Trade, foreign policy, diplomacy and health

3. Tuberculosis control

Jim Yong Kim, Aaron Shakow, Arachu Castro, Chris Vande, Paul Farmer

Tuberculosis as an infectious disease

  • TB is an airborne infectious disease and, with HIV/AIDS, the most important cause of adult mortality in the world
  • Because TB is airborne, control can have individual, local, regional and global impact
  • Globalization has increased international travel and the spread of TB, especially in developed countries

Tuberculosis (TB) is an airborne infectious disease, thought to infect almost one-third of the world’s population. It commonly manifests as an infection of the lungs, usually with symptoms of coughing, weight loss and other constitutional symptoms. Antibiotics and improved basic sanitation and living conditions decreased dramatically the impact of TB in developed countries, but together with HIV/AIDS it remains one of the two most important infectious causes of adult mortality in the world. Because TB is airborne, the effectiveness of a particular TB control program can have individual, local, regional and global impact.

Treating the sick patient with antibiotics (usually for a minimum of 6 months) renders that patient non-infectious, thus halting spread to other close contacts in the home or in the community. Additionally, prophylactic treatment for the latently infected can further reduce the development of cases of active TB. In 1993 the WHO declared TB a global emergency, and promoted the DOTS (Directly Observed Treatment with Short-course chemotherapy) strategy. Although a success in many nations, less than a quarter of the active cases of TB in the world receive this treatment. Globalization has increased international travel, and the spread of TB, especially in developed countries, where multidrug-resistant TB in particualr is a serious concern. A recent US Institute of Medicine report highlighted that it would be impossble for the US to eliminate TB without addressing the problem of TB globally. They concluded that the US should invest more in efforts to control TB in developing countries.