TB Epidemic Threatens Even Superpower Nations

by Marwaan Macan-Markar

Medical experts say the higher levels of tuberculosis (TB) are due partly to heavier migration flows from developing countries to Europe and the U.S., and partly to an increase in drug-resistent strains of TB.

Last December, British newspapers quoted a medical report that summed up the disturbing picture in parts of Britain. TB cases in England and Wales "have soared by more than a fifth" over the past decade, the report stated.

And London, it added, was at the center of the outbreaks, with TB rates in the British capital being four times higher than in the rest of England and Wales.

In most cases, one newspaper noted, the patients were born outside Britain, and "40 percent of them had arrived in the country within the last five years."

The situation in the U.S., according to that country's public health officials, is no different. Early this month, a number of them urged the government to conduct more comprehensive TB screening programs among the foreign-born population as a means of combating the disease.

Such tests, they said, need to be done both in cities with substantial immigrant communities and at the borders of the U.S., including the 2,000 mile stretch it shares with Mexico and other ports of entry.

According to the U.S.-based Centers for Disease Control and Prevention and the American Medical Association, "The key to eliminating TB in the United States is eliminating it in the country's foreign-born population."

This situation, says David Satcher, the U.S. surgeon general, needs to be addressed immediately. "We are well into the midst of a global TB public health crisis and there is no time to lose."

According to his diagnosis, the noticeable increase of TB patients also stems from the TB bacteria having "mutated" and become "immune to current treatment."

Similar warnings have been expressed by the World Health Organization (WHO), as well. Last year, states a WHO report, TB killed more people worldwide than in any other year on record.

Currently, according to the WHO, close to eight million new cases of TB occur each year, mostly in the developing world. And six Asian countries in particular -- India, China, Bangladesh, Pakistan, Indonesia and the Philippines -- account for over 50 percent of the TB epidemic.

However, adds a WHO official, countries throughout the former Soviet Union are fast approaching TB epidemic levels, too, due to a "sharp fall in living standards and health care."

In the Ukraine, for instance, the number of TB cases has doubled in the past decade. "We are registering about 25,000 new infections each year, and some 7,500 to 8,000 people die of TB per year," says Serhly Berezhny, Ukraine's deputy surgeon general.

In his estimation, there are close to 100,000 people with the "most dangerous active form" of TB, out of the 600,000 cases on record.

According to Dr. Carlyle Guerra de Macedo, former director of the Pan American Health Organization, no country is safe from TB as long as the epidemic is allowed to thrive unchecked. "If we allow TB to prosper and multiply in any corner of the world, we do so at our own peril."

And what worries him and other health experts is the long delay by some countries in this region, like Mexico and Brazil, to successfully implement or expand the WHO-recognized program to contain TB -- the Directly Observed Treatment Short-course (DOTS) initiative, which has achieved an 85 percent cure rate.

According to Dr. Arat Kochi, director of the Global TB Program, "DOTS is the most effective means available to stop the spread of tuberculosis."

The DOTS strategy requires health workers, on the one hand, to counsel and observe their patients "swallowing each dose of a powerful combination of medicines" and, on the other, to monitor the patients' progress until they are cured.

Yet, as WHO officials have discovered, only about 10 percent of all TB patients were treated with the DOTS strategy during some years.

"The consequences of not using DOTS more widely are alarming," they add. It could result in the world facing a "deadly infectious disease that spreads through the air, yet is virtually as incurable as AIDS."

This failure has often stemmed from the inadequate and weak health systems in the developing world, since DOTS depends on "one pivotal reason" to succeed -- a country's health system.

"DOTS makes the health system -- not the patient -- responsible for achieving a cure," states a WHO report. "This is critical, as most TB patients start to feel better after just a few weeks of medication and are often tempted to stop taking their pills. Yet it takes several months to rid the body of the TB bacilli."

With DOTS, however, the health system is required to "observe that TB patients take all of their medications, to monitor their progress, ensure all bacilli are gone and document that they are cured."

Since its implementation, say health experts, the use of DOTS has expanded nearly ten-fold.

Nevertheless, admits Dr. Kochi, such progress has not reduced the continued threat posed by TB to public health. "It is simply not enough when compared with the scale of the global epidemic."

And the current prognosis by the WHO lends weight to her view -- close to 70 million people will die from TB by 2020 if it is not contained.