We Know How to End TB. The Problem Is, We Choose Not To.
Yes, tuberculosis (TB). And it’s curable. Still, it kills millions.
You may hear about the TB. Yes, tuberculosis (TB). And it's curable. Still, it kills millions.
Yes, here is the world’s most-carried infection that kills over a million people annually, of which we know the treatment, prevention, and all—yet in 2023, it accounted for more lives than malaria, typhoid, or even war. Why?
Because we choose not to end it.
Tuberculosis is among the oldest diseases known to mankind. Evidence for tuberculosis is found in Egyptian mummies and in the bones of ancient Chinese people. The causative bacterium, Mycobacterium tuberculosis, has been killing human beings for thousands of years.
It is known by many names: consumption, the wasting disease, white death and phthisis. A whole city could be made for its patients during the 1800s and early 1900s when it was rampant. It was the “romantic disease” of poets, painters, and the poor. It didn’t matter if you were rich or poor; you were sure to get it.
But now, it is a disease of the poor.
A cure was discovered for this disease in the 1950s. It was not one drug but a combination of four-Rifampin, Isoniazid, Pyrazinamide, and Ethambutol-combinedly called RIPE. With a daily intake for 6 months, this regime cures most individuals.
That was over 70 years ago. The drugs still work. They are not fancy. They are not new. They are cheap (even in countries like the Philippines).
Following is the approx. cost in the Philippines.
Rifampin: ₱13.65 per capsule → approximately $0.24 per capsule.
Isoniazid: ₱5.75 per tablet → approximately $0.10 per tablet.
Pyrazinamide: ₱6.50 per tablet → approximately $0.11 per tablet.
Ethambutol: ₱12.50 per tablet → approximately $0.22 per tablet.
And yet, TB is still rampant.
What is worse? TB is airborne. Hence it spreads like the flu. You get infected by just breathing air with a person who is active with TB. And a quarter of the world-more than two billion people-has the latent TB within their bodies at this present time. Most will not fall sick. But about 10 million will in a year (like 10.8 million in 2023), and many will die.
If we have the cure, why is TB still here?
Because it’s not just a medical problem. It’s a money problem. A justice problem. A who-we-care-about problem.
Most TB deaths occur in poor countries. Places without health clinics equipped with labs. Where roads flood and people have to walk miles to access medical care. Where drug supplies run out. Where people live in tiny houses without enough fresh air and with too many occupants. Places like Sierra Leone, India, Indonesia, and the Philippines.
I have seen several cases of TB during my rotations in the Philippines.
Let me put it plainly: rich countries don’t die from TB anymore, so they stopped caring.
Just for example. Comparing the USA & the Philippines based on the data from 2022.
Dr. Peter Mugyenyi, a Ugandan doctor, once said about AIDS:
“Where are the drugs? The drugs are where the disease is not. And where is the disease? The disease is where the drugs are not.”
And that is true for TB too.
John Green, a famed author of The Fault in Our Stars, recently wrote a really tough piece titled Everything Is Tuberculosis. This narrates the story of a boy named Henry he lives from Sierra Leone.
At that time, he thought that he was just a 9-year-old child. The truth was that he was 17. Over the years, he became small and weak due to the TB running high. He was a malnourished boy from a very poor family. Multiple first-line drugs were not helping him. He did need second-line treatment.
But it was distant for him. They didn’t have the new medicines at the hospital where he goes. They are too expensive. The system failed him.
The story about Henry is not unique. In reality, this is the normal legacy for people with TB in underdeveloped countries. They wait. They suffer. They die a premature death.
TB strikes the poor overwhelmingly. The reason is:
Because TB flourishes in the dark places we would rather forget. In slums. In jails. In refugee camps. It follows poverty, crowding, hunger, and poor immunity. A germ, but a mirror.
We do not build strong clinics in those poor localities. We do not train enough good doctors. We do not send enough aid food, and whatever support is available. We do not care unless it is someone we know.
The other danger is drug-resistant TB, which occurs when individuals fail to complete their treatment. The bacteria mutate, and the standard drugs then fail to work.
It’s the harder strain of TB to treat. It takes years to treat and costs thousands of dollars for each patient. And yes, it’s spreading.
If we do not act now, TB will come out as even stronger. Harder to kill. More global.
Truth? Not much.
The World Health Organization states that approximately $13 billion would be needed yearly to eradicate TB: quite a sum, compared to so many other expenditures.
If we cared:
Better hospitals and labs in poor countries.
Faster and available for all tests.
New medicines to all people, not only the rich.
Pay for community health workers to assist the patients in completing therapy.
Feed hungry patients.
Fight against the stigma and fear that envelop TB.
End it. But we do not.
Tuberculosis is not a trending topic now. It does not headline. It’s old. It is slow. It is silent. But it kills. Continually.
But the real question is not how we shall stop TB. We know how it should be done already.
The real question is, when will we decide that poor lives matter as much as rich lives do?
Meanwhile, TB will continue wandering the injustice paths that we have laid out. It will continue following hunger, poverty, and silence. It will keep carrying away people like Henry-young, bright, full of life-and rob them of their breath.
We not lacking in the knowledge. We lack the will.
And it is this that should haunt us.