The headline "TB Anywhere is TB Everywhere: World TB Day 2007" was the theme of Saturday's seventh annual World Tuberculosis (TB) Day, an awareness day sponsored by the World Health Organization (WHO) to focus attention on the devastating toll taken by TB, the world's second leading infectious killer after HIV/AIDS.
On this day, as on every other day of the year, one person dies of TB every 20 seconds. By the end of the day, an estimated 5,000 people die as a result of the bacteria-induced respiratory infection, adding up to over 1.7 million deaths each year, according to the BBC. With such staggering numbers, TB has been regarded as a global health emergency by the WHO since 1993. The tragedy is that TB, unlike AIDS, is completely treatable and curable. According to RESULTS, a non-profit grassroots organization, a full six-month drug course typically costs a mere $16 in many developing nations, just a few dollars more than a Dewick dinner.
World TB Day falls on March 24 each year, commemorating the day in 1882 that Dr. Robert Koch discovered the bacterial basis of the disease, allowing for a more accurate diagnosis, cure, and potentially, eradication. Antibiotic use in the 1940s and 50s led to a rapid decline of TB prevalence, but apparent progress against TB was defied by a frightening resurgence of the disease in the 1980s.
This was largely spurred by the evolution of drug resistant strains. According to the WHO, these strains occur when antibiotics are misused and kill only some of the bacteria, allowing the mutated drug-resistant strains to thrive and reproduce. This occurs often in developing regions around the world where insufficient funding results in inconsistent access to treatment and a lack of education regarding the necessity of finishing an antibiotics course.
Mismanaged treatment strategies have led to the emergence of Multi Drug Resistant TB (MDR-TB) and Extremely Drug Resistant TB (XDR-TB), both far deadlier killers than standard tuberculosis.
According to the BBC, MDR-TB is defined as a strain of TB that is resistant to the two most powerful anti-TB drugs soniazid and rifampicin. While MDR-TB may be treatable, it requires up to two years of chemotherapy, an extremely costly and unfeasible option, particularly for third-world countries.
XDR-TB is resistant to three or more of the six known anti-TB medications and was categorized in a BBC News report on Sept. 6, 2006 as "virtually untreatable." XDR-TB is found in 28 countries and according to a memo released by the WHO on Feb. 25, 2007, all G-8 countries, including the United States, report cases of XDR-TB.
While TB is highly contagious, to the extent that WHO statistics approximate that one third of the world's population is infected with TB bacilli, about 90 percent of these infections remain dormant. While the disease itself remains a deadly concern, the situation becomes much more complicated regarding HIV positive individuals.
TB is the leading killer of individuals who are HIV positive, accounting for 13 percent of AIDS deaths worldwide. TB and HIV/AIDS are virtually two heads of the same monster. Due to the weakened immune system caused by HIV, the two diseases combine to accelerate and exacerbate each other, according to the WHO.
In light of the deadly relationship between TB and AIDS, XDR-TB threatens to undermine progress in the fight against HIV/AIDS, a cause for which the United States alone has spent billions on treatment, prevention and care. As Nelson Mandela explained at the 2004 International AIDS Conference, "To fight against AIDS, we must do more to fight TB." World leaders recognized the fatal link before the emergence of XDR-TB, and WHO had already created a program called Directly Observed Treatment, Short-course (DOTS) in order to fight the pandemic.
This program includes political commitment with increased and sustained financing, accurate case detection, standardized and supervised treatment, adequate drug supplies, and capability for monitoring and evaluating the system. This approach has proven to be successful when treating standard TB but new methods must be employed regarding new strains of the disease.
The surge in MDR-TB and XDR-TB has intensified the situation, leading the WHO to devise a new six-point Stop TB Program based on the previous successes of DOTS. The new program is an expansion of DOTS and focuses on addressing the HIV/TB connection, strengthening health systems, engaging health providers, empowering affected communities and promoting research. The developers of this strategy envision a world free of TB and work in conjunction with the Millennium Development goals to significantly reduce the global burden of TB by 2015.
This month, as Congress contemplates an Emergency Supplemental Appropriations bill for additional funding for the war in Iraq, they should also consider a financial response to the global outbreak of XDR-TB, an essentially incurable strain.
The WHO currently calls for the allotment of $650 million to battle MDR-TB and XDR-TB. As explained by Michael E. Fleenor, MD, chair of the Advisory Council for the Elimination of Tuberculosis (ACET), the key to controlling this epidemic is prevention. To achieve this goal, funding is desperately needed; currently, national resources are insufficient for diagnosis and treatment of even straightforward cases of TB.
According to Archbishop Emeritus Desmond Tutu, Honorary Chairperson of the Global AIDS Alliance, "It is critical to realize that nowhere does XDR-TB occur in nature; instead, the world is manufacturing it by failing to provide the essential elements of basic TB control everywhere. In so doing, it is literally turning back the clock to a time before TB drugs even existed."
How can you help push for Congress to allot the $650 million called for by the WHO to battle MDR-TB and XDR-TB? Consider volunteering for WHO or becoming involved in the One-in-Ten campaign, which works to raise awareness on the link between TB and AIDS. Closer to home, a sub-chapter of the national RESULTS organization, a part of Pangea at Tufts, focuses on lobbying members of Congress to support the increased funding needed for an immediate response to the global XDR TB emergency. This is a disaster that is already ravaging third world nations, with more than 80 percent of the world's TB-HIV deaths taking place in Africa. But with identified cases of MDR-TB and XDR-TB in the United States and little to no means of preventing it, these new strains of TB have the potential to affect everyone.
The key to controlling this epidemic is prevention and we must make sure that our government demonstrates an adequate response in the global field.
