Fighting TB: No More 'Good Enough'

Every year for the past two decades, the World Health Organization has released a Global Tuberculosis Report and it has passed fairly directly into obscurity. This year was different. Published on Wednesday, the 204-page survey of the epidemic was covered by newspapers ranging from The Wall Street Journal to The Times of India. The WHO itself described the moment as a “watershed.”

Why? Largely because improved estimates of TB’s prevalence suggest that TB is the new leader in a ghastly race. The number of people who die from the infectious respiratory disease now outnumber those who die of AIDS. Last year HIV/AIDS killed 1.2 million people, while Mycobacterium tuberculosis was responsible for the death of 1.5 million people.

The WHO emphasizes the positives. As is to be expected from a bureaucracy charged with building consensus and setting standards, they chose to focus on the fact that the death rate from tuberculosis is half of what it was in 1990. Despite low funding, the world has made measured, albeit uneven, progress. “The report shows that TB control has had a tremendous impact in terms of lives saved and patients cured,” WHO Director-General Margaret Chan said in a press release accompanying the report.

Partners In Health’s TB experts view it another way. They are of course pleased to hear of lives saved, but with most TB cases curable since 1947, they find any death a moral outrage, not to mention 1.5 million deaths. Last year, as many people died from TB as from a decade of fighting in the Vietnam War.

They are also impatient with the progress. “Although tuberculosis incidence has declined over the past 25 years, it has done so at a glacial pace of about 1.65 percent annually,” writes Dr. Salmaan Keshavjee, senior TB specialist at PIH and director of Harvard Medical School’s Center for Global Health Delivery-Dubai. “At this rate, it will take another two centuries to eliminate the disease.”

Lastly, while they applaud the WHO for pointing out dramatic shortfalls in funding, they stress that finances are only part of the problem. The end of TB will come not from calls that it be “controlled,” as have long been popular, but from demands that the highly contagious disease be eradicated. “The history of TB is the failed policy of ‘good enough,’” says Dr. Joia Mukherjee, PIH’s chief medical officer.

PIH has been fighting TB for decades, beginning with a successful program battling drug-resistant TB in the slums of Peru in 1996. Currently, we’re supporting patients, improving treatment protocols, and shaping national policy everywhere from Russia to Lesotho. This year, we began a four-year, 15-country program with Medecins Sans Frontieres and Interactive Research and Development to find better treatments for drug-resistant TB. This week, PIH TB expert Dr. Michael Rich is collaborating with the government of Liberia and Keshavjee published “Stopping the body count: a comprehensive approach to move towards zero tuberculosis deaths” in The Lancet. The WHO report is indeed a watershed moment—and a call to do better.