World TB Day

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(HOST) March 24th is World TB Day, and, as commentator Helen Labun Jordan observes, reexamining the facts of tuberculosis is a sobering exercise, not only for global health workers, but for those designing health policy closer to home.

(LABUN JORDAN) Tuberculosis has taken more lives than any disease in history. Some of us know it as consumption or the white plague. It’s the world’s oldest infectious disease and, thousands of years after it first infected humans, tuberculosis still reminds us of how fragile public health can be.

Tuberculosis control should be a success story. We’ve had inexpensive drugs to cure TB for more than 50 years. In the U. S. an entire generation has grown up believing that TB is a disease of the past. And yet two million people still die of tuberculosis every year. That’s one person every 15 seconds. In most areas of the world TB never went away, and the epidemic is only getting worse as it combines with HIV.

The unequal distribution of tuberculosis has contributed to a sense of immunity for countries that are rich in health resources and have little TB to contend with. But no country has banished tuberculosis. In fact, the progress of this disease illustrates how many circumstances that allowed the U. S. to achieve its high health status could be reversed.

The drug therapies that many thought would eradicate tuberculosis were never sufficient by themselves. In the United States drugs had a dramatic effect because they were used in the context of a strong public health infrastructure. Tuberculosis bacteria travel easily through coughing or shouting, and so bringing TB under control requires prompt treatment of everyone with an active infection. If patients experience any barriers to medical attention, then TB can spread quickly through a population. The U. S. already experienced this form of backsliding when decades of neglecting our public health infrastructure led to a resurgence of TB in the 1980s.

Today, TB rates are dropping, but other cracks in our protection have started to appear. A growth in drug resistant TB bacteria is now testing the limits of our treatment system. Some strains are so immune to chemotherapy that U. S. doctors are once again performing lung removals to combat pulmonary infections.

Experience has demonstrated that we can’t divide the world into those who have conquered tuberculosis and those who have not. New TB cases will continue to appear in the United States and they may spread through any place where citizens do not have basic access to a doctor. Meanwhile, a host of other diseases that include entirely new threats, like SARS, may wait in the wings.

On World TB Day, March 24th, the U. S. will have another opportunity to declare its commitment to the global fight against tuberculosis. And while this commitment shows a responsibility towards improving public health systems abroad, it also calls for a responsibility towards maintaining strong public health at home. The U. S. can be a leader in international efforts to control TB, but part of this leadership must be providing for the basic medical needs of our own citizens so that our success story remains a success.

This is Helen Labun Jordan from East Montpelier.

Helen Labun Jordan is the former program manager for the Tuberculosis Initiative. She spoke from our studio in Montpelier.

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