Fighting TB around the world saves lives and is a good U.S. investment
Guest columnist Elinor A. Graham recalls the suffering of a Liberian child with tuberculosis. She argues the U.S. Congress should make good on a 2008 promise to help fund TB prevention and treatment efforts around the world. It would help save lives and money here and around the world.
Special to The Times
IF the foundation of your house is starting to crumble, you fix it. Prevention and control of tuberculosis (TB) on our globe is crumbling. It needs fixing.
The life and death nature of this issue was brought home to me recently in Liberia where I looked into the frightened, tired eyes of a child who was panting for each breath. The child, whom I will call Patience, was 13 but thin and stunted, the size of a 7-year-old. She had TB.
Patience's history was all too familiar for children with TB. Her parents had died, likely of TB, when she was five. More than 75 percent of TB-related disease and death occur among people in their most economically productive years between 15 and 54. Parent disability and early death results in TB orphans and economic losses to poor countries.
In this case as in many others, the infection spread from adults living in her home to Patience. One adult with active pulmonary TB in a developing country infects 10 to 15 more people who live or work with them. Healthy adults often localize the infection and it stays dormant in their bodies. But many children, especially those who are young or malnourished or also infected with HIV, become sick and die rapidly. The co-infection of HIV and TB in a developing country is a recipe for death within a few months.
Treatment of Patience, who did not have HIV, was relatively simple. Four inexpensive TB drugs were available through the national TB program. She takes them for nine months at a total cost of a few hundred dollars. The cure rate is 95-97 percent. As long as the country's medication supplies are stable and available nearby, she will get her medications without interruption.
This is important because missed doses of TB medication have resulted in emergence of multidrug-resistant and extensively drug-resistant TB. These resistant strains of TB require very costly drugs with severe side effects for up to two years of treatment. The cure rate is only 60-70 percent.
Treatment costs for one recent case, a Peruvian student studying in Florida, came to $500,000.
Washington State has had as many as five cases a year of multi-drug-resistant TB since 2008 and the treatment cost has drained the state TB program's resources.
These resistant strains are acquired in developing countries where current health systems are poorly organized and treatment can be inconsistent. We are one world. Poor disease control in Africa or Asia costs U.S. taxpayers.
The best way to meet the threat that resistant TB strains pose to global health is by supporting the efforts of the Global Plan to Stop TB and the World Health Organization's (WHO) Drug-Resistant TB Response Plan. These programs seek to strengthen the ability to diagnose and treat TB in developing countries with high rates of the disease. The organizations provide resources at the village level. A new, easy to learn and use, diagnostic test makes this possible even in resource-poor areas.
In 2008, Congress passed the Lantos-Hyde Act that authorized $4 billion over five years in TB funding to developing countries, which was needed to fully implement WHO control programs. Congress must vote each year, but so far only $800,000 has been delivered. Recent House budget votes would decrease the proposed 2012 allocation by 40 percent. We are burying our heads even deeper in the sand!
Global TB control is in our own interests. We have good plans to repair the effort's foundation but we need the materials. Ask your member of Congress to fully authorize the 2008 promise that can create a world where TB is a disease of the past. U.S. action can turn the look of fear and fatigue that I saw in the eyes of this Liberian child into smiles of joy.Elinor A. Graham is a retired pediatrician in Seattle and Associate Professor Emeritus of Pediatrics at the University of Washington. She works as a volunteer in Liberia with Health Education and Relief Through Teaching (www.heartt.net) and with RESULTS (www.results.org.)