World TB Day
A century-and-a-half ago tuberculosis (TB) was such a fact of daily life that the tragic romance of a young woman dying from the disease was immortalized in Giuseppe Verdi’s famous opera La Traviata.
No one is writing operas, or their modern equivalent, movies or television shows about TB these days, and most people probably never give it a second thought — even though it is a disease that has afflicted the likes of celebrities like Nelson Mandela, Ringo Star, Sir Tom Jones and Tina Turner.
But would it surprise you to know that the deadly lung disease remains a potent killer of more than a million people a year worldwide in the second decade of the 21st century?
The World Health Organization (WHO) reports that in 2014 there were 9.6 million new cases of TB and about 1.5 million people died from tuberculosis -- more than the population of the U.S. state of Montana or the population of Swaziland.
When I was a young fellow at the Moscow Medical Academy, my senior colleagues told a story about the time when they started to look for another job after Dr. Selman Waksman, microbiologist at Rutgers University, introduced Streptomycin and later new anti-tuberculosis drugs developed in the early 1960s. Thanks to these medicines thousands of patients even with severe cases were cured in six months.
TB sanatoriums where patients spent years were not needed any more. In the U.S. these places, once dubbed “waiting rooms for death” were finally closed. Many doctors and medical students thought there were no longer any meaningful careers to be pursued in curing TB. The disease faded from the curriculum of many medicals schools in the U.S. and Europe — a trend that soon went worldwide. But TB was not gone and it found the conditions it needed to strike back.
First, poor populations worldwide did not get meaningful access and consistent effective treatment with the new drugs – so the disease continued to spread inexorably.
Then, multiple drug resistant forms of tuberculosis (MDR TB) appeared even in wealthy countries where some populations were not correctly treated until fully cured. And third, HIV/AIDS acted as catalyst for tuberculosis to explode among immune-compromised populations from the mid-1980s. Within a decade, the number of TB cases in the U.S. jumped sharply.
The revived threat of TB inspired a new fight against the disease. A strategy of monitoring patients carefully when they took each dose of anti-TB drugs and recording their progress was pioneered by Karel Styblo (IUATLD) and successfully piloted in Tanzania, Malawi, Mozambique and Nicaragua. It showed early promise for wider use.
Richard Bumgarner, leading the World Bank’s health programs in China, invited Styblo and the WHO to build on this approach to design a TB control project for World Bank financing in China where TB was the number one killer, claiming 400,000 lives a year. By the end of 1991 pilot Chinese counties were achieving double the previous rates of cure in tuberculosis. A large World Bank grant was made to China for TB control. Bumgarner moved to the WHO to help expand its tiny TB program and build the WHO Global TB Programme. WHO declared its first Global Health Emergency in 1993 and named the new TB approach DOTS (Directly Observed Treatment Shortcourse). Nearly 80 percent of people were cured, at a cost of less than $10 per life and $3 per new infection avoided (“TB Join the DOTS.” The Economist. May 20, 1995, P.89).
Project HOPE also started its first TB activities in the early-1990s when Richard Bumgarner wrote to and convinced Dr. Bill Walsh, Project HOPE’s founder, to build TB programs, first in the Central Asian Republics, and later in parts of Europe and Africa. After he retired from the WHO, Bumgarner joined Project HOPE to strengthen the efforts of our team.
Today Project HOPE successfully guides TB programs in Europe/Eurasia and Africa with funding by USAID, GFAMT and private donors for more than US$40 million, and provides additional humanitarian assistance for hundreds of millions dollars to save lives of people all around the world.
Project HOPE invests significant efforts to build political commitment in countries where TB programs are implemented and support principles of humanity that started when Waxman brought, almost illegally, a few grams of the new Streptomycin to the USSR to save the life of Ira Zukerman who was dying from tuberculosis meningitis.
In over 20 years of TB program implementation, Project HOPE pioneered universal education for medical doctors, nurses, patients, their relatives and communities. The programs have sought to combat the stigmatization of patients in their communities, improve tolerance and empower patient and health professionals to address the needs of TB patients.
Much improved methods of diagnosis such as GeneXpert, developed by Rutgers University where Streptomycin was created, are being successfully introduced by Project HOPE in TB control programs in Africa, Europe and Central Asia
Following the WHO’s END TB strategy and US Government TB control strategy, Project HOPE provides assistance to patients and their family members from the most vulnerable groups of population – women, children, migrants, HIV positive people, injection drug users and former prisoners. This fight has made enormous success, helping to save an estimated 46 million lives worldwide since 2000. It must be continued forcefully so that TB does not again come back in even more deadly forms.
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