Not a Problem of the Past: Tuberculosis Is Still Alive and Killing

[This article has been published in Spanish in La Vanguardia]

Every 60 seconds, 20 people in the world develop tuberculosis and 3 die from tuberculosis

Every 60 seconds, 20 people in the world develop tuberculosis and 3 die from the disease. The causative agent is the bacterium Mycobacterium tuberculosis. In Spain, tuberculosis is associated with the post-war period, and it is perceived of as a social problem from the era of our parents or grandparents. Tuberculosis is old news—the stuff of historical documentaries. The reality is that tuberculosis is still very much alive and is still killing people every day. Far from being close to eradicating the disease, we are probably witnessing one of the moments in history when the number of cases is at its highest worldwide.

Far from being close to eradicating the disease, we are probably witnessing one of the moments in history when the number of cases is at its highest worldwide

For that reason, this Friday we are not just commemorating another anniversary. It was 135 years ago today that a scientist first identified the bacillus that causes tuberculosis, the world ‘s most lethal infectious disease, and every year there are still millions of cases worldwide and thousands in Spain. The fight goes on, and we cannot let our guard down. We must continue investing in research to find new tools that will help us to fight this deadly disease.

In 2015, there were an estimated 10.4 million new cases of tuberculosis worldwide and 1.8 million people died from the disease

A couple of statistics are all we need to indicate the scale of the problem. In 2015, there were an estimated 10.4 million new cases of tuberculosis worldwide and 1.8 million people died from the disease. Despite the magnitude of the threat, the impression that tuberculosis is no longer an important issue and the discussion about which diseases we need to focus on has stirred up an incredibly hot debate.

The World Health Organisation failed to include tuberculosis on the list of bacteria resistant to the most important antibiotics

A few weeks ago, the World Health Organisation failed to include tuberculosis on the list of bacteria resistant to the most important antibiotics. This omission gives the international community the impression that drug-resistant tuberculosis is not a priority in the development of new antibiotics, a very counterproductive message. In 2015, there were half a million new cases of multidrug-resistant tuberculosis (MDR-TB), a form of the disease caused by bacteria that are resistant to treatment with the most powerful antibiotics available.  The treatment of MDR-TB involves prolonged treatment with a regimen comprising many drugs, which has significant adverse effects and imposes a heavy financial burden on health systems or the patients’ families. The main institutions involved in the fight against tuberculosis have sent letters to the WHO to protest what they see as a “scandalous” decision in the hope that the omission will be rectified.

US$2 billion are needed every year just to meet current research and development objectives

Funding for tuberculosis control programmes and research projects has decreased considerably in the last two years, a trend that does not augur well for the future in the short term.  An estimated US$2 billion are needed every year just to meet current research and development objectives. However, between 2005 and 2014 annual funding never exceeded US$0.7 billion.  It is now unlikely that the country providing most of the funding for tuberculosis control programmes—the United States—will increase its investment.  A reduction is more likely.

Despite all the problems, there have been advances in recent years. The new molecular test for diagnosing tuberculosis (GeneXpert) has been distributed widely all over the world. The past five years have seen the approval of two new drugs for the treatment of resistant tuberculosis (bedaquiline and delamanid). The bad news is that the fight against tuberculosis still faces considerable challenges.  Those new drugs are currently very expensive.  At present, there is no prospect of a vaccine being developed in the near future. The annual rate of decline in the global incidence (the number of cases as a percentage of the population) has been 1.5%, and this needs to accelerate.  Moreover, the increase in the world population has pushed the number of reported cases this decade to an all time high in absolute numbers.  

There are currently only two new candidates in the clinical development programme for new antibiotics specifically designed to combat tuberculosis. At the same time, the proportion of cases of MDR-TB continues to grow. All these factors, together with the worldwide economic instability and the increase in migratory flows triggered by humanitarian crises and armed conflicts, make it almost impossible to achieve the objective set by the WHO in 2015 of reducing tuberculosis mortality by 90% and the number of new cases by 90% by 2035.

The response of the international community must be unanimous and must include political commitment and greater investment in control and research programmes

Jeffrey Koplan, former director of the United States Centers for Disease Control and Prevention (CDC), defined global health as an area for study, research and practice that places a priority on improving health and achieving equity in health for all people worldwide.  Tuberculosis, the archetypal disease of poverty, is one of the biggest problems in global health. At present, we cannot say that we are winning the battle. The response of the international community must be unanimous and must include political commitment and greater investment in control and research programmes. Millions of patients, their families and whole countries are in need of a determined and energetic response. Only then can we alleviate the suffering, poverty and negative impact on development that is still being generated by tuberculosis every day.