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Story Publication logo August 12, 2014

Vietnam: Tuberculosis Battle Is Global


Image by David Rochkind. Vietnam, 2014.

Vietnam has less than 30 percent of the funding needed to fight tuberculosis. With only the most...

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In a poor neighborhood along the banks of the Saigon River, Tran Ngoc Tam and his wife sat inside a one-room dwelling so tiny it could barely fit a bed. Tam spoke intermittently between frequent bouts of coughing and grimacing, products of his painful battle with tuberculosis.

When he first became infected, Tam delayed getting tested because he knew very little about the disease, and that gave the bacteria time to take hold. The 37-year-old construction worker then contracted a dangerous drug-resistant strain that has greatly weakened his body despite months of intense medical treatment.

"Sometimes I can't breathe. I can't bear it," Tam said. "I have pain in my legs and arms because of all the injections."

Tuberculosis, also known as TB, is the world's second-deadliest infectious disease, killing 1.3 million people a year, according to the World Health Organization. While treatment is readily available, much of the world lacks funding to effectively administer it. WHO says an additional $1.6 billion a year is needed globally to successfully fight the disease, a gap that it says could elevate the future costs of treatment and further spread the multidrug-resistant form of the disease that Tam has, known as MDR-TB.

Such funding discrepancies are apparent at the Global Fund to Fight AIDS, Tuberculosis and Malaria, an organization that receives and distributes donor money from private foundations and developed nations. Despite being the world's largest source of TB financing, the organization has only dedicated 16 percent of its grant money to TB, compared with 54 percent for HIV and 27 percent for malaria. The numbers aren't proportional to the threat: TB kills more people than malaria and almost as many as HIV.

"TB is still a neglected disease," said Cornelia Hennig, WHO's medical officer in Vietnam. "I cannot believe that TB doesn't get the attention it deserves. Families are suffering. Children are dying."

Even though very few of those victims live in the U.S., the lack of focus on TB does pose risks for Americans. Failure to slow the spread of the disease globally increases the odds that more infected immigrants and visitors will arrive from overseas. In fact, 65 percent of new cases in the U.S. are found in people who were born in other countries, according to the Centers for Disease Control and Prevention. The most common countries of origin are Mexico, the Philippines, India, Vietnam and China.

"There's a very immediate desire to ensure that dangerous diseases like TB are under control," said Laurel Fain, director of the Vietnam health office at the U.S. Agency for International Development, which administers foreign aid.

So, why is the fight against TB so underfunded? Global health experts say there's a lack of political will among wealthier donor countries that don't experience the disease as a major threat at home.

"In the U.S. and Europe, there has been a feeling that TB has been addressed, that we've beaten it," said Michelle McConnell, director of the CDC office in Vietnam. "It doesn't get quite as much attention as some newer and more publicized diseases."

Indeed, the Obama administration's budget request for fiscal year 2015 proposes spending $4.35 billion on HIV/AIDS programs compared with only $191 million on TB programs, and it includes a 19 percent cut to development agency USAID's TB funding.

TB prevention and treatment is also at a disadvantage because the disease largely afflicts poor people in developing countries. By contrast, well-known figures in developed countries have contracted HIV and malaria, which has encouraged celebrities and activists to help attract support from private donors and lawmakers.

Bono, Elton John and Lady Gaga, for example, have all campaigned against HIV, while Conan O'Brien, David Arquette and Forest Whitaker have advocated for the fight against malaria. There are few comparable voices for tuberculosis.

"TB doesn't seem to be as attractive or sexy as HIV or malaria," Hennig said.

The effects of that neglect are apparent in Vietnam, which is one of 22 countries designated by WHO as having a high TB burden. The country's capacity to treat patients is satisfactory, but its ability to prevent and diagnose the disease is poor. In fact, nearly half of its TB cases go undetected, a main reason why the disease causes some 18,000 deaths a year — nearly twice as many as automobile accidents.

One reason for that is insufficient education. Because many people like Tam aren't familiar with the disease's symptoms, they end up waiting too long before seeking treatment, giving them time to pass the bacteria on to family members. Some buy ineffective over-the-counter drugs at local pharmacies rather than proper TB medicine, which can make the illness worse.

The lack of funding also means low pay for doctors and nurses that doesn't compensate them for the risks of working in highly contagious environments. As a result, hospitals can't hire enough staff and neighborhood clinics can't attract enough community health workers to provide in-home care.

"Our work isn't celebrated like work in other fields," said Dr. Nguyen Van Thom, director of a TB clinic in a poor area of Ho Chi Minh City. "If we had more support from the international community, it would help Vietnam do TB prevention work and reduce the number of patients in the future."

Despite the funding problems, there have recently been notable scientific advances in global TB care. The diagnostic machine GeneXpert, which was endorsed by WHO in 2010, is greatly reducing the amount of time it takes to give patients test results.

Also, new drugs are emerging for the first time in decades. The nonprofit TB Alliance, for example, announced in April that it was moving forward with clinical trials for a new treatment regimen that would shorten therapy for MDR-TB.

"There have been a lot of innovations lately that have been very promising," McConnell said.

Still, the ability of these technologies and treatments to help people depends on developing countries' willingness to implement them.

"If there isn't enough funding or awareness to diagnose and treat people with TB, it has a huge impact on communities," Fain said. "We're talking about people dying slowly and painfully over time."

That's exactly what Tam is afraid will happen to him. Even more than the possibility of death, he's concerned about his family members, whom he hasn't been able to support financially since he got sick and stopped working.

"I'm very worried about my old mother. No one is going to take care of her if I die," Tam said. "It already makes me sad."



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