TB or not to TB

The most infectious and deadly disease in the world is tuberculosis (TB) - and it’s curable. TB kills 1.5 million people per year. World TB day was on March 24.

The disease now kills more people world-wide than HIV/AIDS, according to the World Health Organization. It is now virtually extinct in the UK, still ravages countries around the world like India, South Africa and Russia. Tuberculosis is no longer on the decline in the U.S., after nearly a quarter century of steady reductions in cases of the deadly airborne disease. The number of TB cases rose last year for the first time in 23 years. More than one-third of the world’s population is infected with the bacteria that cause tuberculosis, which is spread when a person with the active form of the disease coughs, expelling micro-droplets of saliva and mucus. Most of those infected people have immune systems that are strong enough to contain the bacteria, leaving them symptom-free and otherwise healthy. Around 13 million Americans have what’s called latent TB. But approximately 5 to 10 percent of people infected with TB will develop the active, infectious form of the disease at some point in their lifetime. That means as many as 1.3 million Americans could become infectious if not treated.

If active TB is treated properly, over 90 percent of patients survive. But if it’s not treated appropriately — and in poor countries, it often isn’t — two-thirds of those with active TB will die. “Here we have a disease we can cure, and we aren’t,” said Dr. Eric Goosby, the U.N. ambassador for tuberculosis. “Too many times, the political will waxes and wanes.”

The price for a commonly prescribed treatment of TB costs between $1,800 and $4,600 per person per course of treatment, but is difficult for patients to tolerate and can suppress their appetite and cause nausea and vomiting.  Two relatively new drugs, delamanid and bedaquiline, used in conjunction with repurposed drugs not specifically for TB, can “dramatically increase efficacy” and with less side effects, according to Doctors Without Borders. These two drugs were introduced two years ago and were the first new drugs to treat TB in more than 50 years, yet only 2 per cent of the 150,000 people who are in most need of them have access. However these drugs are costly and largely inaccessible. Drug company Otsuka charges $1,700 per person per course of treatment for delamanid in developing countries. Johnson & Johnson charges up to $3,000 for bedaquiline in “middle-income countries“, with only “a fraction” of people in developing countries receiving the drugs for free through its donation program.

Dr Yoseph Tassew, MSF’s medical coordinator for Russia. “It’s frustrating that after half a century, we finally have new TB medicines that can save the lives of the sickest patients, but we can’t offer this hope to all people who could immediately benefit.”

David Bryden, the TB advocacy officer at the non-profit Results has also commented, “It’s just crazy that people are still taking medications that were developed 50 years ago or more. We should be beyond this in this day and age. We still have people in the U.S. dying of this. That’s just an outrage.”