The war on MDR-TB
The three Bronte sisters died before the age of 40. John Keats lived to be only 26. All were killed by consumption, or tuberculosis (TB), as it is now known. In 1815, the year of the battle of Waterloo, the disease accounted for one in four deaths in England. By the end of the First World War one in six deaths in France were still caused by TB. In the 20th Century, it killed an estimated 100 million people.
Tragically, TB is anything but a disease of the past. In 1993 the World Health Organisation declared it a global health emergency. In spite of the fact that it is usually easily and cheaply treated, 1.6 million people die from the disease across the globe every year. The highest burden falls on the developing world.
Even here in the UK, we have not been immune to the resurgence of a disease that many believed was beaten. At around 8,000 new cases a year, TB rates are at their highest level since 1987.
This pales into insignificance in comparison with the developing world - particularly Africa, which accounts for a third of global deaths due to the disease. Now the development of drug-resistant strains of TB, provoked by (amongst other things) poor administration of drug treatment and a failure to complete a whole drug regimen, makes it possible that this unnecessary toll on human lives could get worse.
Multidrug-resistant (MDR) TB is resistant to the two most effective anti-TB drugs. Extensively drug-resistant (XDR) TB is even more alarming as it is also resistant to second-line drugs. The WHO has described it as "virtually untreatable".
Last month the WHO reported that MDR-TB now represents an estimated 500,000 (5 per cent) of all TB cases, while XDR-TB is present in 45 countries. There are now 40,000 XDR cases every year, threatening to derail a decade of progress in TB control.
I have visited Kenya, South Africa and India with the international development charity RESULTS and have seen the appalling effect that TB has on so many lives across the globe. TB is a disease closely linked to poverty. Better nutrition and housing would make no difference to the spread of the world's biggest killer amongst infectious diseases, HIV-AIDS. But it would have a huge impact in preventing TB.
Effective healthcare systems are key to tackling the disease. In many developing countries the basic infrastructure to deliver and then oversee the administration of relatively cheap TB drugs simply doesn't exist. I have witnessed patients three to a bed in Western Kenya in a dismal so-called ‘clinic' - two on each bed, one underneath it. In Chennai I visited a ward where patients were dying from MDR-TB because of lack of access to drugs.
Greater international investment is essential. The WHO estimates that there is a $500 million financing gap in the funds needed to deal with drug-resistant TB alone. Surveillance of the new strains needs to be stepped up; lab services need to be expanded, and awareness enhanced through information programmes.
TB is the leading cause of death among people living with HIV in Africa. There needs to be a more co-ordinated approach to dealing with both diseases, where programmes are often dislocated. And research efforts need to be stepped up to develop a TB vaccine.
TB makes global poverty worse. Conversely, the World Bank has shown that investing in treatment yields huge economic benefits. But this requires political leadership, both from the developing world and in the burden countries themselves. The disease can be beaten. The question is whether there is sufficient global will to do it.
NICK HERBERT MP is co-chair of the All-Party Parliamentary Group on Global TB