Have you ever imagined how the journey from detection to treatment would look if you were infected with mycobacterium tuberculosis? Now you have a chance.
The journey to diagnose and treat TB
You start coughing, then you lose your appetite. You think it is nothing, probably just a regular flu. Or maybe it’s your child who is acting differently than usual. They might just be apathetic, not playing and running and giggling as they usually do. Can a child be sad at such a young age? You wonder.
Weeks pass by, but the cough is still there. New symptoms start to appear: blood in the cough. You decide it’s the moment to go to the hospital, but health facilities are not nearby, and there is only one in the whole district with all the diagnostic tools to tell you what you might have.
After several tests, the health centre has now confirmed you have fallen ill with tuberculosis. The doctors tell you you have to take 4 different types of drugs for the next 4 to 6 months, and even more if you develop drug-resistant TB. You start reading the side effects, and when your eyes see “loss of hearing”, you stop reading. The side effects seem risky, but it’s better than dying, right? Better not think too much about it. You spend sleepless nights worrying about the disease. Will it kill you? Has the disease spread to your family and friends? Do they think YOU spread the disease? What will people think when they know about it? Are the medications making you feel this weak or is it tuberculosis?
Can sheer luck determine if you will live or die from a preventable and curable disease?
This is the reality for many of the 10.6 million people who fall ill with TB each year. They fall sick, or worse they die, from a disease that should have long ceased to exist. Even more unjust is that, depending on which country you are lucky to be born or live in, the outcomes of your treatment will vary dramatically. If you were born in high-income countries like the USA, Australia or Spain just to name a few, the chances of contracting tuberculosis are quite low. Moreover, if you are currently living in one of these countries chances are that sensitive tests and shorter drug treatment regimes with fewer side effects will be available for you. In short, you will have access to better health outcomes.
But, if by a twist of destiny, you were born in a country with a high burden of disease, such as Mozambique, India or the Democratic Republic of Congo, there are higher chances that you or your loved ones will contract TB at one point in life. If you go on to develop active TB disease, you’ll need access to diagnosis and treatment, which will lead you to deal with many of the hurdles described above: barriers to health facilities, outdated diagnostic tools, medicines with many side effects sold at unaffordable prices.
Treatment for drug-resistant Tuberculosis (DR-TB) is a stark example of these bleak disparities. In 2022, the world of TB care was revolutionised by the introduction and WHO recommendation of a 6-month all-oral regimen for the treatment of drug-resistant tuberculosis. This new cure reduces the length of treatment by a year or more and the number of pills needed to treat DR-TB by 95%. Despite global pledges and advocacy, the 6-month-regimen is still not available to many people around the world.
Unfair, again, is the only word that can apply to what happens to some populations, where tuberculosis becomes a Russian roulette. The burden of TB in prisons is about 10 times higher than in the general population. People with HIV are about 14 times more likely to develop TB and have three-fold higher mortality during TB treatment compared to people without HIV. Diagnosis of Tuberculosis in children is so difficult that a study estimated that, of the 239,000 children under the age of 15 who died from TB worldwide, around 96% did so without treatment, and of those under 5, 80% were never even diagnosed. And the list goes on.
Tuberculosis, a forgotten disease
Tuberculosis has gained a reputation for being a forgotten disease that lacks the political will and the funding to push through its extinction. In 2022, only US$ 5.8 billion was available for TB diagnosis, treatment and prevention services, and investment in TB research averaged just under US$ 1 billion per year. But to end TB, estimates show that the global health community will need US$ 22 billion per year by 2027 for TB diagnostic, treatment and prevention services and US$ 5 billion per year by 2027 for investment in TB research.
Fundings are essential to develop new vaccines, shorten drug-regime treatments, and develop sensitive, accessible and non-invasive diagnostic tools. Simply put, funding is essential to create adequate conditions that would make TB prevention, diagnosis and treatment available and accessible for all.
Just because TB disproportionately affects people from middle and low-income countries living in precarious socio-economic conditions, it shouldn’t be a sufficient reason for the global community to ignore the problem. On the contrary, we should double down on efforts to end it once and for all. With COVID-19 we have shown that research can save countless lives without losing precious time, it’s time to do it once again.
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