TB in the Era of Austerity

In the article “The Peruvian National Tuberculosis Program” by Talbot et al. the authors share the account of the scale-up efforts to combat tuberculosis (TB) in Peru in the 1990s during times of economic and political instability. The efforts were led by Pedro Suarez, the director of the National Tuberculosis Program, who managed to substantially increase detection and treatment rates of tuberculosis in Peru by securing funding, attracting dedicated staff, strengthening the technical and operational capacity, and improving data collection and analysis.

However, this article fails to connect the dots. In some countries with good national TB programs, such as Vietnam, there has been no reduction in incidence. A strictly medical approach is likely to fail in a society heavily burdened by structural inequalities and extreme poverty.  Tuberculosis remains a leading killer in the world with approximately 10 million infected and 2 million people dying every year. Socioeconomic determinants, the AIDS epidemic, and multi-drug resistance TB strains facilitate the spread of tuberculosis. Ninety eight percent of deaths occur in low-income countries and communities affected by extreme poverty are particularly vulnerable. Effective governance – promoting poverty reduction programs, debt relief, and a regulated international trade – coupled with robust investments in primary health care with the capacity to promptly detect, treat, and follow-up patients with TB will have better chance to combat the scourge.

The economic and financial crisis that began in the United States in 2008 has disproportionally affected poor communities in the developing world. Soaring food and fuel prices have pushed another 150 million people into poverty (already 1.4 billion people living on less than $1.25 in 2008). European countries and the United States are tightening their belts. Only a handful of developing countries, notably China and Thailand, have so far stimulated their economies since 2008 with sizeable investment in infrastructure and social programs.

The global tuberculosis burden will likely increase in the coming decade for the following reasons: 1) Poverty will deepen in communities where TB is prevalent 2) The AIDS epidemic will continue to ravage poor nations partly because of donor fatigue and a current 15 billion dollar shortfall in the global AIDS response 3) Government revenues in poor nations are in jeopardy which will limit future spending on health and welfare.

The Stop TB Strategy and the Global Plan to Stop TB, launched by the WHO in 2006, should pursue a more aggressive campaign and advocate for a broader agenda than the traditional approach. The cost of neglecting the poorest are far greater than the price tag it would take to eliminate tuberculosis.

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