On a recent visit to a densely populated homeless shelter in Delhi, India, I encountered firsthand the harsh reality of tuberculosis (TB), a disease that continues to claim lives in underprivileged regions despite current medical advances. A young boy whose family had recently moved into the shelter shared his harrowing experience with TB, which, due to a late diagnosis, led to the tragic loss of his sister.
Despite being an airborne bacterial disease that has historically caused a significant share of deaths in developed nations such as the United States, TB has been largely controlled in these regions. However, in low-income countries, the situation remains dire. TB is the world’s deadliest infectious disease, responsible for more than one million deaths each year. Although global efforts have reduced both case and mortality rates significantly since 2000, the disease persists at alarming rates in many areas.
The fight against TB has seen promising developments in diagnostics, prevention and treatments that could radically change the course of this disease if fully utilized. Achieving this goal requires a concerted effort between governments, the private sector and non-governmental organizations, especially in high-burden countries like India. These groups must commit to funding and implementing new strategies to eradicate TB.
For example, the United States has been a leader in providing the innovation, expertise, and support needed to fight TB around the world. This includes direct support for local teams in critical regions and contributions to global initiatives such as the Global Fund to Fight AIDS, Tuberculosis, and Malaria. Recent funding increases from the U.S. Congress have enabled new partnerships with countries that are highly affected by TB, such as the Philippines and Ethiopia, which is a positive step. However, continued investment and increased efforts from other wealthy nations are essential to sustain and expand these efforts.
Socioeconomic factors that exacerbate TB, such as poverty, malnutrition, and poor living conditions, make it prevalent in vulnerable populations. For example, the incidence of TB among homeless people in Delhi is surprisingly high, underscoring the urgent need for comprehensive strategies that have been effective in other settings, such as the United States after World War II. These strategies include systematic screening of at-risk populations, effective treatment of those infected, and preventive measures for those exposed.
Implementing these strategies is challenging. Traditional screening methods are often expensive and slow, and standard treatments can be as intensive and harmful as those for more serious conditions like cancer. However, recent technological advances and cost reductions are making it easier to fight TB. Innovations such as portable digital X-ray machines and artificial intelligence-based diagnostic tools are proving effective in increasing detection rates, as seen in a recent initiative in Nigeria.
Additionally, the development of shorter, less toxic treatment regimens has significantly improved patient adherence and outcomes. For example, a new preventive treatment requires only 12 weekly doses instead of daily doses for up to nine months, significantly increasing the likelihood of completion.
Cost reductions achieved through collective bargaining by consortia like those USAID participates in are also making TB drugs and tests more affordable, allowing for broader access within existing budgets. When combined with increased local funding and integrated community efforts, like those seen in India, these tools are leading to substantial gains in TB control.
Despite this progress, challenges remain, such as inconsistent supply chains and the need for comprehensive coverage of diagnostic and treatment services. However, the commitment shown by some governments, combined with ongoing innovations in TB care, including promising vaccine trials, offers hope. After decades of stagnation, the continued rollout of these new tools could finally turn the tide against TB globally.
