Dodie’s six-year-old daughter frequently suffered from lung infections and struggled to maintain a healthy weight. As a registered nurse, Dodie was understandably concerned, but since her daughter exhibited no other symptoms, she attributed the issue to a common childhood illness from being surrounded by other sick kindergarteners.
But her daughter’s condition soon worsened: she became increasingly fatigued, appeared noticeably sicker and developed an enlarged lymph node in her neck. Panicked, Dodie took her to an ear, nose and throat specialist, who found that her daughter’s lungs were damaged. A biopsy of the lymph node revealed even worse news — her daughter had tuberculosis, a rarity in the U.S. She was placed on an aggressive treatment regimen, which included multiple antibiotics, weekly check-ups and frequent tests. Fortunately, the treatment was successful, and she was eventually cured.
While Dodie’s daughter’s case was serious, her life was likely not in immediate danger because the American healthcare system is well funded and competent at treating TB, which is entirely curable and preventable. But imagine for a moment that Dodie’s daughter lives in India, where someone dies of TB every 90 seconds. The nearest specialist is hundreds of miles away, making regular appointments difficult. The cost of tests and travel are a significant financial burden, not to mention the limited availability of some essential antibiotics. What begins akin to a common cold rapidly progresses to a life-threatening disease, and without the resources or time to get supplementary care, Dodie is helpless to intervene. Under these conditions, Dodie’s daughter risks becoming one of the roughly 1.3 million people who die from TB each year — an overwhelming majority of whom reside in Africa and Asia.
It is inexcusable and dangerous that TB prevention efforts and research are underfunded and underpublicized globally, simply because it is not currently an urgent problem in wealthy countries. Though TB is one of the deadliest diseases in human history and remains a leading cause of death worldwide, treatment remains troublingly inaccessible. And unlike other curable illnesses, TB infection rates have declined very slowly. Between 1975 and 2015, only one new TB drug entered the market. Isoniazid, the most commonly used antibiotic for TB, has been in use since 1952. While recent progress has been made toward developing a new TB vaccine, the only current vaccine was developed nearly 100 years ago, and its efficacy is still debated. In affluent countries like the U.S., these age-old treatments, combined with improved ventilation and sanitation, were sufficient to curb TB. However, once TB was under control in the U.S., many lost interest in pursuing further treatments for the disease globally. As a result, TB prevention and research are now significantly underfunded. Those who are lucky enough to receive treatment still endure the painful, nearly two-year regimen that has existed since the 1970s, which involves months-long cycles of drugs like rifampicin and ethambutol which commonly come with many difficult side effects like nausea and rashes. With increased funding for global health organizations and better intergovernmental cooperation, we can make significant strides toward curing TB worldwide.
There is a clear moral obligation to prevent tuberculosis deaths across the globe. There’s an equally clear practical incentive: failing to control the spread of TB will eventually endanger people in countries where the disease is currently less prevalent. In many places with underfunded TB programs, patients might only receive partial treatment or the wrong treatment entirely, allowing some strains that are immune to these antibiotics to survive. The patient can then spread their infection to others, creating a strain of drug-resistant TB.
This is already becoming a worldwide problem. In 2022 alone, 410,000 people developed TB that was resistant to traditional antibiotics. These strains are difficult to treat even in countries with the strongest healthcare. Alarmingly, TB cases in the U.S. were higher in 2023 than they had been in more than a decade, and a not-insignificant portion of cases are drug-resistant. Though TB may not yet be a public health emergency in the U.S., this upward trend should be taken as a wake-up call to start taking the illness more seriously on a global scale.
Beating TB is not as crazy a proposition as it may seem. In fact, our success in combating COVID-19 proves that it is entirely feasible to develop new ways to tackle TB. Pharmaceutical companies were able to develop effective COVID vaccines within a year of origination, and, not too long after, we had Paxlovid, which dampens the severity of COVID infections. Partly, this was possible because of tremendous funding: governments spent nearly 90 times more developing COVID vaccines that year than they had spent on creating new TB vaccines in the previous 11 years. It was a product of readily apparent political and economic incentives to stop the spread of COVID.
Though TB is different from COVID in many ways, the principles applied to finding remedies for COVID are similarly relevant to TB research. Increased funding and awareness will lead to new vaccines and therapies for TB. There are already reasons for optimism. After a long drought, there have been recent promising innovations in TB treatment. On World Tuberculosis Day, news and hashtags related to the disease reached more than a billion people. These are good first steps in what can hopefully be TB’s version of Operation Warp Speed.
Though TB remains one of the deadliest diseases, TB research and prevention programs are within reach, if we can muster the will for it. Hopefully, in the near future, everyone will be able to receive a standard of TB care similar to what Dodie’s daughter obtained, and will not suffer a death that could have been preventable.
