The fight against TB is not over
It has killed kings and poets. Henry VII fell not in battle but of a feared disease, consumption. Keats, Kafka and Chekhov were victims. When La Traviata and La Boheme first played in the opera houses of Europe, the portrayal of young women coughing their last breath was unremarkable. The disease accounted for a quarter of all deaths.
By the end of the 19th century, the bacteria causing what we now call tuberculosis (TB) had been identified and patients were consigned to sanatoriums. Later the BCG vaccine was developed and the discovery of antibiotics allowed successful treatment. Archbishop Desmond Tutu and Pope Francis are survivors.
So that's the end of the story, right? TB is beaten, a disease of the past. Wrong. TB has made a terrible comeback. Always a disease of poverty, now linked to HIV-Aids, it is killing 1.3 million people a year worldwide, not just in sub-Saharan Africa and India, but in eastern Europe, too. Two decades ago, the World Health Organisation declared it a global emergency. And, actually, there never has been an effective vaccine. BCG only works for children, for a limited time, and offers negligible protection against the most common forms of TB.
Now this oldest of diseases is producing the newest of threats. In 2006 53 patients in a rural hospital in South Africa were found to have contracted a highly drug-resistant form of TB: 52 of them died. Drug-resistant strains now account for a third of all deaths from the disease.
Earlier this year, a Time magazine cover sensationally declared "Contagion: why drug resistant TB threatens us all". Migration has translated TB from an international development cause to a domestic public health challenge. London has the highest rates of TB of any city in western Europe. The borough of Newham has rates equivalent to Nigeria.
Those with access to advanced healthcare who contract drug-resistant TB face a long and extremely unpleasant course of treatment, but stand a chance of living. For those in less developed countries, it is usually a death sentence.
It's unsurprising that drug resistance should have occurred. TB is treated with drugs developed over 60 years ago. Long courses of antibiotics, administered in patchy or non-existent healthcare systems, where counterfeit pills are rife, make non-completion of drug regimes a constant risk.
Indeed, the entire apparatus to control TB in high burden countries is pitifully antiquated. Diagnosis can take weeks as samples are posted off to laboratories. If this had been a disease that had resurged in the west, we would by now have a new vaccine, rapid testing and better drugs.
But there was no commercial market for these life savers, and so the pharmaceutical companies had no interest in developing them. Only the intervention of the west through massive aid programmes and partnership funding for research can change the story.
It is beginning to happen. The rate of new cases of TB has been falling worldwide for about a decade, enough to hit a UN millennium development goal target, and deaths will have nearly halved since 1990. But a decline of 2% a year in the estimated incidence rate suggests that the disease is being beaten at a shamefully slower rate than when the west tackled it a century ago. On current progress it will take at least another 100 years. The latest World Health Organisation report, published last month, warned that 3 million people a year who develop TB are being missed by health programmes. Most worryingly, less than a quarter of drug-resistant cases are being detected and less than half of those that are detected are successfully treated.
Political commitment and new resources are needed. The Global Fund provides over 80% of all international financing to fight TB. So its replenishment, to be agreed in Washington this week, is crucial. To its credit, the UK has announced that it will step up support. Other wealthy countries must follow.
It's hard for western leaders to commit money at a time of austerity. But quite apart from the moral obligation, TB is a disease that does not recognise national borders. We have a common interest in fighting it. The rising treatment costs of inaction, particularly in respect of drug-resistant TB, argue for intervention now. And with a new vaccine, modern diagnostics and advanced drugs all in sight, we could change the trajectory of the disease for good.
Environmental tragedy in the Philippines has killed thousands of people and rightly captured attention. The tragedy of TB is that it is claiming millions of lives, yet no one is talking about it. It's time to tear consumption away from the pages of 19th-century novels and shout to the world that this killer is back.