In Honor Of World TB Day, Think Before You Take A Deep Breath

You hear someone cough and you don’t think twice. Maybe you should.
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Are you reading this on your daily metro ride to work? Or possibly sitting in a lecture hall waiting for class to start? Maybe you’re visiting your favorite coffee shop during the morning rush? You hear someone cough and you don’t think twice. You should.

There is a highly infectious, airborne disease that is circulating the world. It is spread by coughing, sneezing, or even singing. It can infect anyone. It does not discriminate. The infected may suffer from weight and appetite loss, chills, fever, a painful chest, and bloody coughing. The bacterium that causes the disease is modifying itself to resist multiple lines of drug treatment. If these treatments are unsuccessful, death is almost guaranteed.

You’re probably wondering what this mystery menace could be. Why haven’t you heard about it in the news? The truth is, while threats like Zika and Ebola get press, an age old, often ignored disease has quietly become the most deadly in the world. In 2015, tuberculosis (TB) killed more people than any other single infectious disease, causing 1.8M deaths and 10.4M illnesses worldwide.

“An age old, often ignored disease has quietly become the most deadly in the world.”

So why isn’t there a sense of urgency for TB vaccine development? Maybe it’s difficult to feel the impact of a disease that seemingly won’t affect you. Maybe it’s because there is already a TB vaccine and people wonder why we need a new one. But they may not know that this 100-year-old vaccine is outdated and largely ineffective, offering only moderate protection to infants and children, and even less protection to teens and adults (the age group largely responsible for transmitting the disease).

But I understand. I’m a scientist working in TB vaccine development, and even I failed to feel a real sense of urgency about TB. I felt passionate about my work, but also labored under the blissfully ignorant idea that “it could never happen to me.” TB was a problem somewhere else, for someone else.

Then I traveled to Cape Town, South Africa. Our bus drove down a dusty road through the middle of a very poor township known as Khayelitsha. It stopped in front of a bright white building, the location of one of our clinical trial sites. I was there with a group of scientists and doctors to tour the facility, but I would end up seeing much more.

“Why isn’t there a sense of urgency for TB vaccine development?”

A local man appeared and offered to guide us through the community. We agreed, and slowly followed behind him. I looked around: I was in the middle of indescribable poverty, yet I saw flashes of home. Schoolchildren in their uniforms. Teenagers walking together, face down in their smartphones. Brightly colored day care centers with children laughing and playing outside. TB was already here, but it could just as easily be at home. The heaviness of the epidemic was palpable.

Soon we approached a crowded local clinic where children and adults waited in lines, faces covered with masks.

I took a deep breath.

I entered the clinic and a little girl immediately ran to me and hugged my leg. I smiled at her, imagining my own daughter, and wondered why she was there. Was she sick? Was one of her parents? Could they have TB? I started to get dizzy.

I couldn’t take a deep breath anymore.

I knew that it would only take one or two airborne microscopic Mycobacterium tuberculosis to infect me. One or two bacteria could cause a disease that could take my life. That could leave my daughter motherless. That, if curable, could require months or years of treatment that could wreak havoc on my body. It was then that I realized how urgent the need for a new vaccine truly is: TB anywhere is truly TB everywhere.

Last year the number of TB cases rose in the U.S. for the first time in 23 years. Twenty-nine states and the District of Columbia each had more TB cases in 2015 than the year prior. This needs to stop. It needs to stop everywhere. It needs to stop in the poorest of countries, and it needs to stop in the U.S. And while new diagnostics and treatments will be critical, the only way to truly put an end to TB is a safe, affordable, and effective vaccine.

I had to travel halfway around the world to feel the urgency, but it should not be that way. TB isn’t knocking at our back door. It’s here, and funding is desperately needed for a new vaccine before it’s too late. So the next time you take a deep breath, I hope you think twice. I always do.

This post is part of the ‘Tuberculosis Today’ series produced by The Huffington Post highlighting the challenges of combatting TB. Tuberculosis is now back in the top ten causes of death globally, and it is the world’s leading infectious disease killer despite being curable and preventable.

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