TB Infections Rising, Treatments Faltering, Experts Warn
Public health experts warn that the number of people infected with tuberculosis is continuing to grow, in part because the antibiotics that could control the disease are often used incorrectly.
In fact, they say, the disease is now killing 3 million people a year worldwide--more than at the turn of the century.
The experts blame TB’s spread on improper treatment, increasing international travel, refugees fleeing their homelands and AIDS, which destroys the immune system.
“We’re talking AIDS with wings. We’re talking about a disease that’s got a mortality rate higher than Ebola [virus], and it’s airborne,” Richard Bumgarner, deputy director of the World Health Organization’s Global Tuberculosis Programme in Geneva, said in an interview before a recent conference on the crisis.
The experts met at Princeton University to discuss how to pressure governments, international agencies and volunteer groups to better combat what some called “the world’s largest health issue.”
Bumgarner said patients who don’t take daily medication for the six months that it takes to cure TB--at a cost of less than $40 in poor countries--develop strains resistant to the nine antibiotic drugs effective against it because the hardiest bacteria survive, mutate and reproduce.
“Those people are coughing, expelling 10 million bacilli in a cough,” and those bacilli can linger in the air up to 5 hours, Bumgarner said.
If passersby inhale even one of the airborne microorganisms they can become infected with a drug-resistant strain and be at risk of illness and death. A cure can then take several years and cost up to $250,000.
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While there are 8 million to 10 million new cases of active TB worldwide each year and many more people are infected with the bacteria, only 10% of healthy people infected develop an active disease because the body’s immune system walls off the bacteria, keeping it dormant indefinitely.
Bumgarner was part of a panel discussion with the executive director of one of three U.S. model TB control centers. Two prominent members of Princeton’s Class of 1955 public interest group, Princeton Project 55, also participated: consumer advocate Ralph Nader and Dr. Gordon Douglas, president for global vaccines at drug maker Merck & Co., based in Whitehouse Station, N.J.
“About one-third of the world’s population is infected with tuberculosis,” and children under 15 account for 300,000 TB deaths annually, Douglas said. “Nothing that we have done has interrupted the transmission of this disease.”
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Available vaccines don’t work in adults and do little for children, and people in group settings, such as prisons, hospitals and nursing homes, are at particular risk, he told nearly 150 health officials and others gathered at the Woodrow Wilson School of Public and International Affairs.
“Tuberculosis is one of the most important health problems on this planet,” Douglas said. “It’s not going to go away.”
Nader said Project 55, which organized the conference, plans to put together a staff to marshal the talents of Princeton alumni and students--from researchers and politicians to lobbyists, international business executives and marketing and public relations experts--to push for funding and better coordination in a global campaign against TB.
Audience members suggested strategies from holding telethons and finding champions in Congress to joining with existing social and economic programs in poor countries.
Nader, meanwhile, criticized governments for spending billions on defense and other programs and far too little on TB.
Dr. Lee Reichman, executive director of the National Tuberculosis Center at the New Jersey Medical School in Newark, agreed. “Tuberculosis is not eliminated because, and this is the shocking part, nobody cares,” he said.
Reichman said bureaucrats and health officials around the world have failed to establish programs that ensure patients get daily medication until they are cured.
In the United States, nearly 23,000 new cases and about 1,100 deaths were recorded in 1995.
He and other panelists said the solution includes a grass-roots effort to raise public concern and push Western nations to construct a core of consultants to create and monitor programs in developing countries to ensure patients get cured instead of developing drug-resistant TB strains.
Such programs in Newark and other hard-hit U.S. cities have helped level the number of TB cases after a frightening resurgence in the late 1980s. Reichman credited a tenfold increase in U.S. TB funding early in the decade, but warned such progress will be reversed if funding drops.
