Tuberculosis: The Unseen Pandemic Ravaging the World's Poor

Mar 25 , 2023
By Bjorn Lomborg

The infectious disease that killed the most people last year is one we have heard almost nothing about: tuberculosis. In 2022, it likely claimed 1.4 million lives, more than the total toll of COVID. And yet, in rich countries - where virtually nobody dies from tuberculosis any longer - attention has moved on.

Even in developing countries, where the wealthier can afford treatment, it is often the poorest, most disconnected and disadvantaged that suffer from this disease.

The world has long promised to do better. As part of the UN's global goals, known as the Sustainable Development Goals (SDGs), all nations promised to fix almost every global problem by 2030, including tuberculosis. That is not going to happen. With tuberculosis, we will be decades late.

Indeed, we are failing on almost all the world's promises. Based on current trends, the world will be half a century late delivering on all its promises. The reason is apparent: politicians made impossible promises. Having 169 priorities is indistinguishable from having none.

Crucial targets on nutrition, education, and tuberculosis are put alongside much more peripheral promises like boosting recycling, more urban parks, and promoting lifestyles in harmony with nature.

The world will be at halftime for its promises this year, yet it will be nowhere near halfway. It is time to identify and prioritize the most crucial goals. With several Nobel laureates and more than 100 leading economists, the Copenhagen Consensus, a think tank, has worked for years to identify where each Birr can do the best.

A new, peer-reviewed study shows that a dramatic reduction in tuberculosis is possible and one of the most effective priorities leading up to 2030.

Almost a quarter of all people in the world carry tuberculosis bacteria. Even in prosperous Europe and the United States, every 10th person has it. It would not develop into disease for most well-off, well-nourished people, but it is a risk for the less fortunate.

Tuberculosis is a disease of hunger and poverty.

Each year, more than 10 million people develop tuberculosis. Because of a lack of resources, in 2021, only about six million cases were diagnosed, of which more than 100,000 were in Ethiopia. Almost half of the untreated people would die. Those who do not die would continue to spread the infection - on average, actively infected people can transmit it to five to 15 others through close contact over a year.

Those who are diagnosed and offered treatment are in for a rough time. They must take medication for as long as six months. Because the medication clears the immediate tuberculosis symptoms like fevers and weight loss in a couple of weeks, many will drop out of treatment too early.

When people stop treatment too early, it increases the chance that the disease can be passed on to others. It also makes the surviving tuberculosis bacteria more likely to develop drug resistance. The subsequent treatment could require 18-24 months and would be much costlier.

We can do much better. It is possible to diagnose many more people and ensure most TB patients stay on their medication.

Our new study shows this can be achieved for an additional 6.2 billion dollars annually. It is less than what the world has already promised - in 2018, the UN pledged to increase funding by about seven billion to eight billion dollars annually by 2022. Disappointingly, spending since 2018 has declined.

The additional funding can deliver diagnosis, care, and prevention that achieve the world's tuberculosis promises. It would ensure that at least 95pc of people with tuberculosis will be diagnosed. It can provide simple ways to ensure people complete their six months of medication - perhaps with incentives to complete the treatment, such as food, clothing, juice boxes, or gift cards, or through support groups for patients to encourage each other.

These days, mobile apps can also help.

The extra resources would mean that high-risk, vulnerable populations can access periodic screening. Over the coming decades, 50 million people will access appropriate treatment, and 35 million people will have access to preventive treatment.

This will dramatically reduce tuberculosis deaths by 90pc. It will essentially wipe out tuberculosis, as we should have done decades ago. Up to mid-century, the additional resources will allow us to avoid an astounding 27 million deaths and untold human suffering. The total economic benefits, mainly from avoided deaths, would reach three trillion dollars. Each dollar spent will generate 46 dollars of social benefits for the world.

Global dithering has allowed tuberculosis to become the biggest infectious killer. Ending TB is one of the world's most effective policies. We have promised way too much, but tackling tuberculosis is one of the few most effective policies we must carry through.

PUBLISHED ON Mar 25,2023 [ VOL 23 , NO 1195]

Bjorn Lomborg is President of the Copenhagen Consensus and Visiting Fellow at Stanford University's Hoover Institution. His new book is "Best Things First", which The Economist named one of the best books of 2023.

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