Skip to main content
Move the World.
To Eradicate TB, We Need Old-Fashioned Ambition
A new short drug treatment for tuberculosis, called BPaMZ, is showing promise in trials.Credit: NCTLD (Georgia), on behalf of TB Alliance, author provided

I recently had chance to attend the first-ever United Nations high-level meeting on tuberculosis. It was an historic opportunity for heads of state to acknowledge the enormous burden of tuberculosis (TB), the world’s leading infectious killer, and to show their commitment to eradicating it by 2030.

When given the opportunity to intervene from the floor at the meeting, I pointed out that the biggest problem is not money or science but a lack of ambition.

The 2014-2016 Ebola outbreak in West Africa, for example, caused an estimated 11,000 deaths and yet it resulted in a phenomenal amount of innovation around Ebola — including a brand new vaccine and new, rapid diagnostic tests. These innovations were rapidly deployed during the recent Ebola outbreak in the Democratic Republic of the Congo (DRC).

During the same two-year period, TB killed more than three million people. And yet we are still using a TB vaccine that dates back to the 1920s.

The BCG vaccine has poor efficacy but is
still widely used.
The BCG vaccine has poor efficacy but is still widely used. Credit: CDC, author provided

The front-line diagnostic tool for TB dates back to German bacteriologist Robert Koch who identified the TB bacteria under a microscope in 1882.

Patients with drug-resistant TB have to endure a prolonged (up to two years) and toxic treatment with multiple drugs (more than 14,000 pills) — including painful daily injections that can make people deaf.

The fact that we are still using century-old tools to tackle the biggest killer infection betrays a complete lack of ambition. So, before we can eliminate TB, we must end our lack of ambition. Only when we become more ambitious will our heads of state come around, rally and support us.

A realistic dream

A modern TB care system will include a much better TB vaccine, and recent trials show great promise for new vaccine candidates.

For those who develop TB symptoms, we will offer a rapid, simple triage test. Those with positive triage test results will get a point-of-care molecular diagnosis, followed by confirmatory drug-resistance testing using sequencing.

Soon, rapid, molecular TB tests can be
used at the point of care and produce
results within an hour, along with
information on drug-resistance.
Soon, rapid, molecular TB tests can be used at the point of care and produce results within an hour, along with information on drug-resistance. Credit: Madhukar Pai, author provided

People diagnosed with TB will receive a short four-month course of oral medicines. Such short regimens are currently in trials with promising early results. In fact, shorter treatments for latent TB infection are already available.

Patients will have access to digital technologies that can help them stick to their treatment plan and allow them to make money transfers.

A modern TB service will be free of paper. And, thanks to cloud-based information and communication technologies, TB program staff will be able to monitor the epidemic locally and nationally, as well as offering patients the personalized care and support they need.

Is this modern TB service an unrealistic dream? I don’t think so, because many such tools and solutions already exist, in some form or fashion. They have just failed to come to together to serve those who need them the most. And, for some tools such as a better vaccine and a shorter drug therapy, new investments are urgently needed.

Examples of personalised care using
mobile technologies include
video-observed treatment.
Examples of personalised care using mobile technologies include video-observed treatment. Credit: SureAdhere Mobile Technology, author provided

Yes, developing new tools is going to cost money — an additional US$1.3 billion per year. But if the global health community can find a way to fight Ebola with modern tools and technologies, I see no reason for the TB field to be unambitious.

We need to “science the shit” out of TB and this is possible if we make the investments. If each country spends 0.1 per cent of its annual gross domestic expenditure on research and development (GERD) on TB research, the funding gap can be bridged.

Poor quality care kills TB patients

TB care is more than just new tools. We also need to improve the quality of care that we give to persons with TB.

Last month, The Lancet Global Health published a landmark report entitled “High quality health systems in the Sustainable Development Goals era: Time for a revolution.” The authors assert that providing health services without guaranteeing a minimum level of quality is ineffective, wasteful and unethical.

Throughout the report, TB is used as a key example — to illustrate the need to go beyond coverage and focus on quality of care. The authors estimate that half of the annual 946,003 global TB deaths that are amendable to health care occur due to poor quality care. The remaining 476,047 deaths are due to not using health-care services.

As highlighted in this report and in our own work on this topic, studies show large gaps in care across types of TB and countries. Analyses show long, complex pathways to health care — with private or informal sectors being the preferred first point of contact, and an evident lack of adequate services at the primary care level.

Simulated patient studies, using a methodology developed by our team, in four countries (India, Kenya, China and South Africa) show poor quality of care in both public and private sectors, with the private sector faring worse.

TB patients suffer high costs and long wait times while seeking care and receiving treatment.

As I have argued earlier, the field urgently needs to develop new tools, as well as adopt and implement the science of quality improvement. The TB community must think beyond coverage and demand high quality care for all patients in all countries.

