Tuberculosis (TB) has been responsible for killing more people than any other infectious disease throughout history. In the early 20th century and before the discovery of antibiotics, TB was essentially a death sentence with incredibly high mortality rates. Patients were quarantined in sanatoriums, where they were given fresh air, sunshine, and rest, but few survived.
In 2021, 151 cases of TB were reported to, and verified by, the Massachusetts Department of Public Health, and in 2022, 153 cases were confirmed. Racial and ethnic minority groups are disproportionately affected by TB in Massachusetts: around 90% of active TB diseases are diagnosed in members of minority groups, particularly African American, Asian, and Hispanic. According to the World Health Organization (WHO), TB is the leading infectious cause of death in the world, killing more than a million people each year. In 2021 alone, an estimated 10.6 million people fell ill with TB, and 1.6 million died from the disease. The vast majority of TB cases and deaths occur in developing countries, particularly in sub-Saharan Africa, Eastern Europe, and Asia. The disease is also prevalent among vulnerable populations, such as people living with HIV, malnourished individuals, and those living in crowded conditions.
Tuberculosis (TB) is a contagious bacterial disease that primarily affects the lungs but can also attack other parts of the body such as the kidney, spine, and brain. According to the Centers for Disease Control and Prevention (CDC), TB is caused by the bacterium Mycobacterium tuberculosis, which spreads through the air when an infected person coughs, sneezes, or talks. The disease has been around for centuries and has a long and horrifying history. However, it was believed to have been defeated in developed countries until recent years, when it began to resurface, particularly in developing nations.
To combat TB, there needs to be a sustained effort to improve healthcare systems in developing countries, increase funding for TB research and development, and raise awareness about the disease. There are effective antibiotics to treat TB, but many people in developing countries do not have access to them. Significant efforts are being made globally to combat TB, from increasing funding for research and development to improving healthcare systems and raising awareness about the disease.
In addition to the long period of diagnosis and treatment, one of the major challenges in combating TB is the emergence of drug-resistant strains of the disease, which pose a significant threat to global health. Drug-resistant TB occurs when the bacteria that cause TB develop resistance to the antibiotics used to treat it, making it more difficult to cure. According to the WHO, in 2020, there were more than 450,000 estimated cases of rifampicin-resistant TB, the most potent first-line drug, and more than 200,000 estimated from drug-resistant TB. Every year, about half a million of cases diagnosed are resistant to one or more drugs in standard treatment regimen. For patients with drug resistant TB, treatment is especially grueling and can take more than two years. To address drug-resistant TB, there has been a concerted effort to develop new drugs and treatment regimens. According to the CDC, bedaquiline, the first new drug for TB in 40 years, was approved by the United States Food and Drug Administration (FDA) in 2012. Since then, other new drugs, such as delamanid, have been approved, providing hope that drug-resistant TB can be successfully treated.
Another key strategy in combating TB is improving healthcare systems and increasing access to treatment. For example, the WHO’s End TB Strategy aims to reduce TB deaths by 90%, cut the incidence of new cases by 80%, and eliminate catastrophic costs for TB-affected households by 2030. To achieve this, the strategy calls for universal access to TB care and prevention, including diagnosis, treatment, and vaccination. This includes improving the capacity of healthcare systems to diagnose and treat TB, particularly in low- and middle-income countries, through models that adapt for diverse country settings.
In addition to improving healthcare systems, raising awareness about TB is also critical. Many people in developing countries are unaware of the signs and symptoms of TB or the importance of completing the full course of treatment. This lack of knowledge can lead to delayed diagnosis, treatment failure, and the development of drug-resistant TB. Efforts to combat TB are also supported by international organizations such as the Global Fund to Fight AIDS, Tuberculosis, and Malaria, which provides funding to support TB prevention, treatment, and care programs in countries with a high burden of the disease. Several other organizations are also committed to prevent and control TB, such as the National Institutes of Health, the Tuberculosis Trials Consortium, the International Union against Tuberculosis and Lung Disease, the Stop TB Partnership, the TB Alliance, and so on.
According to the WHO, TB deaths are on the rise again today in a new crisis after declining for more than a decade, and the threat of drug-resistant strains still looms large. In addition, the amount of attention that the disease is receiving, which often translates into funding, is nothing near commensurate with the burden of the disease or the number of people who are suffering and dying without access to treatment. According to the WHO Global Tuberculosis Report, 1.6 million people died of TB in 2021. Among infectious diseases, only COVID-19 killed more. As such, TB deaths have risen for the first time in a decade. At the same time, however, spending on treatment and services for TB has fallen significantly. This marks a reversal of progress of previous years.
TB and COVID-19 share some similarities. Both are contagious respiratory diseases that spread through the air, and both can be deadly. However, while COVID-19 has dominated the news and global health discourse for the past two years, TB remains a pressing disease with serious impacts around the world. The WHO estimates that in 2020, there were 1.5 million TB deaths, while there were around 3 million deaths from COVID-19. “Let’s not forget, during COVID-19, we used previous TB strategies to tackle the disease, whether it’s our doctors, whether it’s our machines. I think it’s really important that we have TB in the center of these pandemic-preparedness conversations,” stressed Rhea Lobo, Board Bember of the Community Delegation of Stop TB Parnership, in the Harvard panel event. “If there is another pandemic to sweep the world (other than TB, which is an existing pandemic that everyone’s ignoring), it is going to be respiratory. It’s going to be a lung pandemic. And I think it is really worthwhile to invest in TB and put in the money. Whether it’s in technology, prevention, treatment and care, or diagnosis: we need to tackle these issues together.”
The development of antibiotics in the mid-20th century brought hope in the fight against TB. Following the successful isolation of the tubercle bacillus by scientist Robert Koch, the Pirquet and Mantoux tuberculin skin tests, Albert Calmette and Camille Guérin (BCG) vaccine, Selman Waksman streptomycin and other anti-tuberculous drugs were developed to help combat TB. By the 1960s, most developed countries had nearly eliminated the disease. However, by the late 1980s, TB made a frightening comeback, particularly in developing countries.
