Cape Town, South Africa — What do George Orwell, Frederic Chopin and Archbishop Desmond Tutu have in common?
They each had tuberculosis. But while Chopin died aged 39 and Orwell died aged 47, Desmond Tutu received effective TB treatment as a child and was cured.
As World TB Day approaches on March 24, it is sobering to consider that despite our knowledge of how to prevent and cure TB, the challenges that have faced public health systems worldwide for decades - adequate funding, improved medicines and efficient health systems - remain in 2012.
In the 19th century TB, or "consumption", was responsible for one in seven deaths across Europe and North America, and treating it was mere guesswork. But on March 24, 1882, while European powers were vying with each for greater control of Africa and its resources, a German scientist in Berlin presented an experiment that was to revolutionise medicine.
In a theatre-like performance lasting more than six hours, Robert Koch brought his laboratory to the lecture hall and, using his microscope, test tubes and tissue samples, showed the audience how he was able to isolate and identify the bacterium that causes TB.
The discovery made newspaper headlines in European capitals, but 130 years after Koch's presentation in Berlin, and more than 50 years after the identification of an effective antibiotic, 8.8 million people a year still fall sick from the disease and some 1.4 million people die.
TB remains a threat to anyone whose immune system is weak - a consequence of infancy, malnutrition or HIV/Aids. But while TB can be treated by a six- to nine-month course of drugs, it requires strict adherence to a medical regimen. Partial or ineffective treatment has led to the emergence of multi-drug resistant MDR-TB, as well as extremely resistant XDR-TB, which are far more expensive and difficult to treat. The TB bacterium is transported through air, so it can affect anyone, anywhere.
In an ambitious effort to stem the spread of the disease, the TB Alliance on Monday announced that it had launched a first-of-its-kind clinical trial to test a novel drug combination - in both patients who have TB and those who have MDR-TB. This could shorten the length of required treatment to as little as four months in both patients with TB and some forms of drug-resistant TB.
Just 20 years ago, TB caused alarm in one of the world's financial capitals. The TB epidemic in New York in the late 1980s and early 1990s, "took root in a setting of inadequate treatment regimens, homelessness, a diminished public health system, and the onset of the HIV/Aids epidemic", wrote William Paolo and Joshua Nosanchuk in The Lancet in 2004.
The outbreak was contained through better treatment using a broader combination of drugs, directly observed therapy (DOTS), and improved prevention guidelines for hospital control and disease prevention.
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In an editorial about the New York epidemic, the British Medical Journal highlighted key lessons that could be learned from the New York experience.
"Firstly, tuberculosis is as much a social and political disease as a medical one," wrote Richard Coker. "Even in affluent nations, when social disintegration is allied to a poor health infrastructure, disastrous consequences result."
Coker also quoted from the New York City Board of Health's annual report from 1915, published long before any kind of anti-TB treatment existed.
"The city can have as much reduction of preventable disease as it wishes to pay for," wrote the Board. "Public health is purchasable; within natural limitations a city can determine its own death rate."
According to Coker, the sentiment is as true today as it was almost a century ago. "Globally tuberculosis is preventable and treatable: it just depends on how much we are prepared to spend and how. Political will needs to be allied to a political and public health mandate."
"If the importance of a disease for mankind is measured by the number of fatalities it causes, then tuberculosis must be considered much more important than plague, cholera and the like," said Koch in his introductory lecture that was to stun the Berlin Physiological Society on March 24, 1882.
One hundred and thirty years later, World TB Day remains a call to arms to commit sufficient funding to both research and health systems to reduce the impact of a disease that we know how to cure.