More importantly, we need to reinvent the way we are managing TB, and, as medical anthropologist and physician Paul Farmer put it, we must overcome our collective failures of the imagination.The Conversation

Madhukar Pai is the Director of Global Health and a Professor at McGill University. This article was originally published at The Conversation.

More About

Future of Food
It’s Time to Embrace the Frankenfish
It’s Time to Embrace the Frankenfish
Watch Now
Future of Food
It’s Time to Embrace the Frankenfish
Would you eat fish that was genetically designed in a lab? What if it was your only option? Like it or not, GMO salmon and other futuristic foods are revolutionizing the global food system right in front of our eyes.
Watch Now

Bioengineered fish have been known to cause mixed feelings. Unnatural, right? Well, after 30 years of debate on whether we should be eating “Frankenfish,” this funky food source is finally coming to a store near you. Like it or not, GMO salmon and possibly other genetically engineered animal meats will soon be on the shelves of your local supermarket. And, these new futuristic foods may be revolutionizing the global food…

Longreads
Fixing the Way We Fund Science
Fixing the Way We Fund Science
Longreads
Fixing the Way We Fund Science
Basic science funding is a mess. Fixing it could radically improve the pace of innovation.
By Dan Bier

Basic science funding is a mess. Fixing it could radically improve the pace of innovation.

Dispatches
How NASA Scientists Learned to Stick with Super Long-Term Goals
How NASA Scientists Learned to Stick with Super Long-Term Goals
Dispatches
How NASA Scientists Learned to Stick with Super Long-Term Goals
When the New Horizons spacecraft launched in 2006, Pluto was still a planet and the iPhone didn't exist.
By Bruce Barry and Thomas Bateman

When the New Horizons spacecraft launched in 2006, Pluto was still a planet and the iPhone didn't exist.

Dispatches
Why We Need a Universal Flu Vaccine
Why We Need a Universal Flu Vaccine
Dispatches
Why We Need a Universal Flu Vaccine
Two scientists explain why the flu is still such a problem, a century after it killed 50 million people —…
By Ian Setliff and Amyn Murji

Two scientists explain why the flu is still such a problem, a century after it killed 50 million people — and what we can do stop it.

Science
Fighting Superbugs with Viruses
Fighting Superbugs with Viruses
Watch Now
Science
Fighting Superbugs with Viruses
This Yale scientist's experimental treatment is a Texas woman's last resort.
Watch Now

Ben Chan searches sewers, lakes, and pig farms all around the world for bacteriophages (bacteria-destroying viruses) that could help fight antibiotic-resistant bacteria, also known as “superbugs.” Paige is a young woman in Texas with cystic fibrosis who is suffering from a drug-resistant infection; Ben’s experimental phage therapy is her last resort. We follow Ben as he travels from his laboratory at Yale to Lubbock, Texas, to deliver the treatment —…

Dispatches
Driverless Cars Go Off-roading
Driverless Cars Go Off-roading
Dispatches
Driverless Cars Go Off-roading
Computer-game simulations can train self-driving cars to navigate in the real world.
By Matthew Doude, Christopher Goodin, and Daniel Carruth

Computer-game simulations can train self-driving cars to navigate in the real world.

Teaching Engineering with Dirt Bikes
Teaching Engineering with Dirt Bikes
Watch Now
Teaching Engineering with Dirt Bikes
This teacher is using dirt bikes to help Baltimore's kids learn STEM.
Watch Now

Baltimore’s kids are obsessed with dirt bikes. Some people think that's a problem, but teacher Brittany Young is using dirt bikes to get kids into engineering and STEM education. Her organization, B-360 Baltimore, aims to use dirt bike culture to help end the cycle of poverty, disrupt the prison pipeline, and bring together communities — while giving dirt bikes a better reputation. Dirt bikes are a controversial issue in…

Dispatches
Two Billion People Have TB. What Should We Do about It?
Two Billion People Have TB. What Should We Do about It?
Dispatches
Two Billion People Have TB. What Should We Do about It?
In the fight against TB, sometimes it's better to just get along.
By Dan Bier

In the fight against TB, sometimes it's better to just get along.

Technology
eSight Lets the Legally Blind See
eSight Lets the Legally Blind See
Watch Now
Technology
eSight Lets the Legally Blind See
This legally blind man is seeing his wedding for the first time. 15 years after he got married.
Watch Now

Some people who are legally blind can still see, but images can be blurry and in low contrast. eSight has created a headset that can give sight to the blind through three technologies. First, an HD camera captures video. Second, a built in computer increases contrast and clarity. Third and finally, the image is projected on displays in real time. 15 years after marrying his wife, eSight helped a legally…

Superhuman
Meet the Paralyzed Man Who Can Walk Again
Meet the Paralyzed Man Who Can Walk Again
Superhuman
Meet the Paralyzed Man Who Can Walk Again
Robert is paralyzed from the chest down. But now a robotic exoskeleton is giving him what he calls "a second…
By Mike Riggs

Robert is paralyzed from the chest down. But now a robotic exoskeleton is giving him what he calls "a second chance at life."