasingly common. Tuberculosis strains resistant to the newest drugs, bedaquiline and delaminid, have already been identified and if unchecked, drug resistant tuberculosis is predicted to cause more than 10 million deaths per year by 2050.
The Path to Ending TB
To finally eliminate TB globally we should not expect countries to go through what my grandfather’s generation did—mountain air and outdoor schooling—but instead be able to access the latest innovations in TB control. That means access to the full suite of the tools currently on hand: rapid molecular diagnostics, highly effective treatment regimens, and preventive therapies as well as improved systems to deliver these tools. And such systems will work best when integrated into other, existing systems like primary or universal health care programs and related disease responses (i.e., HIV, diabetes, and nutrition programs), which focus on meeting the patients’ needs. We must invest to end TB and save lives. The response to Covid-19 showed that the world can respond to a pandemic. It’s time the same determination is brought to the fight against TB. Or else, we’re just putting our faith in fresh air.
ABOUT THE AUTHOR
Michael “Moe” Moore has two decades of experience designing and leading public health and international development projects. From health systems strengthening work with vulnerable populations to tuberculosis control and elimination activities in high burden settings, Moe has worked across the spectrum of global health and international development with a focus on post-conflict countries.
Moe directs TB programs at ICF for the Infectious Disease Detection and Surveillance (IDDS) project funded by USAID. IDDS strengthens the ability of health systems in low- and middle-income countries to quickly detect, track, and respond to infectious disease threats. The views expressed in this article are the author’s; they are not necessarily those of USAID or the U.S. government.