March 24 was World TB Day
The disease, although preventable and curable, still claims a high death toll
Editor’s Note: Linda-Gail Bekker is Professor of Medicine at Cape Town University, Deputy Director of the Desmond Tutu HIV Center, and President-elect of the International AIDS Society. The opinions expressed in this commentary are solely those of the author.
Each year, March 24 marks World Tuberculosis Day. One day in the year when the world’s lens will focus on the fact that almost 4,000 people globally die every day as a result of this preventable, curable disease.
An ancient disease that has claimed many millions of lives, tuberculosis continues to wreak havoc on public health in many countries in this century.
Fast forward to recent decades and another pandemic has claimed more than 30 million, mostly young lives and today at least another 30 million people live with HIV – an incurable, although treatable infection.
Inextricably linked by the interactions at the level of the host immune system, there are many similarities in these two epidemics. Both diseases are reliant on recognition of possible infection prior to the onset of symptoms, yet both are engulfed by crippling stigmatization undermining that self-identification, and both require long periods of adherent pill-taking to control or cure disease.
- Symptoms include coughing up blood, fever, chills, night sweats, shortness of breath, chest pains, loss of appetite, weight loss, and fatigue.
- It is possible to spread the TB bacteria from the infected person to others.
- A skin or blood test will indicate if a person has been infected with the bacteria.
- Treatment with antibiotics for 4-9 months is required to treat active TB disease.
- Persons with a weak immune system, such as those with HIV or diabetes, are more prone to catching the TB disease.
- TB is a leading cause of death for people infected with HIV.
This becomes especially important but increasingly difficult as the impact of the disease lifts and the patient feels better.
Perhaps most important of all, both diseases feed off the frailties of human society, occurring most frequently where social and structural barriers have contributed to unprecedented burdens of disease and have made public health responses all the more challenging to implement.
In 2016, it is salient to ask what can the TB world learn from HIV and vice versa?
From the very outset in the early 1980s, community demanded a strong stake in the ownership of the AIDS response. Many would argue it was the unprecedented bottom up approach of the earliest HIV/AIDS response with community leading the charge. This momentum continues to move the AIDS response forward.
Lessons learned from three decades of responding to HIV/AIDS have taught us that we cannot hope to end the HIV epidemic through treatment alone.
We must revolutionize the approach to HIV prevention of transmission and at the same time convey to the broader public and decision makers the urgency in providing a comprehensive response.
In similar vein, the STOP TB Partnership´s Global Plan to Stop TB, 2016-2020 presents a new way forward for the next five years on the road to eliminating TB by 2035. The Global Plan focuses on actively engaging community as part of the response – lobbying for greater political leadership, investing in new drugs and new drug regimens, and investing in an effective vaccine, but also asking where and how to reduce transmission of TB in families, communities and settings.
As we know, TB spreads from person-to-person through the air. TB most heavily impacts the urban poor, where undernourished people live in crowded conditions and commonly face economic, social and cultural barriers to completing the minimum of six months of treatment.
We can make it harder for TB to spread by improving indoor air quality and sanitation, investing in proven antipoverty measures but those measures need to be complemented by social support mechanisms that enable patients to be identified early in their disease, and then to access and stay on treatment. Ending TB will require bolder investment in research and development.
Currently there is no effective TB vaccine. The standard TB medicines are more than 50 years old and require at least six months of use. Treating multi-drug resistant TB is even longer, involves injections and is arduous. And the most widely used diagnostic test requires a person to search for TB germs through a microscope, using the naked eye.
Interrupting transmissions will need a better understanding of where and how TB is transmitted with sufficient resources to intervene where needed to the scale required to have an impact. Many developed regions of the world have done this and have driven back the ravages of TB as a generalized epidemic.
Moving the global TB response forward will ultimately need committed political leadership that understands the urgency of a TB free world with the same sense of commitment and urgency that we seek a world free of HIV. We are entering a new era in global health under the framework of the Sustainable Development Goals (SDGs) agenda.
To complement renewed political commitment it is clear that that to move towards the goal of the elimination of many diseases including TB, we´ll need to cross-pollinate ideas across discipline and sectors.
The situation in South Africa shows how difficult it will be to end TB without bold new approaches to fighting the disease.