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Grania Brigden: Time to make TB the enemy that can’t hide

20 Apr, 12 | by BMJ

Grania BrigdenAs the Kony 2012 campaign continues to sear the image of Joseph Kony—head of the Ugandan guerilla group, the Lord’s Resistance Army— into the world’s consciousness, it’s worth remembering that there is another, more deadly killer at loose on the African continent. This killer is tuberculosis.

The two have much in common. They have no respect for international borders. They prey on the vulnerable. They kill relentlessly. And they are ignored by global leaders.

The success of the Kony 2012 film is unprecedented. It has made people care about what is happening in parts of the world that very few have even heard of, let alone visited. It has made people angry and it has forced politicians to act. It has prompted a resolution by the United States Senate and troop commitment by the African Union. Cover the Night, a day of global action planned for Friday 20 April, promises “something epic” that will “let the world know… we’re serious about stopping LRA violence.” The events planned around the world will likely keep Kony in the headlines, for another few weeks at least.

What can we learn from the incredible success of this campaign? And can we exploit it? With Sub-Saharan Africa in the spotlight, perhaps now is the perfect time to build on the success of Kony 2012 and get people angry about TB.

In 2010, over 5,000 people died from TB in Uganda. If you include its neighbours Tanzania, Kenya, Ethiopia, and the Democratic Republic of Congo, this number rises to over 77,000 people, more than Kony is thought to have killed in his entire twenty year campaign. If this is not enough to make people take notice, surely the global figures will—in 2010, 8.8 million diagnosed, 1.4 million killed. These statistics are well known within the TB community, but they have failed to generate anything like the response they deserve.

In fact, in recent years TB activists have been unable to prevent the withdrawal of vital funding—funding that ensured the casualty rates were not far higher. What is needed is more awareness, more money, more political will, and more action.

As funding is slashed, the TB killer continues to mutate and become ever more dangerous. The rise of multi-drug-resistant TB (MDR-TB) has been caused by the lack of access to effective TB treatment. Without adequate support to TB programmes, patients struggle to complete the six-month treatment regime, allowing stronger and more deadly strains of TB to evolve.

It gets worse. MDR-TB is no longer the preserve of patients who failed previous treatment. It can now spread directly from person to person. As MDR-TB is more expensive to diagnose and is not routinely tested for, it is harder to gauge its devastating impact. The withdrawal of donors and the cancellation of Round 11 of the Global Fund will profoundly affect the world’s ability to address the crisis that MDR-TB poses. This makes the need for a global response ever more pressing.

I may not have a picture of this killer to spray on my t-shirt, but resources to start raising awareness are available. The Stop TB Partnership has many excellent videos and photo essays showing the effects of TB on an individual. There are cases like Fentene, a 13-year-old from Ethiopia who spent four years trying to receive appropriate diagnosis and treatment. Unfortunately it came too late.

MSF, on its TB&ME blog, shows the personal experience of Grace, an MDR-TB patient in Uganda. She comes from Kitgum—an area once ravaged by Kony and his LRA—but is now struggling with a killer that never left.

Fighting TB is not cheap. Patients need access to quality diagnostics and quality treatment, and political will is essential to meet this need. A global commitment to deal with the MDR-TB problem is called for, with new tools, drugs, and diagnostics that are affordable and accessible to all.

So if the 90 million people who watched the Kony 2012 film want to help defeat TB, what should we tell them?

Just as with Joseph Kony, there are no simple solutions. However, there are things that can be done now including:

  • The Global Fund needs greater support from donors.
  • Governments of countries with a high TB burden need to prioritise fighting TB.
  • The World Health Organization needs to include children in estimates of global TB numbers, and ensure they have access to appropriate drugs.
  • The stigma of TB needs to be challenged, as has already happened with HIV/AIDS.
  • Better tools to diagnose TB need to be made more available.
  • MDR-TB drugs must be made available to all, quality-assured, and appropriately priced.
  • Researchers need to focus on shorter and better TB treatment.

It’s time for TB to learn some valuable lessons from the Kony 2012 campaign. It’s time for TB to go viral.

Grania Brigden is the TB advisor for the MSF campaign for access to essential medicines.

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  • RP

    Very good article.

    I also think the WHO and International Governments need to think about how to address the problem in a strategic and well-thought-through multi-disciplinary approach.

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