One hundred and thirty one years ago today, Robert Koch announced the discovery of the bacillus that causes tuberculosis. As a result, for the last thirty one years, 24 March has been observed as World TB Day, highlighting that nearly a century and a half on from Koch’s discovery, we are still facing a global pandemic of TB.
The stats are quite shocking – In 2011 alone, there were an estimated 8.7 million
new cases of TB (13% co-infected with HIV) and 1.4 million people died from TB, or around 4,000 TB related deaths every day.
Edward Trudeau, the pioneer of TB treatment in the nineteenth century pointed out that the aim of medicine was to ‘to cure sometimes, to relieve often, to comfort always.’ This was at a time before antibiotics, so the only hope was to care for people and hope that they were strong enough to recover on their own. For more than half of the last century we have had drugs that can treat TB effectively, but no new ones for over thirty years, and no new vaccination since the BCG. There are no financial incentives for the drug companies to develop them.
But we are living through the emergence not just of drug and multi-drug resistant TB (MDR TB) but of strains that are resistant to virtually all known pharmaceuticals (so-called XDR TB). MDR TB now accounts for 3.7% of all notified new TB cases, and is an increasing proportion and numbers year on year. While XDR TB is still quite rare, the concern that it will follow the same trend as the MDR variant is growing. And it is estimated that only one if five cases of MDR TB is being identified or reported – so the scale of the problem is almost certainly much bigger than it seems.
It is not all bad news – some real progress has been made in the last couple of decades. New cases of TB have been falling for several years and fell at a rate of 2.2% between 2010 and 2011. The TB mortality rate has decreased 41% since 1990 and the world is on track to achieve the global target of a 50% reduction by 2015.
There are new drugs and vaccines finally in clinical trials, including new classes of drugs. But there is a shortage of funding for research, extending treatment programmes, or screening. The progress made so far could stall or go into reverse.
The irony is that TB has been preventable and treatable for years – it’s just that the political will to do the difficult job of screening, vaccinating and treating, along with public health messages (e.g. stopping people spitting in the street) has simply not been there. It illustrates the need to go beyond medicine alone to tackle major health problems.
This World TB the message remains to challenge the global community, national governments, civil society and churches to do more to raise awareness about TB, mobilise political will and funding to eliminate deaths from the disease, see new and effective drugs and vaccines in use, and ultimately see the end of TB. as we have seen with smallpox, it is possible to eliminate major diseases, but it is far from easy.
And while this may seem distant to us in the UK, the fact is (as any inner-city GP will tell you) we are seeing an increase in cases here as well. It’s in our interests to see TB controlled and eliminated around the world.
If you want to know more about actions you can take to help the global fight against TB, please go to the World TB Day website.