As part of our series honoring World TB Day, the following is a commentary by Carol Dukes Hamilton, MD, senior scientist of Health and Developmental Sciences at FHI and associate professor of medicine at Duke University Medical Center.
Today is the day that we acknowledge the progress and the ongoing challenges associated with the second leading infectious disease killer in the world today—tuberculosis (TB). This ancient disease continues to take a tremendous human toll of 1.8 million lives annually. Without dramatic increases in funding and political commitment, the World Health Organization (WHO) estimates that more than 10 million additional lives will be lost between now and 2015 to this preventable, curable disease – 4 million of them will be women and children. Drug-resistant tuberculosis cases will increase with more than 2 million multidrug-resistant TB cases emerging. The deadly synergy of HIV and TB will continue to be a major threat to the lives of people living with HIV infection.
These stark forecasts need not be our future. We celebrate the extraordinary progress we have made recently in battling TB. For the first time in decades, we have new anti-TB drug compounds in the pipeline which hold the promise of shorter and less toxic treatment regimens for drug-susceptible and drug-resistant tuberculosis. The new diagnostic technology Gene Xpert can diagnosis TB in record time (less than two hours) including drug-resistant TB and TB in HIV-infected persons. There are TB vaccine candidates in clinical trials. Recently-announced, critical clinical trial findings unequivocally prove that antiretroviral therapy (ART) is a life-saving intervention when administered early during the course of TB treatment in persons with HIV infection. Since 2002, The Global Fund to Fight AIDS, TB and Malaria has provided treatment to 7.7 million people and saved the lives of 4.1 million people from tuberculosis.
Research developments could make a dramatic difference in the morbidity and mortality toll wreaked by tuberculosis across the world. But will new tools to combat tuberculosis reach the communities that need them the most? Will health systems in high impact countries be adequately strengthened to use new tools to save lives? Can we expand the reach of current tools – including “DOTS,” the WHO’s successful strategy for TB control, more sensitive TB screening, improved preventative therapy, infection control, and intensified case-finding – to reduce transmission, increase detection and increase treatment completion rates? Will new diagnostic and treatment research address the growing epidemic of tuberculosis in expecting mothers, infants and children? These are questions of leadership and political will for heavily impacted governments, for donors and for communities where tuberculosis thrives on poverty and complacency.
All of us have a role in the battle against tuberculosis. When it comes to this airborne infection, TB anywhere is TB everywhere.
Let us spend this day and those that follow recommitting ourselves to the battle against tuberculosis from the research lab to the seats of governments to the sick beds of those infected, and the communities in which they live.