The end of March has a couple of “days” we in public health can commemorate, World Water Day and World TB Day. Since I’ve already discussed World Water Day and how water impacts the transmission of infectious diseases, let’s take a look at humanity’s ancient but still problem-causing scourge, TB.
First, a little background on World TB Day. World TB Day is celebrated on March 24th, commemorating the event on that day in 1882 when a dude you may or may have heard of, Robert Koch, announced his discovery of the mycobacterium that causes tuberculosis (Mycobacterium tuberculosis). Celebrating World TB Day allows organizations like the CDC, WHO, the STOP TB Partnership, and others to raise awareness about TB-related problems and highlight the work being done to combat TB around the world.
So now let’s talk a bit about the current state of TB and why World TB Day is even necessary. STOP TB Partnership’s 2015 World TB Day slogan was “Reach the 3 million: Reach, Treat, Cure Everyone”. This illustrates the sobering facts that every year 9 million people become sick from TB and 3 million don’t get the care they need, resulting in nearly 1.5 million TB deaths every year. Many of these patients are in the marginalized corners of society and don’t have access to TB diagnostics and treatment. TB diagnosis and treatment can be successful at preventing the person both from dying of TB related causes and from spreading the TB to family members. But this treatment is expensive and requires the patient to take many pills for months on end, which causes some people to think that those marginalized infected persons are not worth the money and effort to ensure adherence.
One of the main challenges facing TB now and in the near future is the emergence of drug-resistant strains (MDR-TB = multi-drug resistant, XDR-TB = extremely drug resistant). Because people have to take medications for so long and have to be quite strict in taking the pills at the same time every day, life can sometimes happen and without good health infrastructure for people to continue taking their medications, some people stop. So over time as people start and stop taking their TB medications (sometimes for reasons outside of their control, like supply interruptions to the clinic they access the medicine from) the bacterial strains develop resistance to the common drugs and those drugs become less effective or completely ineffective. This is a large challenge in resource-poor settings where drug resistant strains are circulating, because it becomes necessary to test every newly diagnosed person to determine if their TB strain is resistant to any drugs. This testing is expensive and challenging in many areas of the world, but it’s quite important because it doesn’t help the person to just put them on whatever drugs you think might work without having the resistance test results, since those drugs may not work for the person (resulting in a waste of time and money).
With so many people becoming infected with TB and so many people dying from TB, what hope do we have for eliminating or eradicating TB from the world? Innovations are happening with diagnostics, development of new drugs, development of new drug regimens, etc. Furthermore, companies are coming together to tackle drug resistant TB in comprehensive ways, like this partnership between PIH, MSF, and Interactive Research and Development, funded by UNITAID. While it does take a while for new drugs to be developed, and for access to those drugs to trickle down to the people who need them most, the presence of events like World TB Day and the epidemic of drug resistant TB are putting more of a global focus on TB, which will benefit all people.