Tuberculosis still afflicts millions

By James Orbinski Smallpox has been eradicated, and polio could follow suit shortly. The world can justifiably be proud of such far-reaching public health achievements. Friday is World TB Day. Most people in the industrialized world think of tuberculosis as a disease of the 19th century that disappeared along with smallpox. Not so. This year, 3 million people will die of tuberculosis, and 8 million people will develop the disease, almost all in poor countries. In Amsterdam on Friday, health and development officials from the United States and the European Union are meeting ministers from the 22 countries worst affected by the disease. The World Health Organization estimates that if tuberculosis is left unchecked, it could kill more than 70 million people worldwide in the next 20 years and infect nearly a billion more, most of whom will go untreated. Tuberculosis represents the tragic failure to use medical advances for the wider benefit of humanity. Despite the explosion of scientific knowledge and techniques over the last two decades, the last new drug was developed more than 30 years ago. The vaccine we use today was developed in 1923. There is an urgent and immediate need for short and simple treatments. Current treatments are long and cumbersome, with enormous labor costs for governments. The treatment lasts six to eight months, but patients start to feel better quite early on and drop out too soon because of the heavy social and economic cost of treatment. Uncured, they pass the disease on to others. This also leads to the development of drug resistance, making old drugs redundant and subsequent treatment - from $5,000 to $8,000 a patient - prohibitively expensive. However, none of this concerns the pharmaceutical industry. Eager for a share of the lucrative Western markets, all efforts are concentrated on finding yet another drug for impotence or baldness. Unfortunately for the millions who die every year, tuberculosis is not a lucrative market. We cannot wait for the pharmaceutical industry to respond spontaneously to this global crisis. We must move beyond debates about "market forces" and "commercial incentives." We are facing a global public health challenge, and governments must either intervene in the market or establish their own capacity to promote research and development for new, affordable, effective drugs and vaccines. Governments should lead the way and develop a system for sharing the burden. Tuberculosis is not just a medical crisis. It is a political and social problem that could have incalculable consequences for generations to come.

The writer, president of Médecins Sans Frontières International Council, contributed this comment to the International Herald Tribune. Médecins Sans Frontières won the 1999 Nobel Peace Prize.