Tuberculosis and its effect in the 21st Century

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Though commonly thought to be a “deadly disease of the past” – an ancient enemy and no longer a real threat, Tuberculosis (TB) remains among the top 10 leading causes of death worldwide. The disease is no new phenomenon. Dating back five millennia, mummies in Egypt presented signs of tubercular decay in their spines, and in 460BCE “consumption” as it was then called earned a nasty reputation as the most widespread disease of the era. Today, TB continues to wreak havoc in the world’s poorest communities, killing more than 1.8 million people last year alone – 4,900 people every day. A highly contagious, bacterial, airborne disease, it poses the most significant health risk to poor and malnourished people living in crowded conditions with limited access to healthcare. It would therefore come as no shock that 95 percent of today’s global TB cases and deaths occur in developing countries, despite growing global efforts to target outbreaks of the killer disease in such regions.

TB attacks its victims subtly and slowly at first, producing symptoms that resemble a cold or flu. The uneducated or uninformed usually ignore their fatigue, fever or chronic cough, thinking them to be merely symptomatic of a common cold. But as the highly infectious disease slowly eats away at one’s lungs, the symptoms grow worse and unless patients are treated immediately and effectively – the result can very often be fatal.

The average annual risk of TB infection (ARI – the probability that any person will be infected or reinfected with Mycobacterium tuberculosis in a year) is highest in the South-East Asia, Western-Pacific, and Africa regions. In 2014, these regions had the highest prevalence and accounted for around 80% of the world’s latent TB cases.

But TB is preventable and curable.

Between 2000 and 2016, 53 millionlives were saved through effective diagnosis and treatment – although this did not make nearly enough of an impact in the grand scheme of things. The reason for the lukewarm results is that the TB treatment programs in developing countries have poor patient compliance with therapy, lack of education among the populace, rapid growth of drug-resistant organisms, and failure to control drug supplies and therapy properly.The cost of containing, treating and preventingTB is, however, the number one factor preventing developing countries from truly ridding themselves of the disease.

The cost of treating TB per patient in developing countries, in 1986, was $123 for standard 12-month chemotherapy and $168 for short-course chemotherapy, with the cost per patient cured $368 for standard 12-month chemotherapy and $314 for short-course. In 1986 this was no small sum, and even in today’s terms this cost is prohibitive to people living and working in developing countries, excluding them from accessing such life saving services. US$2.3 billion per year is needed to fill the resource gap for implementing existing TB interventions. However, there have been holistic and alternative suggestions, such as the use of cbd hemp oil to treat and cure TB.

This year also marks the 25th anniversary of the World Health Organization declaring TB a public health emergency. In these past 25 years, we have seen improvements – but not many. Rather, this quarter century of response to TB has been defined by its failures with TB surpassing even HIV, a disease for which there is no cure; and infecting 645 million individuals, almost none of whom have access to effective preventive measures.

In Vietnam for example – a country so burdened by corruption that it is currently making headlines for its highest profile corruption trial in memory, a country where one cannot access the BBC or other “influential” international news websites without the use of a  VPN, and where environmental and political activists are regularly imprisoned – corruption has spread to the health sector. In this particularly corrupt socioeconomic environment, the legality, certification and licensing of many medical practitioners are inauthentic. Not even compliance and enforcement are effective solutions to the resulting problems in inadequate healthcare. And it is having an impact on the national tuberculosis epidemic.

With around 100,000 new cases of tuberculosis and 17,000 deaths from TB every year, Vietnam ranks 12 out of the world’s top 22 countries for having the highest number of TB patients.

“Forty per cent of undetected TB patients (in Vietnam) will die because they haven’t treatment,” Director of Hanoi-based Central Lung Hospital, Nguyễn Viết Nhung, said.

People in Vietnam often fail to recognise the symptoms of TB, due to a lack of awareness and education but also due to fear of discrimination. Unqualified or uneducated health workers operating in rural areas exacerbate the problem by failing to detect the deadly disease. But it’s not only medicalcorruption that is preventing the country’s TB victims from receiving treatment – the country’s tuberculosis program is significantly underfunded, despite international efforts.On World TB Day 2017, Vietnam was estimated to need at least US$66 million per year in order to reduce the burden of TB from 112 to 20 per 100,000 people by 2030and eliminate tuberculosis as a public health problem. Currently, the national TB prevention programme is beingfunded at $26 million a year, including $19 million from foreign aid. The rest remains unfunded.

But there is one partnership seeking to change that.

The EndTB partnership is an unprecedented attempt by Partners in Health (PIH), Medicins Sans Frontieres (MSF), UNITAID and Interactive Research and Development to develop a four-year, $60 million trial for treating antibiotic-resistant TB across three continents and 15 high disease burden countries.The program aims to end the global epidemic, reducing TB deaths by 95% and cutting new cases by 90% between 2015 and 2035.

Efforts in fighting TB are already paying off. Incidence rates are declining worldwide – as are the number of deaths from TB – the United Nations has identified reducing the global TB burden as one of its key Sustainable Development Goals and awareness of the disease is growing. But while the number of cases and deaths from TB in most developed countries has been declining; in developing countries, TB remains a major problem.

This needs all our attention moving into the next decade, so that no one should have to die from this preventable, treatable disease ever again.

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