Why tuberculosis has come back

New data from the World Health Organisation shows that we have allowed a preventable, curable disease to become the world’s biggest communicable killer. The millenniums-old lung disease tuberculosis now outranks even HIV/AIDS in the number of lives it claims. The fact is that we’ve been very successful at curing people of TB since the 1950s — so why is this illness still such a scourge?

TB is an airborne infectious disease. If untreated, one person with TB can infect 10 to 15 others in the space of a year. The existing vaccine is largely ineffective, and there is no simple test where most people first get care.

Drug-resistant strains of the disease continue to spread, far outpacing the development of new drugs. And the treatment for drug-resistant TB can be gruelling, with sometimes devastating side effects. These challenges are real, but the biggest problem we face with tuberculosis is not scientific. It’s political.

TB has climbed up the list of major killers worldwide, but it’s stuck at the bottom of the list of political priorities. We need look no further than the Obama administration, which can and must do much more on TB. The president’s budget request has proposed slashing international funding for TB in each of the last four years, including a planned cut this year alone of $45 million from the previous budget’s level of $236 million.

Fortunately, Congress has recognised the essential role that the United States plays in combating the global threat of TB. Bipartisan opposition has rejected the president’s proposed cuts. Our main development agency, the US Agency for International Development, helps countries with high TB burdens to get better data on their epidemics, strengthen services and provide new diagnostics and drugs.

When new molecular-testing machines became available  years ago, USAID technical support helped countries roll them out. Now more people who are sick can get the diagnosis and treatment they need, more quickly. Public health experts believe that, to be fully effective, the US government funding for these kinds of activities should be far higher than its current level. Taking $45 million out of the budget would clearly be a big step in the wrong direction.

At present, fewer than two out of three people sick with TB find their way into their countries’ health systems. Not all of them then make it into treatment, and fewer still complete it. The countries that have the highest burdens of TB shoulder nearly 90 per cent of the financial cost already, but investment from the US and other donors goes a long way to supporting them.

The Obama administration has historically shown real leadership on global health. The US and other donors have helped enable poorer countries get 15 million people into lifesaving HIV/AIDS treatment, which many observers thought was impossible 15 years ago.

Top infectious killer

Earlier this year, it looked as though the administration might be getting on the right track in its TB response as well, by committing to developing a new action plan on drug-resistant TB. The government held encouraging public consultations, indicating that its new plan would extend to ambitious targets that would include more than doubling the number of new patients being treated.

According to promises, the interagency plan should have gone to the president by September. That deadline has come and gone — even as TB now tops the list of infectious killers.

In the words of South Africa’s retired Anglican archbishop Desmond Tutu, “TB is the child of poverty — and also its parent and provider.” Tuberculosis is also a key driver of the growing problem of antibiotic-resistant disease. Left unchecked, drug-resistant TB alone could account for one in four deaths from antibiotic-resistant infections by 2050. The WHO has revised its figures upward for the second year in a row, now estimating about one million more annual cases than were recorded just two years ago.

This isn’t necessarily an indication that the epidemic is growing, but it does mean that the problem is bigger than we realised. This throws the underfunded, lackluster global response into even sharper relief.

We have the means to cure an overwhelming majority of people sick with TB. And thanks to recent breakthroughs in molecular-based tests, we can now diagnose and start to treat patie-nts faster. But these things alone won’t be enough. We need the tools to get ahead of the epidemic, not just struggle to keep up, and we need the global investment to get the best diagnostics and the right treatment to the people who need them most.

As White House officials weigh next year’s budget request this fall, and decide what to do with the delayed drug-resistant TB plan, the Obama administration must grasp the chance to make the fight against this killer disease a top priority.