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Patients wait to be tested for tuberculosis at a hospital in Liberia.
Patients wait to be tested for tuberculosis at a hospital in Liberia – one of the countries most affected by the disease. Photograph: SOPA Images/LightRocket via Getty Images
Patients wait to be tested for tuberculosis at a hospital in Liberia – one of the countries most affected by the disease. Photograph: SOPA Images/LightRocket via Getty Images

Scientists warn of global crisis over failure to tackle tuberculosis

This article is more than 5 years old
With 10 million new cases each year, outcome of UN summit in New York could prove crucial

Heads of state, doctors and scientists will gather in New York next week to discuss one of the world’s most alarming medical crises: the failure of global efforts to tackle tuberculosis, the deadliest infectious disease on Earth.

More than 10 million new cases of TB are detected every year and about 1.7 million people die of the disease, according to a recent report by UK doctors. At the same time, the group describes current global anti-TB measures as “woefully inadequate”.

In a letter to Theresa May the group – UK Academics and Professionals to End Tuberculosis – says the intervention of world leaders is urgently needed to contain TB as the number of antibiotic-resistant cases continues to rise. The letter urges May to attend the UN general assembly meeting on ending TB on 26 September as the head of Britain’s delegation.

“If we have low-level officials decisions can get side-tracked, but if you have heads of state then any measures that are agreed will get much higher priority,” said Professor Tim McHugh, a University College London expert on TB and a signatory of the letter to May. However, Downing Street last week said it could not yet confirm whether the prime minister would attend.

TB is caused by a bacterium that destroys the tissue in patients’ lungs. The disease is spread when they cough or sneeze and aerosol droplets containing bacteria are breathed in by others. The disease was a major killer in the UK in the 19th and early 20th century. Victims included DH Lawrence, Emily Brontë, Frédéric Chopin and Robert Louis Stevenson.

Slum housing in London, circa 1900. The eradication of extreme poverty is a key factor in controlling TB. Photograph: Popperfoto/Getty Images

Vaccines and antibiotics have since played a key role in reducing deaths from TB in the west, with the result that in Britain cases have plunged from more than 100,000 a year to a few thousand. “Medicine has played a key role in bringing TB under control in the UK, but so has the eradication of extreme poverty,” said McHugh.

“Room occupancy in 1910 stood at around eight people to a room but has since gone down to one or two per room as slums have been cleared. The crucial point is that when you look at the curve of that decline you find it very closely maps the decline in TB cases in Britain. And because TB is spread by aerosol droplets in a person’s breath, so having fewer people in a room ensures the disease’s spread will be reduced.”

However, TB remains a very real problem in the UK, McHugh said, while in poorer countries it is a major killer and has confounded UN plans to eradicate it by 2030. It is estimated that it will have cost the world more than $1tn in lost economic output by 2030. Factors that hampered the battle against TB include poverty, civil wars and the spread of HIV, which depresses natural immunity to the condition.

Scientists have put forward a number of proposals to regain control of TB. These include:

 New anti-TB medicines that are easier to administer. Current drug regimes can take months to complete.

 Better tracing of those who have been in contact with newly diagnosed patients.

 Improving living conditions in many areas of the developing word.

This last proposal will be the most difficult to ensure, for example in the townships of South Africa where large numbers of people live in close proximity and where nutrition is poor. “Disease control becomes very difficult in places like that,” said McHugh. “It is why TB rates are so high in South Africa. But we have to put that right.”

In the end, the most important outcome of the UN meeting will be an acceptance by world leaders that TB is a very real problem, said Dr Marc Lipman, of University College London. “A declaration to this effect and a pledge to follow up the summit with future high-level meetings will be a key development. It will acknowledge that world leaders realise we have a real problem on our hands.”

Analysis

Shame remains a major problem facing doctors and health services trying to combat TB. “It works both at an individual level and at a national level,” said Marc Lipman, of University College London.

“My clinic recently diagnosed a lady from India as having TB. She was aghast, not because she had contracted such a serious condition but because she felt it reflected on her way of life. ‘How can I have TB? I keep a clean house,’ she told us.”

The woman’s TB was probably latent and had been with her for years, said Lipman. It did not reflect on her home’s cleanliness. “However, she was horrified because she thought only the poor and unclean got TB.”

In the past, people often did not reveal that a death in their family had been caused by TB. It would have implied lack of cleanliness, or poverty. Crucially, that trend is mirrored at a national level. Countries often hide the disease’s prevalence within their borders. “Managers who run a nation’s health service are unlikely to acknowledge at an international conference that TB is an issue in their country because of its associations with poverty,” said Lipman. “They could lose their jobs if they admitted that. However, if you get heads of state at a conference then they can acknowledge that all is not well in their country. That is especially true if you do that in an environment in which everyone else also says they have a problem with TB – and of course that is actually the case.”

This was one of the main reasons that the UN summit on TB was set up – as an event at which world leaders could come clean about the crisis. “Once that has been achieved, we can start to get things done,” said Lipman.

Robin McKie

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