The Return of a
Forgotten Killer
In the last two
centuries, tuberculosis has claimed more lives than any other disease: an
unprecedented and unsurpassed death toll of one billion. And, despite a
compelling economic and moral case for investing more in controlling the
disease, it has quietly resumed its position as the world’s leading infectious
killer.
Bjørn Lomborg
Prague - In the last two centuries, tuberculosis has claimed more
lives than any other disease: an unprecedented and unsurpassed death toll of
one billion. And, despite a compelling economic and moral case for
investing more in controlling the disease, it has quietly resumed its position
as the world’s leading infectious killer.
Thanks to the advent of a vaccine and cheap drugs, TB kills
very few people in the developed world nowadays. So it has quickly been
forgotten in rich countries – thought of as a relic from the Victorian era.
TB
not only gets scant attention, but also a fraction of health funding.
Around 3.4% of total development assistance for health is devoted to TB,
compared to 27.7% for maternal and child health and 29.7% for HIV in 2015.
Such complacency is dangerous. Despite
a compelling economic and moral case for investing more in controlling the
disease, it has quietly resumed its position as the world’s leading infectious
killer, claiming more lives than either HIV
or malaria. Data for 2016, the latest available, show that 6.3 million new
cases of TB were reported (up from 6.1 million in 2015) and almost 1.7 million
people died.
Researchers
from the University of Sheffield and London School of Hygiene & Tropical
Medicine (LSHTM) estimate that in 2014, approximately 1.7 billion
individuals were latently infected with TB – just under one-quarter of the
global population. Roughly 10% of latent cases turn into active TB. Nearly 100
million children already carry a latent TB infection.
Even if all TB transmission were somehow
stopped tomorrow, the researchers find that the current pool of latent
infections alone will prevent the number of TB cases from falling to the World
Health Organization’s global targets for 2035
In
research for the Copenhagen Consensus Center, which I direct, Anna Vassall of
LSHTM has made the case for greater investment in global TB control.
“TB treatment is low cost and highly effective, and on average may give an
individual in the middle of their productive life around 20 additional years of
life,” she concludes. What’s more, investment in TB disproportionately helps
the world’s poorest people.
TB
control in poor countries is highly vulnerable to fluctuations in attention
from rich-country donors, on which low-income governments depend for almost 90%
of their response. While international funding reached $1.1 billion in 2017,
this was recognized to be $1.5 billion short of what is needed to enact
the Global Plan to End TB.
Treatment reduces the spread of dangerous
and expensive multi-drug resistant TB, and the WHO recommends providing
preventive treatment in high-risk populations.
But while treating most TB cases costs just $21 per person for drugs, this does
not account for the cost of improving detection of TB and other aspects of the
health system. The disease can be difficult to diagnose, and many programs rely
on sick people to report to hospitals. As a result, nearly one-third of active
TB cases go unrecognized.
Globally,
Vassall concludes that every dollar spent investing in TB control would
generate benefits to society worth around $43. Those are outstanding returns,
and a panel of Nobel laureates that studied the United Nations’ new Global
Goals determined that controlling TB is one of 19 phenomenal development
investments that should be given high priority globally.
In
high-prevalence countries, there can be no argument that governments and donors
need to focus more on TB. A panel of development and economic experts that
examined policy options for Bangladesh last year found that TB control should
be the highest national priority.
In
Bangladesh, one in 11 deaths is caused by TB. Every hour, nine people die from
a disease that we know how to treat effectively and cheaply. Almost half of the
cases are never detected. Investment in TB is not only important from a health
perspective, but also for poverty reduction, because loss of income forces
those with TB further into destitution.
A
95% reduction in TB deaths and a 90% reduction in new cases in 20 years’ time
is achievable in Bangladesh for about $300 million a year. This would give each patient another 25 years of life, on
average. Treating one person prevents at least one new case from developing,
and every dollar spent on TB returns $21 in benefits to society.
These
research findings were part of the reason the Bangladeshi government increased
its health investments in its 2017-18 budget. But Bangladesh is just one
of 20 high-prevalence countries that, together, account for 83% of
the global total.
Unlike
diseases like Ebola or Zika, TB seldom makes headlines. It should. Given all
that we know about how to prevent and treat TB, and a powerful economic case
for investing in eradication efforts, there is no excuse for the heavy toll
that it continues to take.
Bjørn
Lomborg, a visiting professor at the Copenhagen Business School, is Director of
the Copenhagen Consensus Center, which seeks to study environmental problems
and solutions using the best available analytical methods. He is the author of The
Skeptical Environmentalist, Cool It, How to Spend $75 Billion to Make
the World a Better Place and The Nobel Laureates' Guide to the
Smartest Targets for the World, and was named one of Time magazine's
100 most influential people in 2004.
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