While global and U.S. health officials had hoped TB elimination efforts would wipe out the disease in our lifetime, today's projections are somewhat grim. Based on U.S. TB rates from 2000 to 2008, the disease will be eliminated by 2107, according to Randall Reves, director of TB control at the Denver Public Health Department, who presented during today's session on "Tuberculosis: The Effect of Social Justice on a Global Epidemic."
Colorado has a long history with TB. In fact, in the late 1880s, the Denver Chamber of Commerce advertised the mountainous state and its dry atmosphere as being good for one's health, Reves said. With up to a third of Colorado residents in 1900 affected with TB, treatments of the day included fresh air, bed rest, nutritious food, exercise and long stays in sanatoriums. As the decades went by, officials recognized that the disease was, indeed, a public health issue, drugs were developed and a globally recognized treatment regimen known as directly observed therapy — or DOTS — was introduced.
Still, as much as things change, they also stay the same. Just like in the late 1800s, TB in Colorado is still significantly connected to immigration, Reves said.
Kenneth Castro, director of the Division of TB Elimination at the Centers for Disease Control and Prevention, said TB is "clearly a disease of racial and ethnic minorities." The overwhelming number of TB cases in the United States are among non-whites, with foreign-born U.S. residents accounting for a majority of TB cases in 2009, Castro said. Foreign-born U.S. residents also bear a higher burden of multidrug-resistant TB than those born in the country, he noted. Globally, there were more than 9 million TB cases in 2008, with almost 2 million deaths.
"The most vulnerable carry the burden of tuberculosis," Castro said.
Eighty-five percent of TB cases occur in Asia and Africa, with 80 percent of cases in just 22 nations, said presenter Carole Mitnick, who works with the group Partners in Health. And in certain parts of the world, the lack of infrastructure means the TB burden is simply not known — "we really don't know how big the problem is," Mitnick said.
The major obstacles to TB's control? Drug shortages, regulatory hurdles, lack of financial incentives to develop new and better drugs, gaps in diagnostics, and the high price of available drugs, among other reasons. And while presenters said that major improvements are not "pie in the sky," it will take serious, committed efforts backed with much-need funds to make such improvements materialize.
"The people who suffer from TB are not those who are most often heard," said Mitnick. "I personally do see lots of cause for outrage."
For more on TB, visit the World Health Organization's TB page.