Tuberculosis and Inequality: Where's the Outrage?

Approximately 9 million new cases of tuberculosis and 2 million deaths occur each year. Ninety percent of these occur in poor people. More than 20% of these cases are caused by Mycobacterium tuberculosis resistant to the two most effective drugs to treat TB or occur in patients who are coinfected with HIV. For both of these groups, the standard of care for treatment (40 years old), diagnosis (more than 100 years old), and prevention (more than 100 years old) are wholly inadequate. In spite of 20 years of rigorous, organized global TB control, the absolute number of TB cases in the work continues to increase. Ten years of efforts to improve care for multidrug-resistant TB has resulted in treatment of 19,000—or approximately 0.5% of the cumulative incident cases of multidrug-resistant TB—through quality-assured programs. This talk will describe the unmet need in TB treatment, prevention and research; explore the entrenched disparities that have consistently limited advances in development of new tools and expanded treatment of all forms of TB; and propose mechanisms for overcoming these barriers. The case of MDR-TB will be highlighted as an illustration of the links between economic, social, and political inequalities and continued morbidity and mortality due to a curable disease. The rapid scale up of antiretroviral therapy for HIV will be presented as a counter-example.