World TB day was last week, March 24, 2009.
According to the Stop TB Partnership, tuberculosis caused the deaths of more than 450,000 persons with AIDS in 2007, two times more than previously estimated by the World Health Organisation (WHO) and the Joint United Nations Programme on HIV and AIDS (UNAIDS). Approximately 9 million people are affected by TB annually, with over 1.5 million dying from the disease each year.
Here is the WHO fact sheet on TB.
This week, health leaders are meeting in Beijing at a meeting organized by WHO, China’s health ministry and the Bill and Melinda Gates Foundation. The meeing is focused on drug-resistant tuberculosis.
Today, our local paper ran a version of this story, in which the WHO Director-General Margaret Chan calls for serious action against drug-resistant TB, noting that if left unaddressed, the situation will soon become explosive.
What's going on here? What are the economic reasons for this sudden resurgence in a disease for which we've had a proper cure for decades?
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Drug-resistant strands of TB are on the rise. Current treatments are becoming less effective for many (especailly in poorer countries) who are simply not receiveing the treatment or given those that don't meet WHO standards. TB is spread primarily by coughing, sneezing, speaking, and kissing, which is possibly why nearly one third of the world has TB bacillus, 5-10% which become sick and iffectious. For poorer nations, the increase in new strands are developing rapidly for antibiotics are often misused due to the lack of healthcare and education networks. The intellectual property rights of effective medicines belonging to those in the developed world may not reach many of those in need in the less developed nations because of the high costs. With the rise of TB, costs increase, sickness and deaths increase, which all affect productivity negatively and prevent economic growth. With the strengthening of health care systems and promotion of research, increase innovation is likely and a better understanding of what is happening is possible which can in turn prevent TB from spreading and finding new preventive measures that will halt the spread from the very beginning.
ReplyDeleteWILLIAM writes...
ReplyDeleteOne of the chief problems associated with tuberculosis is its relative lack of pathogenicity. Though it kills a fair number of people, as a percentage of world population over 80% of cases are found in Asia and Africa, continents that are poor and ill-prepared to fight the disease. TB is asymptomatic and latent in 90% of cases, so unless people are tested, they likely will never know anything is wrong. They carry the bacillus and spread it to 10-15 people a year on average, but unless the disease becomes active and pathogenic or unless loved ones become infected with an active form, most will simply go about their business as carriers of the bacillus. Moreover, when speaking of Asia and Africa in particular, there are plenty of other microbes to be worried about: malaria, HIV, Y. pestis, and other tropical and subtropical germs. The mortality rate of HIV and malaria or even dysentery is higher than that of those who contract TB. So from a financial standpoint, it makes more sense to world donors and agencies to combat the most lethal of diseases. However, given that TB has spread to over 1.7 billion people worldwide, the US and other OECD countries may wish to concentrate more fully on testing their populations. Treatment of TB is easy relatively speaking, but it must be carried out uniformly and across everyone in a population to assure decreased prevalence. Then the question is what do you do with those who test positive? Can you make them seek medical care or complete a required pharmacological regime? How does that interfere with individual rights to refuse treatment? And who bears the cost of treatment: the gov't or the individual? And if such a regime is hard in the US, how can one expect the poor of the world, who are often illiterate, rural, with little access to medical care or medicines, to follow suit? Moreover, there is no vacccine for TB. There is only a TB skin test, but if one has had TB anytime previously, one will always test positive. What is needed is a cheap TB test that can be administered in hospital settings or in the African steppe and which only tests for the current presence of the bacillus, not past infections. The test should also determine how pathogenic and antibiotic- resistant a sample is. Such improved testing would reduce the cost of treatment and better guarantee success across a population.