TB, Or Not TB Most Neglected? That Is The Question

Globally, 2 billion people ― one-third of the world’s population — are infected with the tuberculosis (TB) bacilli, the microbes that cause TB. TB is an opportunistic pathogen, and not everyone infected with TB bacteria becomes sick. However, 1 in 10 people infected with TB will become sick with active TB in their lifetime. TB is contagious and spreads through the air; if not treated, each person with active TB infects on average 10 to 15 people each year. TB remains a major global health problem, with 10.4 million cases and 1.8 million deaths from the disease in 2015. By the time you finish reading this, TB will have killed at least 12 people.

Undoubtedly, increased resources and new tools are needed to address this global pandemic. Pharma has had little interest because TB primarily affects poor people in poor countries and the prospects of a blockbuster drug to recuperate R&D costs are low. In addition, the cost of developing TB drugs is higher than drugs for other diseases because of the need for large sized and lengthy clinical trials. As a comparison, in over three decades since its discovery, HIV has become one of the biggest targets of global health funding; TB, on the other hand, an ancient disease discovered in the 19th century, receives less funding, although both threaten lives. Worryingly, TB is the leading infectious killer in the world, killing more people than HIV/AIDS, as reported today by the World Health Organization (WHO).

Each year, 580,000 TB cases across the globe are classified as drug-resistant, meaning drugs that used to treat TB will not kill the bacteria. Extensively drug-resistant tuberculosis (XDR-TB) is the deadliest and most dangerous type. It is resistant to at least four of the best anti-TB drugs and has spread worldwide. Now in more than 105 countries worldwide, XDR-TB is at least 20 times costlier to treat and takes more than two years to cure.

Early this year, the WHO published it’s first-ever list of bacteria with the highest priority needs for new antibiotics. Pathogens considered critical were chosen based on the level of drug resistance that already exists for each, the numbers of deaths they cause, the frequency with which people become infected with them outside of hospitals, and the burden these infections place on health care systems. TB checks all the criteria and we naturally expect TB to be there as it poses the greatest threat to human health — for which new antibiotics are urgently needed. However, the experts compiling the list failed to include TB. This is unfortunate and disappointing, as the list is expected to be an advocacy tool used and referenced by policy-makers to assist in the prioritization of investments in pharmaceutical research and development.

After publishing the list, WHO Director-General Margaret Chan issued a statement saying, “Addressing drug-resistant TB research is a top priority for WHO and the world.” But the fact that TB has been left out (some may even say neglected) of the list designed to influence policymakers’ priorities may send a different message ― that TB is not a priority pathogen! Hopefully the list will be amended to include TB in the list of critical pathogens.

Many people in developed countries think of TB as a disease of the past, because in their countries, it actually is. Of the “big three” diseases – HIV/AIDS, TB, and malaria – TB and malaria largely affect the developing world. On the other hand, HIV is more common in developed countries and is perceived as a more urgent danger. Each year buildings and landmarks across the world turn their external lights red to show support for World AIDS Day but this does not happen for TB or malaria.

Well-known personalities have been infected with HIV or malaria. Several well-known celebrities have HIV and globally-known celebrities like Bono, Scarlett Johansson, Jimmy Kimmel, Elton John, Charlize Theron, Lady Gaga, Cyndi Lauper, Rihanna, and Prince Harry have all campaigned against HIV. George Clooney getting infected with malaria in 2011 became big news and Conan O’Brien, David Arquette, Elizabeth Banks and Forest Whitaker have advocated for increased efforts against malaria.

TB makes for a boring news story ― TB patients undergo a slow disease process that cannot be translated into an attention-grabbing headline, unlike the fast and dramatic impact of Ebola or the cases of microcephaly that is associated with Zika.

World TB day is globally observed on March 24 – on this day let us not neglect TB. Spread the message “Unite to End TB”. Tell your political leaders to step up for TB. Share over social media these e-postcards to Heads of State, Governments and Ministers of Health. Share this blog on Facebook, Twitter, and Tumblr. The more people know about TB and the importance of stopping the spread of the disease, the more efforts and funds can be shifted toward stopping it. #UnitetoEndTB

Dr Melvin Sanicas, vaccinologist and public health physician, is a regional medical expert at Sanofi Pasteur, a consultant for the World Health Organization, and an agenda contributor for the World Economic Forum. He was a Global Health Fellow and Program Officer at the Bill & Melinda Gates Foundation where he managed the Collaboration for TB Vaccine Discovery. He is a partner at the Brighton Collaboration, a fellow of the Royal Society of Tropical Medicine and Hygiene, and a fellow of the Royal Society for Public Health.