Trade, foreign policy, diplomacy and health

3. Tuberculosis control

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


Tuberculosis and globalization

  • Although clearly a concern for poor nations, TB is also a concern for the wealthy
  • Inadequate therapy has led to selection for multidrug-resistant TB (MDR-TB)
  • These lethal TB strains travel readily along with their human hosts: 46% of TB cases in the US in 2000 among 'foreign born’ vs. 27% in 1992
  • Drug-sensitive TB can cost $60,000 per case, MDR-TB $200,000 per case

Although clearly a concern for poor nations, the fight against TB is also a matter of self-interest for the wealthy. In many of the regions where TB is already rife, inadequate therapy has led to selection for multidrug-resistant tuberculosis (MDR-TB), creating a reservoir of bacilli that cannot be treated with standard therapy. In an increasingly integrated world, these lethal TB strains travel readily along with their human hosts via air, land, and sea. While 95% of all cases of TB occur in developing regions, people latently infected with TB travel and are making up an increasingly large number of the TB cases in industrialized countries. The case rate for foreign-born persons remains seven times that of U.S.-born individuals, and 46% of all cases of TB in the United States in 2000 were among the 'foreign born'; in 1992 these cases comprised just 27% of the national total. When these patients are found to be sick with drug-sensitive TB, their care in the United States will cost many thousands of dollars and, in some settings, costs to treat fully susceptible TB can average as high as $60,000 per case. When patients have MDR-TB, costs can go as high as $200,000 for a single case.

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