Drug-Resistant TB Strains

Ralph Nader and Gordon Douglas raise vital points in reporting the global tuberculosis emergency (Commentary, Feb. 16). But they did not acknowledge one of the hidden generators of the emergency: large-scale humanitarian disasters, where TB spins wildly out of control in countries that have endured years of war or famine.

War and famine create the very conditions that encourage TB transmission: poverty, malnutrition and population displacement. In Bosnia, for example, national health authorities have anecdotal evidence of 1,000 new reported cases of TB, with an untold number of unreported cases. If true, Bosnia’s notification rate--the number of cases that have been brought to the attention of authorities in one year--may be as high as 100 per 100,000 persons. By contrast, in the former Soviet republics, where the World Health Organization and the U.S. Centers for Disease Control and Prevention have confirmed a rampant TB epidemic, the notification rate is 75 per 100,000; even in Kyrgyzstan, the republic most affected, the notification rate is 92 per 100,000. (In comparison, the notification rate in the U.S. is eight per 100,000.)

TB respects neither international boundaries nor short-term solutions. It is an infectious killer that demands a comprehensive, unfortunately expensive disease control program. The U.S. should work to diminish “Ebola with wings” in the countries Nader and Douglas mention, and provide the means to diminish the disease in countries mired in misery and too often ignored.

MARTIN ZOGG

Senior Desk Officer

International Medical Corps

Los Angeles