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Infectious Diseases Q1 2023

Tuberculosis is still on the rise in low to middle-income countries

Will Boase / The Union

Professor Guy Marks

President and Interim Executive Director, International Union Against Tuberculosis and Lung Disease

We have the tools to find, cure and prevent tuberculosis (TB). Yet, it is still wreaking havoc on the lives of millions every year.

Not enough effort is devoted to finding and treating everyone with TB. This is not just to benefit those with TB now but also to protect others from acquiring it.

To make matters worse, there has been an increase in the number of people falling ill with TB (10.6 million in 2021) and a rise in deaths (1.6 million in 2021) for the first time in many years. We need the same resolve to tackle the scourge of TB that we achieved to deal with COVID-19. We can look to the past for inspiration.

Reducing tuberculosis cases globally

After WWII, many countries in Europe, North America, Australasia and the Far East mounted campaigns to end TB. In Australia, this included free X-ray screening aiming to diagnose and treat all cases, a TB pension to reduce the financial impact on affected individuals and research funding.

They were so successful that, by the mid-1970s, there were few cases to find, and the campaign was abandoned. Unfortunately, adopting similar policies in the Global South, where TB is common, was deemed unaffordable — a decision that condemned people to continue to live, and die, with the disease.

The world needs new strategies to end TB.

Trialling new strategies against tuberculosis

We cannot continue to make the same mistakes. The world needs new strategies to end TB. Community-wide screening for TB, followed by effective treatment for all those found to have active TB is a key part of the answer.

We conducted a trial of this strategy in Vietnam. By screening 60,000 people annually for four years, we were able to reduce the prevalence of TB (number of people with TB) by 44% and the incidence (number of new cases developing) by 57%.

These dramatic reductions are encouraging, but we need further evidence of this approach in low and middle-income countries. We believe this approach has the potential to see the end of TB.

We cannot continue to refuse to acknowledge the deadly threat of TB. Renewed commitment and intense global scrutiny need to pave the way for investment in new strategies. We need to make TB history.

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