Dr. Bibek Kumar Lal & Dr. Virender Singh Salhotra

The World Tuberculosis (TB) Day is being observed across the globe today. On March 24, 1882 Dr. Robert Koch discovered the bacterium that causes TB, which paved the way for diagnosing and curing the killer disease. The World TB Day is an occasion to spread public awareness of TB’s devastating impacts on people’s health, social and economic life. This year the Day bears the theme: ‘The clock is ticking.’ It veritably conveys the message that the world is running out of time to act on the world leaders’ commitments to eradicate TB.
Coined as "white plague" by Oliver Wendell Holmes in 1861, TB has infected the people since the prehistoric period. Lesions have been found in the vertebrae of Neolithic man (5000 BC) and in Egyptian mummies (3700 BC). Recent DNA studies on a Peruvian mummy have shown conclusive evidence that TB of lungs (called pulmonary TB) existed in the Americas centuries before the arrival of Columbus. Historically the word ‘phthisis’ appears early in Greek medical writings. However, this was a non-specific term to describe wasting away. A Latin word ‘consumption,’ became the popular term for TB in the seventeenth century.

Public health problem
With an estimated 10 million people afflicted and 1.4 million dying of it in 2019, TB remains a major public health problem. Globally, there are 30 high burden countries which account for 87 per cent of Global TB Burden. Three countries in the SAARC region, namely India, Pakistan and Bangladesh, which feature amongst 30 countries, account for 35.7 per cent of the Global TB Burden. Furthermore, as the bacteria causing TB is getting resistant to the commonly used first line drugs, it has led to emergence of Drug Resistant TB for which the treatment is longer, less effective, expensive and associated with more side effects. In 1993, the WHO declared TB a public health emergency and called upon all governments to scale up steps to control TB.
Since then, the WHO, the United Nations, national governments, non-governmental organisations (NGOS) and communities have been making sustained efforts to eradicate TB. Their joint initiatives were bolstered by an increased commitment for funding the gaps for TB control activities. This saved the lives of 63 million people. This is no mean feat but it is not enough. How do we control and get rid of it? We can emulate the success story of TB eradication by the European and other developed countries. It was not only the treatment of TB with potent antibiotics which enabled these countries in controlling their TB burden.
There were many other determinants, contributing to control of TB in these countries. There are several risk factors which are clearly documented to increase vulnerability to TB. For example, malnutrition resulting into low immunity is a risk factor. We all know that HIV leads to decreased immunity and the person becomes vulnerable to TB. HIV is on top of the list in the risk factors for TB. An HIV-infected person is 15-22 times more likely to develop TB than a person without HIV.
Another factor is overcrowding that increases chances of infection transmission while improved housing decreases risk of disease transmission. Smoking is also a major risk factor. Smokers have chance of catching TB by 2-3 times higher than that of non-smokers. There are other indirect salutary effects of development - improved literacy reduces risky behaviour and household smoke and ensures access to quality of health services. Another important intervention is the implementation of TB preventive therapy. One fourth of the global population is estimated to be infected with TB bacillus. One of 10 has chance of developing TB. With the advent of new drugs and researches, it is now possible to eliminate TB through preventive therapy. However, it is easier said than done to convince even healthy people to take drug regimen from 3-6 months.
All UN member states have agreed to work towards achieving the United Nations Sustainable Development Goals (UN SDGs) - 17 goals with 169 targets - by 2030. They set out a vision for a world free from poverty, hunger and disease. Health has a central place in SDG 3 that stresses ‘ensuring healthy lives and promoting well-being for all at all ages,’ underpinned by 13 targets. The target 3.3 states eradicating the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases. Almost all of the other 16 goals are related to health or their achievements will contribute indirectly to health, including the control and eradication of TB.

Multi-sectoral initiatives
In order to achieve the goal of eliminating TB by 2030, the United Nations Assembly, for the first time, held a United Nations High Level Meeting on TB where global leaders committed to detecting and treating 40 million TB patients, and provide TB preventive therapy to 30 million people by 2030. This will help meet the target of diagnosing and treating 15.7 million people with TB and provide TB preventive therapy to 9.8 million people by 2022. However, this formidable task suffered a setback due to the COVID-19 epidemic.
It is evident that the efforts of Ministry of Health and Population alone can’t lead to eradication of TB. There is a need for multi-sectoral initiatives to deal with the social determinants of TB infection and disease. They include the poverty alleviation, social protection, nutrition and housing quality, education and other development related works.

(Dr. Lal & Dr. Salhotra work at the SAARC TB and HIV/AIDS Centre, Thimi, Bhaktapur)