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Time to Target Tuberculosis

Katherine A. Romer

Last year, almost nine million people became sick with tuberculosis (TB), the vast majority of them in the developing world. Nearly two million died, even though TB is easy to detect and almost 100 percent curable with antibiotic treatment. Year after year, TB remains one of the world’s deadliest infectious diseases. And, if we do nothing, the TB epidemic in the developing world will likely get worse. As the AIDS epidemic spreads, TB rates are exploding in sub-Saharan Africa — not only is TB the largest killer of those with HIV/AIDS, but AIDS patients with active TB infections pass TB on to their previously healthy family, friends, and neighbors. In 1993 and again in 2005, the World Health Organization (WHO) declared TB a health emergency. We need to contain the global TB epidemic now.

Unfortunately, the fight against global TB is still grossly underfunded. Most of the nations hardest hit by TB are poor, and the governments of the developed world have been slow to provide funds to help them improve TB detection and treatment. The WHO’s Global Plan to Stop TB estimates that turning back the TB epidemic over the next ten years will cost $56 billion, but countries around the world have pledged only $25 billion — an enormous funding gap. In the past, our own government has provided little support; last year, out of a budget of over $2 trillion, the U.S. provided just $550 million for the Global Fund to Fight AIDS, TB, and Malaria and just $85 million for other global anti-TB programs.

Our failure to support the fight against TB is a real tragedy, because we have clear evidence that funding TB detection and treatment makes sense. Providing a patient with the drugs for a six-month course of treatment, and getting community volunteers or health workers to ensure he or she takes all the drugs correctly, costs just 20 to 40 dollars. When a TB patient doesn’t get treatment, he or she has just a 45 percent chance of surviving; with the WHO’s preferred treatment program, DOTS (Directly Observed Treatment, Short-course) the survival rate is 80—95 percent. The three main recipients of government funds in the fight against global TB — the Global TB Drug Facility, the Global Fund to Fight TB, Malaria, and AIDS, and bilateral U.S. programs — all have repeatedly used money from donor countries to successfully introduce DOTS around the world. So our government funds go directly to proven, cost-effective anti-TB programs. The Global Plan to Stop TB estimates that, if TB treatment and detection programs get the $56 billion they need over the next ten years, we can treat 50 million people with DOTS and prevent 14 million deaths. We seldom get a chance to save so many lives for so little.

Furthermore, increasing funding for TB detection and treatment won’t just save lives right now. The Global Plan to Stop TB aims to use TB detection and treatment to eliminate it as a global health problem by 2050. This goal may seem hopelessly ambitious, but we have good reason to believe it’s possible. Over the past century, the death rates from TB in Europe and America have fallen from one out of every seven to one out of every 10,000, thanks almost entirely to widespread TB testing and antibiotic treatment. If we fund the fight against TB, we can virtually eradicate TB in the developed world, just as we have in our own country.

Containing and eventually eliminating TB will not only save millions of lives a year now and for many decades to come, but also substantially reduce poverty. Disease is one of the most important causes of poverty in the developing world, killing vital members of the community and making others unable to work and care for their families. TB is particularly devastating because it disproportionately affects working adults and puts those infected out of work for up to nine months; a single TB infection often plunges an entire family into extreme poverty. If we allow the TB epidemic to grow into a crisis, it will substantially slow progress in communities and nations throughout the developing world. On the other hand, if people are healthy, they have a chance to use their own hard work and innovation to improve their lives. Many economists who study development agree that containing contagious diseases is one of the most cost-effective ways to fight world poverty.

To prevent a global TB crisis, to save millions and millions of lives, and to fight poverty and suffering all over the developing world, our government should do its share and provide close to a billion dollars a year to the fight TB. And that means that each of us needs to do our share to alert our representatives of the urgent need to fight global TB. If we make containing TB a priority, our government will follow. President Bush’s original 2007 budget proposal cut funding for the Global Fund by $250 million; thanks in large part to activists across the country, Congress passed a budget amendment instead increasing its funding by $300 million.

So pick up your phone and call your Massachusetts senators, Ted Kennedy (617-565-3170) and John Kerry (617-565-8519), and ask them to support the fight against TB. Thank our government for supporting the Global Fund, and ask it to commit 300 million additional dollars to combat TB. Educate your friends and family about TB, and ask them to take action. If you’re interested in learning more about how to stop TB, check out RESULTS, a new MIT student group dedicated to education and activism on TB and other global poverty issues at http://web.mit.edu/tac.

We can stop the spread of TB. With enough effort and resources, we can end the TB epidemic worldwide and take a big step forward in the fight against global poverty. Let’s make sure we have the political will to do so.

Katherine A. Romer ’07 is a member of RESULTS.