The Scale of the TB Epidemic in Africa
In the nineteenth and twentieth centuries a billion people died of TB (and please bear in mind that for a full fifty years in this period the current drugs were available...). That's more people victim to this single disease than all the wars, than all the famines, than all the natural disasters...It's hard to believe that this could be true and that it isn't a key part of our collective history that we learn in school.
TB disease has since slipped from consciousness as one of the main enemies of mankind in the developed world - and it took less than two generations for this to happen. Wherever there's still real poverty, however, it's been pretty much business as usual - the same old dreaded killer disease, the same old coughing-up of arterial blood as the consumption took its toll...
...that is until it got MUCH worse.
First it found a friend in HIV/AIDS - the two most lethal infectious diseases making Sub-Saharan whoopee.
And then it started to mutate into strains that are simply untreatable in any country that doesn't have a robust health and social infrastructure, and even into some strains that are simply untreatable anywhere.
Please just think for a moment about the import of this one sentence: Not one single low-income country anywhere has proper TB surveillance in place - and yet 98% of deaths from TB occur in the developing world. Surveillance is simply vital to containment of drug-resistant disease.If there was ever an inconvenient truth this must be one.
But what's so terrible about DR-TB in Africa is that there is so pitifully little in the wings to help, despite all the might of modern medicine.
Programs needs billions of dollars of investment to become effective (and last year a round of the Global Fund got cancelled, so this simply isn't on the cards in a depressed global economy – for three whole months earlier this year there were NO TB drugs at all in Uganda, for instance!).
It needs new strategies (and nobody we've met who's at the sharp end of this struggle thinks for a second that the current strategies are actually working in Africa).
It needs new drugs (and frankly we have no expectation that new drugs, when they appear, will be affordable where they're most needed).
It needs new diagnostics.
Here's what we think (for what it's worth). You simply don't hear much about TB in Africa in the health media, not just because it's being scaled by the AIDS epidemic, but also because no-one in global health has truly got a clue what to do about it. It's certainly not because of ignorance. Back in 1991 a prophetic article was published in the Lancet entitled "Is Africa lost?". It was about TB....and twenty-one years later the situation is FIVE times worse than it was in 1991 (that's another uncomfortably inconvenient truth). At least five times worse than it was, when the Millennium Goal concerning TB deaths in Africa was that they should have halved...
Here's other things we think. We personally suspect that there could be at least twenty million people already latently infected with untreatable drug-resistant disease in Africa. We think that a new vaccine might just appear (though we know with flu how hard it is to vaccinate against a mutating disease...), but, if it does, it will take at least two generations for it to protect populations in Africa because of the incredible rates of existing latent infection. We're also pretty sure that current rates of TB in Southern Africa today are roughly three times what they were when they were at their very worst in old Europe. That's terrifying if it's true.
What's so desperately needed is a treatment that can be appropriately applied in the environment it's needed in - one that's simple, that's cheap, that's low tech. We don't see anything of this sort coming....
Do you know of anything? This is why we are determined to find out if moxa might fit the bill.
If any of the above shocks you, shocks your sense of injustice for instance, or even makes you think we're exaggerating, we sincerely invite you to read a list of direct quotations from recognised experts - the president of MSF, the president of the World Bank, the director general of the WHO, the Secretary General of the UN to name a few.
You can also learn much more by browsing a section of the website where we've put together a whole section on TB - something which was previously significantly lacking. There you'll find out more about:
- how four out of five Africans today are estimated already to be latently infected
- some of the causes and complexities of DR-TB
- how current treatments for DR-TB alongside HIV have no existing evidence base
- how there are no effective approved treatments for children with DR-TB
- the extent of the complications when HIV and TB walk hand in hand
- how cheaper TB drugs have actually stoked up the problem
- how drugs for DR-TB are too expensive despite being well out of patent
- how incredibly difficult they are to tolerate
- how only one in two patients survive the treatment for MDR-TB
- how new drugs may finally be on their way but may not get used where they're needed
- how any new vaccine will have no effect in Africa for probably twenty years
- how pharmaceutical treatment of TB is impossible without diagnostics which simply don't exist in Africa.