Doing it for Jane: eradicating tuberculosis
Sometimes in discussions of global health we get lost in the numbers.
It's something I am often guilty of myself.
Individual stories of the people affected get swept up and lost in the proliferation of numbers and databases we have today.
This Wednesday world leaders will meet in New York for the first ever United Nations General Assembly High Level Meeting on the fight against tuberculosis. The meeting will be on the margins of the UN General Assembly to agree on a series of actions to finally wipe tuberculosis off the face of the Earth.
Discovering only recently that my own family was affected by tuberculosis was a sobering reminder that health isn't just about the numbers.
In summer of 1855 in the coal fields of northern England Jane Shaw, my great, great, great grandmother, finally succumbed to tuberculosis in her home.
Edward, her husband and my great, great, great grandfather, was with her when she died.
Jane’s death left Edward a widower with two young children: John aged 10 and Elizabeth aged 6. Both the kids grew to be adults with their own families, John becoming my great, great grandfather.
Jane’s death certificate lists her cause of death as ‘phthisis’, a term from ancient Greek times used to refer to what today we call tuberculosis.
Jane was part of the tuberculosis epidemic that swept through England and other parts of Europe and North America in the 18th and 19th centuries. In her day, one-in-four people in England died from tuberculosis, spurred on by the pollution of the Industrial Revolution, poverty, urbanisation and poor living conditions.
Of course, today the incidence of tuberculosis in most western countries is very low. Almost non-existent.
The good news is that the development of diagnostics, medicines and vaccines since Jane died has spared the lives of millions of people around the world.
I myself still remember as a kid growing up in Australia with the 'TB shot' just being part of normal school life.
Today the pharmaceutical industry lists 82 R&D projects that 16 companies are currently investing in worldwide to develop new medicines and vaccines to treat tuberculosis, including 11 promising products in late stage development and 7 in Phase III clinical trials – the final stage before approval for use in treating disease.
Some of these promise to be the next generation medicines, vaccines and diagnostics to fight tuberculosis in the future.
But today there are still 10 million cases of tuberculosis every year, largely in Africa and Asia.
Source: World Health Organization, "World : Estimated TB incidence rates, 2016" Global Health Observatory Map Gallery, http://gamapserver.who.int/mapLibrary/app/searchResults.aspx, accessed 23/9/2018.
Two-thirds of the 10 million people today with tuberculosis live in just eight countries: India (27% of cases), China (9%), Indonesia (8%), the Philippines (6%), Pakistan (5%), Nigeria (4%), Bangladesh (4%) and South Africa (3%).
And, like Jane 160 years ago, every one of the 1.4 million people who die each year from tuberculosis will have family and friends.
The fact each of them dies from a disease that today can be detected, prevented and eradicated is not acceptable.
And while tuberculosis is often forgotten in western countries these days because it has been all but eliminated, the World Health Organization has warned that tuberculosis also sometimes does not get the attention it deserves even where it is still prevalent.
This is remarkable.
Tuberculosis is real. As real today in Asia and Africa as it was in England in 1855.
Tuberculosis is a disease that has followed humanity for millennia. Studies of Neolithic communities show it was present at least 9,000 years ago and tuberculosis has been found in mummies from Ancient Egypt.
So tuberculosis has been with us for a long time.
After steady falls in death rates over a century or more, tuberculosis is still here today due to a combination of inadequate health systems, insufficient investment, lack of detection and treatment, and because the disease is becoming increasingly resistant to some of the frontline drugs that are used today to treat it.
Today the world has a goal, as part of the UN Sustainable Development Goals, to practically eradicate tuberculosis from the world by 2030.
But the WHO has warned that the world is not investing enough to achieve this goal.
To reach the targets for reduction in tuberculosis, global incidence needs to be falling by 10% per annum by 2025 and the death rate needs to fall to 6.5%.
The WHO has recently said that:
“Such levels have only been achieved in the context of UHC (universal health coverage), combined with social and economic development that reduces known risk factors for TB infection and disease.”
This week’s UN High Level Meeting will review and approve an ‘action-oriented political declaration’ to commit world leaders to identify and treat the 3.6 million people out of the 10 million people with the disease who currently miss out on treatment altogether, to provide diagnosis and treatment for 40 million people, and to overcome the growing problem of multiple drug resistant tuberculosis.
Here's hoping the resolution prompts a renewed global commitment to eradicate the disease everywhere.
Whether it's one life or a million, every death from tuberculosis is one too many.
We should finally be consigning this disease to the dustbin of history.
I reckon it's something Jane would have wanted.