Tuberculosis, the Global Bacterial Killer

"The infectious disease that killed the most people last year is one we've heard almost nothing about: tuberculosis."

"In 2022, it likely claimed 1.4-million lives, more than the total toll of COVID. And yet, in rich countries, where virtually nobody dies from tuberculosis any longer, attention has moved on."

"Even in poor countries, where the wealthier can afford treatment, it is often the poorest, most disconnected and disadvantaged that suffer from this disease."

Bjorn Lomborg, Copenhagen Consensus think tank

 

 

"Tuberculosis, or TB, is a bacterial infection that can spread through the air. It is most often found in the lungs, but can exist in any organ in your body. When a person coughs or sneezes, they can transmit so-called “active” TB. However, many people are also infected with an inactive form of TB, known as latent TB. The bacillus that causes the disease is called Mycobacterium tuberculosis (M.tb). M.tb's unique cell wall, which has a waxy coating primarily composed of mycolic acids, allows the bacillus to lie dormant for many years. The body's immune system may restrain the disease, but it does not destroy it. While some people with this latent infection will never develop active TB, five to 10 percent of carriers will become sick in their lifetime."

TB Alliance

Close to a quarter of all people in the world carry the tuberculosis bacterium. Every tenth person in wealthy Europe and the United States carries the bacteria. Well-nourished people who are financially comfortable will not develop tuberculosis. For those less fortunate it remains a risk that the bacteria they carry will develop into full-blown tuberculosis. This is what defines tuberculosis as a disease linked to hunger and poverty. 

Over ten million people annually develop tuberculosis worldwide. Owing to a lack of resources, about six million only were diagnosed in 2021. Fifty percent of those undiagnosed and untreated will die. Those whom tuberculosis does not kill will go on communicating the infection to others. Five to fifteen people can potentially be infected by one actively infected individual through close contact over the space of a year.

The six million who do become diagnosed and who undergo treatment must take medication for up to six months. Since the medication clears the more immediate symptoms of tuberculosis such as fevers and weight loss in a number of weeks, many undergoing treatment will simply drop out long before the prescribed six months of treatment has elapsed.

Once treatment is foregone too early, the chance that the disease can be communicated to others increases The surviving tuberculosis bacteria, at the same time, is then more likely to develop drug resistance, leading the next treatment to require 18 to 24 months to succeed and at the same time be much costlier to pursue.

"Common symptoms of active lung TB are cough with sputum and blood at times, chest pains, weakness, weight loss, fever and night sweats. WHO recommends the use of rapid molecular diagnostic tests as the initial diagnostic test in all persons with signs and symptoms of TB as they have high diagnostic accuracy and will lead to major improvements in the early detection of TB and drug-resistant TB. Rapid tests recommended by WHO are the Xpert MTB/RIF Ultra and Truenat assays."

World Health Organization (WHO)

"It's possible to diagnose many more people and ensure most TB patients stay on their medication. Our new study shows this can be achieved for an additional $6.2 billion annually, less than what the world has already promised: in 2018, the UN pledged to increase funding by $7.8 billion annually by 2022. Disappointingly, spending since 2018 has actually declined."

"The additional $6.2 billion annually can deliver diagnosis, care and prevention that will achieve the world's tuberculosis promises. It would ensure at least 95 percent of people with tuberculosis will receive a diagnosis. It can provide simple ways to make sure people complete their six months of medication."

"The extra resources will mean that high-risk, vulnerable populations will be able to access periodic screening Over the coming decades, 50-million people will access appropriate treatment and 35-million people will have access to preventive treatment."

Bjorn Lomborg