Amid the COVID-19 pandemic, the last thing any of us want to hear is more bad news. As the virus appears to be moving in the right direction, becoming an endemic disease that we can learn to live with, we must remain aware of other threats to human health. Tuberculosis, a disease that many of us in the global North are privileged enough to live without thinking about, usually attacks the lungs but may also impact organs such as the spine, brain and kidneys. A whopping 1.5 million people die of tuberculosis each year, with 10 million becoming sick in 2018. Before the emergence of COVID-19, tuberculosis was the deadliest infectious disease on earth. So why don’t we hear more about it in the news?
Tuberculosis primarily impacts lower-income communities in the global South, with India containing the most cases (3 million). Mumbai is a particular hotspot for TB. Urban planning in the city has centered around making cheap labor available in urban centers. This involved building high-rises with barely 3 meters between buildings, preventing people from getting light or fresh air. Close packing allows germs to spread rapidly from person to person.
According to journalist Vidya Krishnan’s new book “Phantom Plague: How Tuberculosis Shaped History,” TB’s catastrophic impact has to do with lack of treatment, overtreatment or the wrong treatment. People with low incomes do not have access to antibiotics used to treat TB. Meanwhile, those who can afford treatments often receive too many antibiotics due to corrupt hospitals sapping as much money as possible from patients. Overuse of antibiotics, incorrect prescriptions and patients not following the full course of treatment have led to the development of antibiotic-resistant pathogens, creating multidrug-resistant TB that Krishnan refers to as a “monster.” Multidrug resistance TB is resistant to Isoniazid and Rifampin, two of the most important drugs used to treat TB. Extensively drug resistant TB is a rarer type of MDR-TB that is resistant to the drugs mentioned previously as well as fluoroquinolone and at least one of three injectable second-line drugs. XDR-TB is particularly dangerous for patients with HIV infections or other conditions that depress the immune system. They are more likely to develop disease after becoming infected and are more likely to die after developing TB.
According to Krishnan, the way to curb the spread of TB is to provide access to free medicines, counseling and care for patients. In addition, public health awareness campaigns are needed in India and other countries to teach people about the impact of TB and how to protect themselves from becoming infected. Many people are simply not aware of how prevalent TB is and the risk it poses to human health. While it is important to avoid a white savior complex towards those in low-income countries, educating people on the importance of public health measures can legitimately help these populations. In addition, grants should be provided to researchers to incentivize projects that focus on developing new antibiotics that TB is not yet able to resist. Due to the possibilities of antibiotic resistance, pharmaceutical companies have invested less and less in antibiotic development, fearing this research will not deliver monetarily. However, it is vital that these companies continue to develop antibiotics as multidrug-resistant TB becomes increasingly prevalent. Finally, hospitals need to be held accountable when they are overtreating patients or operating for financial gain rather than for the benefit of their patients. This could take the form of patient advocacy groups that investigate specific cases of treatment; however, it is important that these organizations do not maintain a white-centric point of view or belittle the societies they are trying to help.