TB

To many Americans “tuberculosis” sounds like a word out of the past. For our country, it was, but no longer is. Cases of TB have doubled in the U.S. to about 25,000 a year since 1985 and the dreaded drug-resistant strains of this disease are increasing also.

To much of the rest of the world, TB is THE scourge, taking about 3 million lives a year. That toll is equal to all the deaths from all other infectious diseases put together, making TB the deadliest infectious pathogen in the world. Because TB is an airborne disease, what is happening in the rest of the world, where in many nations the epidemic is worsening, affects the risk levels in the U.S. Travelers, immigrants and returning Americans on planes, ships and motor vehicles bring it to this country. Recently, an international flight attendant on Continental Airlines infected 23 of her co­workers with TB before detection. So, while TB is a disease of poverty, no one who breathes is immune — rich, middle class or poor.

On the brighter side, public health specialists have long known how to control TB and cure infectious patients very inexpensively — about $13 per cure in some developing countries such as China. What then is the problem?

This question haunts J. Richard Bumgarner, senior program manager for the tuberculosis section of the World Health Organization (WHO). He is trying to interest governments, multilateral aid organizations and large foundations in making the minuscule contributions needed to start a 20 year process of rolling back this epidemic before it grows more ferociously lethal and multi drug resistant.

What astonishes Bumgarner is that all these groups who turn down proposals to fund TB eradication programs do not dispute the facts.

They soberly nod when they hear that the spread of HIV infected persons expands greatly the number of immune-weakened victims of tuberculosis. They are duly impressed when he tells them about the spectacular success his handful of public health specialists are having with the bare-foot doctors in China. Why in less than a year, his office can identify 80,000 people in China whose lives were saved in less than a year’s work.

They shake their heads in deep concern when he forecasts a death toll exceeding 30 million in the next ten years. But the answer they give him is always “no.” Governments, except for the Netherlands, Sweden and Japan, say that budget constraints make a contribution to the WHO’s desired annual TB control budget of $10 million (it is now about $4 million) impossible.

The US Agency for International Development (AID) just said NO to his request for $3 million in 1994. AID throws that much money away to a tiny number of Beltway law and consulting firms who then waste it on taxpayers. Already, Los Angeles County is spending $23 million a year to fight TB there.

This is not the usual foreign aid request. As Dr. Thomas Frieden, chief of the New York City Bureau of TB Control put it: “If we are going to treat TB in New York, we have to control TB in the world.”

Bumgarner says that $100 million a year for 20 years, contributed by all sources, private and public, could save 35 million lives and bring TB under control. He doesn’t think any more money is needed, remarkably enough. WHO in Geneva will train the technical people from around the world, equip them with the control and cure “cookbooks” and send them out to work with public health experts in the developing countries. This is no pipe dream. Exactly these kinds of frugal effective programs are working in China, Tanzania and Malawi.

How much is $110 million a year? It is what the Pentagon spends in a morning, what our country spends for dog and cat food in a week, what is spent on video games in 10 days.

Bumgarner is confident that several nations will come up with the $100 million a year. Expanding the “cookbook” center and number of trained personnel sent out from WHO’s Geneva office will be more difficult. That requires, ironically, only another $6 million a year. This is not a large grant for any of the giant U.S. Foundations.

With 15 million Americans already infected with TB, though not yet infectious, and with a burgeoning growth of multidrug resistant TB strains around the world (and in New York state and other state prisons), it is time to shed the collective insanity of indifference and apply the practical knowledge of the public health profession as fast as possible.

Interested readers may obtain more information about TB from J. Richard Bumgarner, World Health Organization, 20, Avenue Appia, CH-1211 Geneva 27, Switzerland.

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