How We Can Fight TB in the 21st Century - Reevaluating DOTS

When the WHO released its Global Tb Report 2015 in October 2016, health experts and organizations alike were horrified by the numbers presented. Stated in the report, “ TB deaths jumped to 1.8 million in 2015 from 1.5 million in 2014, with 41% of people estimated to have fallen sick with the disease being left undiagnosed and untreated” (WHO). The statistic that stands out to us the most is the sheer amount of people left untreated. While drug-resistant TB is a growing problem, it currently only compromises 3.3% of new TB cases (Kaiser Family Foundation). Greater efforts need to be made towards fighting TB in areas with quickly developing countries, particularly South East Asia and Africa, which (from a 2014 study) make up 42% and 28% of all new TB cases globally.

DOTS, or directly observed therapy shortcourse, is the method most widely used to treat TB patients. There are five aspects: diagnosis with septum-smear microscopy, treatment with a steady and accessible amount of drugs, observation of the patient, and political and financial backing. But has it truly been effective? In 2014, governments at the World Health Assembly agreed to step up efforts to fight tuberculosis, with the goal of reducing cases by 95% in 2035. However, no explicit plan has been set, and if no incentives are given to researchers and pharma companies to produce a wide-ranging effective TB vaccine, how can any real progress be made? But we must accept a reality: an effective vaccine will not be created by tomorrow. It may take years to change the current mindset of the governments of first-world countries; the mindset that more cannot be done to overcome the spread of infectious diseases.

Other factors that affect the spread of tuberculosis should also be taken into consideration. The National Center for Biotechnology Information lists tobacco smoke, malnutrition and air pollution, diabetes, harmful use of alcohol, and HIV infection as primary reasons for the continually high rates of tuberculosis in developing countries. The WHO reports that HIV-infected people are “26-31 times more likely to develop TB” than those without HIV, while tobacco smoking increases the chances of contracting TB by 2-3 times and diabetes by 3 times.

By understanding which factors can contribute to increased acquisition of TB, governments are given several methods and various paths from which to approach and tackle the TB epidemic. For countries which do not have money to spare on medication for the general public, or find it difficult to make essential antibiotics cheaper and more accessible, more effort can be put towards movements to curb smoking, malnutrition, and practicing safe sex. Countries who have put larger taxes on tobacco have seen a fall in TB rates (WHO TB and Tobacco Control, 99). A move in these directions are the right effort, and will have a positive effect on TB rates. Meanwhile, if governments continue to do little to fight TB in their country, nothing will change.

Statistics and data will enable both organizations and governments to determine what methods work most effectively, to choose between MDR- and XDR-TB regimens for one example. Identifying the barriers of people’s access to medicine in these countries is another important step that should be taken in making it simpler for rural citizens living in developing countries have easier access to essential medication. Comprehending how much of an impact attempting to control the prices of medications for TB and using that data to advocate for more would be a useful, a needed step, to advance in this fight. The Global Health Initiative provides an interactive map and graph addressing this and more.

References:

1. http://www.who.int/tb/areas-of-work/treatment/risk-factors/en/ "TB Comorbidities and Risk Factors." World Health Organization. World Health Organization, n.d.
2. http://apps.who.int/iris/bitstream/10665/43812/1/9789241596220_eng.pdf "WHO Library Cataloguing-in-Publication Data." N.p., n.d. Web.
3. http://kff.org/global-health-policy/fact-sheet/the-u-s-government-and-global-tuberculosis-efforts/ 23, 2016 Mar. "The U.S. Government and Global Tuberculosis Efforts." The U.S. Government and Global Tuberculosis Efforts. N.p., n.d. Web. 08 Nov. 2016.