TCS Daily


TB: Good News, Bad News, Good News

By James K. Glassman - March 18, 2004 12:00 AM

If you think tuberculosis is a disease of the dim past, think again.

More people will die of TB this year -- two million-plus -- than ever in history. And it's getting worse. The World Health Organization estimates that in the next decade another 90 million people will develop the disease, and 30 million will die.

In 1993, the WHO recognized that a modern TB epidemic had begun. When President Bush last year pledged $15 billion, it was not just for AIDS but for malaria and TB as well. Every year, eight million people come down with TB, about a quarter of them in Africa. The disease is affecting the United States, too, with more than 1,000 cases in New York.

There's good news, bad news and good news on TB.

The good news is that, with a course of relatively inexpensive antibiotics, the standard strain of the disease is eminently curable in nearly all cases.

The bad news is that new "multi-drug resistant" (or MDR) strains of TB are spreading quickly. They become resistant when patients with standard TB are given inadequate or incomplete treatment. The WHO this week released what it calls "startling findings" that there are now 300,000 cases of MDR-TV, focused on Russia, India and China -- areas critical to U.S. security and trade.

The MDR-TB "super bugs" are exceptionally difficult to wipe out. The Global Alliance for TB Drug Development notes that it "requires aggressive two-year treatment that, when successful, costs $250,000 per patient in the U.S." and that "drugs developed decades ago are no match against an estimated 90,000 different resistant strains."

The second good news, however, is that a public-private partnership is making significant headway against MDR-TB. The partnership was formed last June among the WHO, the U.S. Centers for Disease Control and Prevention (CDC), the Harvard Medical School, Purdue University, the International Council of Nurses and Eli Lilly & Co.

Two Lilly antibiotics, Capastat and Seromycin, are used to fight the super bugs, and the company is making them available to the WHO at discounted prices. More important, Lilly is transferring technology to India, China and South Africa that will allow those countries to produce and distribute low-cost drugs themselves.

Such public-private partnerships -- which involve businesses, non-profit organizations and governments -- are the wave of the future, not just in health care but in environmental stewardship. I have seen partnerships at work in two recent trips to Africa, but their successes are generally going unrecognized.

Big, multilateral state-to-state treaties like the Kyoto Protocol get most of the attention from press and politicians, but public-private partnerships are far more efficient and practical. The MDR-TB model, which also includes Harvard training programs in Russia and a CDC global surveillance system, looks especially promising. And not a minute too soon.

In the late 19th century, TB killed one of every seven people in Europe and America. While there was a certain romance associated with the disease -- in part because its victims included writers like Keats, Chekhov, Thoreau, and Orwell -- it's a horrifying way to die. You cough your life out.

On March 24, 1882, the great German scientist Robert Koch identified the tubercule bacillus -- which became the key to proving the theory that diseases were spread by germs. A century later, the WHO declared World TB Day. This year's event, on March 24, marks the 122nd anniversary of Koch's discovery.

But TB persists. It is easily spread through the air when an infected person coughs, sneezes or even talks. As a result, one-third of the world's population is carrying around the TB bacillus. You may have it yourself.

But, for most people, TB remains dormant. It's activated by a breakdown in the immune system, caused, in many cases by HIV.

TB is mainly a disease of poverty. As I learned on a December visit to Uganda and Kenya led by HHS Secretary Tommy Thompson, the lack of communications, transportation, education and medical services make it extremely difficult for poor countries to administer a long-term treatment regime to a patient.

TB, AIDS and malaria - the three global pandemics - kill five million people, most in the prime of life, every year, and the diseases bring misery to many millions more. They claim far more victims than war and terrorism. Ultimately, prosperity is the cure. But, in the meantime, public-private partnerships, flying well below the radar screen, are carrying relief.

James K. Glassman recently wrote for TCS about "The Real Benedict Arnolds."


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