‘We Can End TB If We Put Our Minds to It’.
While the novel coronavirus has dominated the news for most of 2020, there is another infectious respiratory disease killing thousands of people around the world every day. It will sicken an estimated 10 million people by the end of the year, 1.5 million of them fatally.
It has also plagued humanity for millennia, but it is treatable and preventable.
“Tuberculosis has been with us for about 3,500 years, and the reason it hasn’t gone away is that we haven’t focused our attention on it,” says Robert Horsburgh, professor of epidemiology and global health at the School of Public Health and of infectious diseases and medicine at the School of Medicine.
Horsburgh was elected vice president of the International Union Against Tuberculosis and Lung Disease (known as “the Union”) at the 50th Union World Conference on Lung Health, held in Hyderabad, India, last fall, for a three-year term.
“My election to this position in this important international organization reflects the good things that BU is doing,” he says. “It’s not just about me. It’s about our team and our network here, in the Department of Global Health at SPH and in the Section of Infectious Diseases at the School of Medicine, where a large group of people are working on TB.”
On World Tuberculosis Day, March 24, SPH will host the online Public Health Forum “TB: The Hidden Epidemic.”
Ahead of the event, Horsburgh discussed the Union, why TB has continued to exist despite being treatable and preventable, and how to bring new energy to a long fight.
Working on a widespread but often-overlooked infectious disease, how do you view the attention that COVID-19 is receiving?
Obviously, both are big public health problems. The natural reaction of people to something new is to be afraid of it, and to focus their attention on it—and we do need to focus our attention on COVID-19 and get it under control.
On the other hand, it’s hard to focus our attention on tuberculosis, because people are used to living in a world with TB.
The truth of the matter is that TB kills 4,000 people a day, every day, year in and year out, and has for the last 25 years at least. It’s a tremendous burden, and is something we could do something about, if we put our minds to it.
The real challenge is energizing people to pay the same amount of attention to TB that they pay to COVID-19. At the moment, we don’t have tools to get rid of COVID-19, but we have tools for TB. We need to get them out there.
What led you to work on tuberculosis?
My first interaction with tuberculosis was at a hospital right downtown in Boston where I was working in the ER. A man from Jamaica came in. He had a cough. He had lost weight. He had a fever. We took a chest X-ray, and he had a big cavity in his lung. We did a few tests and identified him as having TB. We put him on treatment and he got a lot better.
I followed him, and he was eventually cured. I thought to myself, ‘Wow. This is a disease that affects a huge number of people in the world, and we can treat this and cure it.’
That made me want to get moving. I thought, ‘Well, we have the tools. We just need to get out there and do it.’ Unfortunately, 40 years later, we still have not gotten out there and done it completely, despite many people’s best efforts. It’s been a very tough bug to lick.
Beyond treatment itself, what are the tools to eliminate tuberculosis?
TB really is a social disease: It takes the whole community to fight it. The biggest problem with getting rid of TB is we’re not finding all of the cases of TB. When you wait for people to figure out that they’ve got TB and come in to the clinic and get diagnosed, by that time, they’ve spread it through the community. So, we need to get communities engaged in helping their residents understand that they have a potential place to go to get diagnosed—and that, if they think they have TB, the stigma won’t penalize them.
The community should be getting behind you and helping you complete the medicines, because it’s as good for them as it is for you. I’ve done community work around TB, and I think that this really is one of the places we can make the biggest impact, helping combat the stigma and convincing communities that this is something where they can come together and they can beat it. It has to be a community effort.
I worked in a community in South Florida where we there was a shopkeeper who had gotten TB. She had the shop in the middle of town where everybody went, and everybody knew her. She was willing to go on TV in a video that everybody saw. She said, “Well, I have this. You might have it. But it’s curable. You should come in and get treated.” That made a huge impact.
Businesses don’t want to be seen as hotbeds of TB, but they do want to be seen as part of a community that has its act together. You just have to really help them understand that this is a battle they can win.
We’re not going to make TB go away in a year. It’s a longer struggle, but we can do it.
There also continue to be new tools to both diagnose and treat tuberculosis, and perhaps even prevent tuberculosis. There have been some very tantalizing recent reports about vaccines against tuberculosis.
This raises the level of energy, because people love to have new tools that work better than the old tools and perhaps are less expensive.
Is tuberculosis completely treatable?
TB has a worse cousin, and that’s drug-resistant TB. Some of the new drugs work against it, but we still don’t have very good treatments—they’re much more toxic than treatment for drug-susceptible TB, and they take longer.
We really need to get out there and start getting drug-resistant TB under control. It’s not a disaster waiting to happen, it’s already happening. We’re starting to see increasing numbers of cases of MDR TB—multidrug-resistant TB. The genie is out of the bottle. We have it circulating in our communities. We need to do something about it.
How is the International Union Against Tuberculosis and Lung Disease fighting TB?
The WHO has developed what is known as the End TB Strategy. The Union’s focus is on helping to implement that strategy, as a boots-on-the-ground organization that actually tries to get public health done.
Develop a tool and we’ll roll it out. We’ve participated in the rollout of some of the new diagnostics for TB. We do a lot of on the groundwork to help national TB programs get organized, get trained, get resources, and write grants. Those are the kinds of things that we think will make a more immediate difference.
I should mention that, in 2018, the World Health Assembly actually recognized that TB was a global emergency. The World Bank has also identified finding and treating TB cases as the single most cost-effective health improvement strategy, bar none, in the world. So, there really is some recognition that there’s a problem and that we need to address it. Hopefully more funds will follow.
It’s very important to get that message out, and help generate more resources to do this work. Reducing, and even eliminating TB is something that we can do—but the current way we’re going about it, the current amount of resources we’re putting into it, is not getting the job done.
One of the reasons that I’m most pleased to become the vice president of the Union is because the Union has really been on the forefront of practical measures to try to get people to wake up, and listen, and do something about the global TB epidemic.
The online Public Health Forum “TB: The Hidden Epidemic” on March 24 is free and open to the public. Register here.