Tuberculosis Is the World’s Deadliest Disease

Tuberculosis Is the World’s Deadliest Disease
Every year, a million people die of a curable disease. Why haven’t you heard about it?

Last year, tuberculosis killed more people than malaria, war, and murder combined. More people than COVID-19 or HIV/AIDS. One-quarter of all people alive today currently have tuberculosis, and every twenty seconds, someone dies from it.

Tuberculosis is the most deadly disease in the world. It is also curable. So, why haven’t you heard of it, and why do people keep dying from it?

Living With Tuberculosis

Tuberculosis is one of the oldest human infectious diseases we know of—it has been with us for as long as we have been humans. We have called it White Death, consumption, phthisis, and dozens more names besides. It is in our bones; in our history.

Pasadena, California, where Caltech is situated, was first founded as a tuberculosis colony, where the warm climate was thought to provide a reprieve. At the time, in the late 1800s, it was estimated that 90% of people in Europe had tuberculosis. There was no cure. It was a terrifying, emaciating disease that killed with abandon. Airborne, it initially resembles the flu before evolving to consume and emaciate the body with terrifying effectiveness.

Today, California still has twice the national rate of infection: 2,000 people will die this year in our state from tuberculosis. But internationally, more than a million people will die this year. This is not a disease of the past. Why do we treat it like one?

Dying From Tuberculosis

Tuberculosis is an unusual disease.

It is incredibly difficult to treat due to its uniquely complex outer coating of fatty acids (which the M. in the name of M. tuberculosis bacteria refers to: “mycobacterium” are those coated with mycolic acids). Without help, your immune system is able to isolate and contain the bacteria, but not kill them, forming clumps of immune cells and bacteria called granulomas. This is a latent tuberculosis infection, which doesn’t produce symptoms but remains carefully balanced on a knife’s edge.

However, if your immune system falters, this latent infection can spiral rapidly out of control into an active tuberculosis infection. Today, about 10% of people with latent infections will eventually develop active infections. The people most susceptible to this are those with weakened immune systems: think malnutrition, HIV/AIDS, or cancer treatment.

Therefore, tuberculosis is—by its very nature—a disease of inequality. When someone is already struggling, when their immune system can no longer handle the situation it is in: that is the moment where tuberculosis strikes. Worse yet, tuberculosis treatment is a much more difficult endeavor than with a typical bacterial infection. Even in the best case, it requires at least 4-6 months of ongoing antibiotic treatment to resolve. Not only does poverty make you more likely to get tuberculosis, it then also makes it more likely that you cannot afford consistent access to medical care to treat it—another layer of inequality.

Adding to the horror has been the modern boom of multidrug-resistant tuberculosis (MDR-TB), which is unable to be treated with the standard cocktail of antibiotics. Access to these treatments is much more difficult and expensive, and these illnesses can take years to treat. Above all, they are haunted by the simple possibility of the development of a tuberculosis strain that cannot be treated by any of our antibiotics.

Finally, we still do not have a fully effective tuberculosis vaccine. What we do have was developed a hundred years ago, and unless you were born in or have traveled to a country with high rates of tuberculosis, you almost certainly have not received it due to those same concerns about its inefficacy. Inadequate investment has been put towards replacing it with a better one.

Tuberculosis, therefore, currently ravages the Global South while being almost forgotten in the Global North. More than 95% of tuberculosis deaths occur in low- and middle-income countries worldwide. But diseases know nothing about our borders, and multidrug-resistant tuberculosis is a looming threat to us all.

Treating Tuberculosis

Tuberculosis in the US did not disappear by accident. Rather, in the 1950s, the US began pioneering a highly effective form of tuberculosis management called STP: Search, Treat, and Prevent. If you were to wander down the streets, you would have seen doctors driving vans with signs reading: “Stop Two Minutes To Save Your Life: Free Chest X-Rays for Tuberculosis.” This is Step 1, Search. If you were diagnosed with tuberculosis, you would have received free treatment: Step 2, Treat. Finally, your friends, family, and close contacts would be given the same opportunity as well: Step 3, Prevent.
This system is so effective that, in a single year in the 1970s, implementation of Search, Treat, and Prevent programs cut tuberculosis rates by 70% in a town in Alaska.

This is the answer to why you no longer have to worry about tuberculosis in the US: because we lowered the number of cases with Search, Treat, and Prevent programs, and we treated the remaining cases with cocktails of antibiotics. There is no reason this same program cannot be taken globally.

It took effort and money, certainly, but much less than many other comparable programs, and its effectiveness has been definitively proven: simply look at how quickly Americans have forgotten tuberculosis. Now, we have to commit to bringing this work worldwide: to living in a world where nobody has to die from this preventable, curable disease.

Ending Tuberculosis

The United Nations has set the ambitious goal of ending tuberculosis by 2030, requiring an estimated $250 billion of funding committed worldwide. Due to the intensive nature of tuberculosis treatment and research, most of this funding must come from the governmental level, not nonprofits. Unfortunately, current funding levels are woefully inadequate, with only 26% of the necessary funding committed by countries worldwide.

This is despite the fact that tuberculosis treatment is a remarkably effective financial investment. For every dollar put into tuberculosis treatment, an estimated $31 is saved, considered by researchers to be “exceptional value-for-money.”

Indeed, even at the current level of insufficient funding, over the past two decades, global tuberculosis prevention efforts have saved 79 million lives. For the average American family that pays about $20,000 in taxes each year, your contribution to this has been a mere five dollars per year. And yet, even with so little, you have personally helped with saving those lives. Imagine what we could do with slightly more.

However, as I write this, those same aid programs are not gaining funding; in fact, they are in severe jeopardy. It is estimated that the cuts to USAID since January 24th have already caused the death of more than 10,000 people from tuberculosis. If funding is not restored, in the next five years, we expect to see two million unnecessary, preventable deaths from tuberculosis.

If you find this horrifying, you are not alone. Personally, I endorse the work done by the non-profit organization Partners In Health, whose website provides templates for phone calls and emails to your congress members, as well as opportunities to donate to their advocacy work. Not only have they received Charity Navigator’s highest rating for 18 years in a row, but they are also traveling to Washington D.C. on April 9th to advocate in person for greater tuberculosis funding. I will be in D.C. with them.

Tuberculosis is not a disease of the past. It is a disease of our shared present. Join me in ending it.