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Story Publication logo April 1, 2011

Tuberculosis: A 21st Century Disease

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Media file: Moldova.jpg
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Tuberculosis is a disease both preventable and curable. Nevertheless, it is estimated that more than...

Media file: Moldova_TB_1_10289.jpg
After the fall of the Soviet Union, Moldova’s health system struggled to cope and the country became vulnerable to a growing tuberculosis (TB) crisis. Image by David Rochkind, Moldova, 2010.

Experts in the field of tuberculosis research met in the Capitol Visitors Center on Thursday March 24 to address why we are treating one of the world's deadliest diseases with the equivalent of "muskets and sticks."

TB killed 1.7 million individuals in 2009, second only to HIV/AIDS; one third of the world's population is infected with the TB bacteria. It is also the leading cause of death among people living with HIV/AIDS in Africa. According to the World Health Organization, without proper treatment, about 90 percent of people living with HIV/AIDS die within a few months of developing tuberculosis.

The Capitol Hill event featured presentations from: Joel Spicer, a Senior Strategist at the Stop TB partnership, Payam Nahid, M.D., an associate professor at the University of California San Francisco, Christy Hanson, PhD., the Division Chief of Health, Infectious Diseases, and Nutrition at USAID and David Rochkind, a photojournalist who has chronicled people affected by TB around the world. Jon Sawyer, the Pulitzer Center's executive director, moderated the panel.

The panelists said the sobering statistics on TB shed light on the growing problem of tuberculosis worldwide and the steps needed to address the issue. David Rochkind, a Pulitzer Center grantee, used his photography and personal stories to connect the audience with people struggling with the disease in different areas of the world.

Rochkind also announced the launch of a new free educational website http://www.tbepidemic.org/. The website provides educational resources that can be used by teachers to inform students on the issue and shed light on, "a disease that is woefully underreported in the developed and underdeveloped world." It also features Rochkind's photojournalism from South Africa, India, and Moldova.

The panelists provided a comprehensive overview of the state of tuberculosis in the modern world and what is needed for the future.

Joel Spicer, of Stop TB, said the reason tuberculosis has not been controlled at a global level is because, "we are fighting the war with muskets and sticks." Spicer cited three major levels where the technology used to identify and act against TB is falling behind: The sputum smear microscopy used to diagnose TB was developed in the 1880's. The most commonly used vaccine was first used on humans in the 1920's. The standard drugs used to treat the disease are more than 40 years old.

Spicer also emphasized the growing concern over multi-drug resistant tuberculosis (MDR-TB), which accounted for close to 150,000 of the 1.7 million deaths worldwide in 2009. Not only does the treatment of the disease cause formidable challenges for doctors and health officials (liver toxicity and long courses of treatment, among other issues) but the cost of the drugs required is exponentially higher. The cost of "standard" TB drugs is about $30, Spicer said, compared to as much as $1,500 for drugs used to fight MDR-TB. The cost is even greater once the actual treatment for the MDR-TB diseases is factored in.

Payam Nahid, of the University of California San Francisco, said that TB, a "seemingly forgotten ghost of the past, seems to plague us in the 21st century," and is a disease "which knows no international borders or boundaries." Nahid acknowledged that in recent years the incidence of TB in the United States has declined but he cautioned against overconfidence. There was a similar decline in the early 1980's followed by a resurgence in TB rates. Rates of infection increased during a period when tuberculosis was neglected by public health officials and pushed out of the American consciousness due to the rise in HIV/AIDS. The problems of HIV/AIDS, persistent poverty, poor/absent TB control and inadequate laboratory and infrastructure are among the reasons the disease persists today.

Christy Hanson of USAID outlined the response by the U.S. government to the current tuberculosis threat and she emphasized that the U.S. government's commitment to addressing the disease. She cited the passage of the Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008 and President Obama's support of the Global Health Initiative as examples of the commitment of the United States to treating tuberculosis. Hanson referenced the goals of USAID in containing and treating the disease and was positive about the role that USAID is currently playing "in USAID focus countries we have seen dramatic increases in detection but also in successful treatment."

During his presentation, David Rochkind used his photography to connect the statistics outlined by the panelists who preceded him with the individual stories of people influenced by the disease all over the world—and to make the magnitude of the disease real. "These individual stories help convey the gravity, depth and complexity of tuberculosis," Rochkind said. He showed pictures of one Moldovan woman who was denied adequate treatment for her tuberculosis and eventually died. At the Great Noligwa Mine in Orkney, South Africa, Rochkind explained that TB is easily spread because of the tight work environment in the mines, the high instances of HIV, and high rates of the lung condition silicosis due to inhaling large amounts of dust during mining.

Rochkind said he hoped to bring these issues home to the American public, especially students, through Epidemic: TB in the Global Community. The free educational website was developed in collaboration with the Educational Development Center (EDC) and the Pulitzer Center and with support from the Lilly MDR-TB Partnership. The website includes two educational curriculum units; it is a featured presentation of the Pulitzer Center's Global Gateway education program.

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