September 15, 1995. Copyright, 1995, Graphic News. All rights reserved

TB Ð THE NEW EPIDEMIC
By Nicholas Booth, Science Editor

LONDON, September 15, Graphic News - The world faces an epidemic of tuberculosis, warned doctors meeting in Washington D.C. yesterday, and unless drastic action is taken the epidemic could claim 30 million lives in the next ten years. Even worse, the disease could become pandemic, spreading from poorer countries to the developed nations. Delegates at the conference on ÔThe Challenge of TuberculosisÕ, organised by the medical journal ÔThe LancetÕ, called upon governments, health authorities and doctors to work together more effectively.

ÔThe world needs to be aware that TB isnÕt a thing of the past,Õ says Dr Lee Reichman of the U.S. National Tuberculosis Center. Ô90 million people may become infected with TB in the next decade.Õ Opening the conference, Dr Reichman said that governments should take more preventative measures against a disease which their shortsightedness had failed to eradicate.

The introduction of antibiotics and a general increase in living standards in the Western world led to its near eradication in the 1970s. By then, TB cases were decreasing by roughly five to 10 per cent per year and, had this trend continued, it is quite possible the disease would have been eradicated totally. ÔPeople lost interest and wound down their TB control,Õ says Dr Reichman. ÔWe should learn from this lesson.Õ The expected 30 million deaths from TB over the next decade represent a quarter of all preventable deaths in the world.

Delegates to the conference heard Dr Reichman reserve his most severe criticism for drugs companies. ÔThere have been no new drugs for TB since 1966,Õ he says. ÔAs most of the cases are in the third world, it is affecting the poorest people. So theyÕre not going to make a profit.Õ

But new drugs may not be a panacea as another lesson has been that half a cure is as bad as none at all. Because the various strains of TB bacteria have become resistant, each individual strain must be eradicated completely. The new epidemic stems in part from the fact that individual strains have only been partially eradicated.

ÔThe World Health Organisation has declared TB a global emergency,Õ says Dr Reichman. ÔIt is the only global emergency they have ever declared.Õ

In the United States, a marked rise in TB cases has received a lot of attention. It has come mainly from patients who are HIV positive and a concerted effort has gone into selectively curing it, as the most recent U.S. statistics show. In Britain, the situation is not nearly so pronounced among those with AIDS, but there is no room for complacency.

ÔTB is a social barometer,Õ says Professor Douglas Young of St MaryÕs Hospital in London. ÔIf you live in poverty or bad social conditions, you are most likely to become infected.Õ Indeed, most of the outbreaks of TB in Britain come from the immigrant community because the disease may take years before it develops. In other words, childhood exposure to tuberculosis in one country may lead to its development in another.

And it is a similar process of incubation which is putting the first world at risk. One doctor terms it, Ônice direct air flights bringing with them exposure to the most resistant bacterial strains.Õ Greater awareness through education, research into new drugs and a political commitment to complete eradication are needed.

The statement by ÔThe LancetÕ conference in Washington does not pull any punches. ÔIt is not an indigenous problem, Õ warns Professor Young. ÔIt is a worldwide problem and we ignore it at our perilÕ.


Sources: The Lancet, World Health Organisation