If there is one infection that terrifies me, it’s tuberculosis. Not AIDS, not influenza. TB; it keeps me up at night. It has the capacity to devastate our planet in ways we can’t even imagine yet. Tuberculosis is the single worst pandemic our planet has every faced. It has every characteristic of a superbug. Tuberculosis spreads through the air, and it mutates quickly into drug-resistant forms. It’s not bound by any animal or insect vector and it’s not bound by climate conditions.

It spreads fast from person to person, especially in dense urban environments. It has a long infectious period, so a person with TB can spread the infection for months before they realize they need treatment. TB is difficult to treat in even its mildest forms, and we are now seeing untreatable forms. XXDR-TB – extremely drug resistant tuberculosis – cannot be cured through any known drug regimen.

My fear is backed by data. The numbers coming out of this year’s World Health Organization report on drug-resistant TB are bad. Very, very bad. Seriously, I could barely stand to read it. The numbers are especially ugly in the former Soviet Union. Some regions in Russia are reporting multi-drug resistant tuberculosis rates of over 25% in new cases of TB. Not cases that have failed treatment before – new infections.

My current home of Dushanbe, Tajikistan, is reporting that over 60% of people repeating TB treatment have multi-drug resistant TB (MDR-TB) which is resistant to two of the front-line treatments. 58 countries worldwide have confirmed at least one case of extensively drug-resistant TB (XDR-TB), which is resistant to both first and second line drugs.

It is World TB Day, so I should end on a positive note. And there is one – there was one glimmer of hope in the WHO report. World rates of MDR TB seem to have peaked. It appears that with intense effort – particularly susceptibility testing for TB drugs – drug-resistant TB can be controlled. The Stop TB partnership is helping to do that. So it’s not inevitable that we will see our global TB pandemic turn into an MDR TB pandemic.

However, it is going to depend on serious funding and concerted international action. How often do we actually get that right?

Image:  James Natchway’s valuable XDR-TB Gallery

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