Back in the first decades of the 20th century, tuberculosis (TB) was the leading cause of death in the U.S. And it wasn’t even close: 280 out of every 100,000 New York City residents died from TB in 1900. My grandfather’s family lived in New York at that time and when he fell ill, he was sent to the White Mountains in New Hampshire for the “fresh air cure” and his baby sister, my great-aunt, went to an “open air” school, exposed to the elements all winter to avoid infection. We’ve made enormous strides in TB control and now, in the 21st century, the U.S. has greatly reduced the impact and incidence of TB to less than 10,000 cases per year with steady reductions over the last several decades.
While richer nations tend to regard TB as history, it rages on in much of the rest of the world. Until 2020, when the COVID-19 pandemic struck, TB had been the world’s leading killer among infectious diseases. And while attention was diverted from TB to COVID-19, TB refused to go away. The disease rebounded with infection rates and mortality rising for the first time in years: 10.6 million people sickened and 1.6 million killed in 2021.
But it doesn’t have to be this way. TB is detectable, preventable, and treatable, even in its most complicated presentations.
The United Nations High-Level Meeting on Tuberculosis in New York in September 2018 set ambitious targets to accelerate progress to end TB. Optimism was high that a 90% reduction in TB deaths by 2030 could be realized. This September, New York will host the second High-Level Meeting on TB against a backdrop of a global surge in tuberculosis cases. While we have fallen short of our 2022 targets, we can—and must—recommit ourselves to realizing the 90% reduction by 2030 and redouble our efforts to expand access to diagnostics and treatment.
Applying advances in science, data, and technical expertise to accelerate progress
Despite the pandemic, we have opportunities to end TB that we have not had before. New innovations are available for TB detection, prevention, and treatment and many of the investments in COVID-19 response can also support the TB response. In many countries where routine care is challenging, there is still a need for basic diagnostic and treatment access. In addition to increasing the ongoing efforts to overcome those challenges, the United Nations should lead with targets on increased access to the latest tools for TB for the countries with the highest burdens of TB, such as India, Kenya, and Ukraine, where TB remains among the 10 leading causes of death. That means access to the full suite of solutions on hand: rapid molecular diagnostics, highly effective treatment regimens, and preventive therapies, as well as improved systems to deliver these tools.
In low burden countries, like the United States and Japan, sharing lessons learned and technical expertise with high burden countries, combined with targeted domestic programs, will reduce disease transmission because TB anywhere is TB everywhere.
A renewed commitment to ending TB is going to take funding, but it doesn’t have to be hugely expensive. There are new models emerging to drive down costs of delivering test results and patient care as well. For example, an innovative private-sector partnership model in India’s Haryana state is greatly increasing patients’ access to testing, including for drug-resistant strains, and rapid follow-up care. It is a replicable model that could be the basis for TB diagnosis in every high-TB burden country with an effective private sector.
The response to COVID-19 showed that the world can mobilize incredible resources to respond to a pandemic. It’s time the same determination is brought to the fight against TB. Or else we’re just putting our faith in fresh air.