OVERVIEW – GLOBE.

Summary:
Why TB continues to be so rampant in the developing world despite man having effective medicines to cure it since half a century!
Tuberculosis is a neglected medical field since it belongs to realms of poor. Global Health R&D is heavily tilted in favor of the diseases of the rich and there is a stark lack of research in TB:
• The two main tools used in India today to diagnose tuberculosis are quite ancient; sputum test is 124 years old while chest X-ray, 111.
• For prevention, newborns are given a shot of BCG vaccine – 85 years aged & fruitless.
• 5 effective anti-TB drugs, being used to treat the sick, materialized over 40 years ago.
However, using the same tools wisely, West was able to rein in TB way back in 1970s.
Then, global R&D on TB was switched off, ignoring Asia and Africa, still visibly simmering.
Hence, no new tests, vaccines or drugs since! And sadly, none, it appears, in the offing.
Details:
In order to get an overview, to comprehend the big picture and to keep things in perspective, we must first glance through the history of tuberculosis, appreciating some important global events that have impacted the Indian scenario.

1.For thousands of years, Tuberculosis managed to thwart human research:
Although several diseases – such as small pox and plague – have consumed millions of lives, their reign has been relatively short-lived. Tuberculosis, on the other hand, has gone on playing havoc for thousands of years over almost all continents of the globe, sneakily evading relentless human research.
2. Trends of tuberculosis in the affluent West:
Not too long ago, TB had been quite common even in (the now affluent) Europe and North America. By 1800, one of every 250 people in the Eastern United States was dying of it. In England and Wales too, it remained much the largest single cause of death till 1850s. Then, it began to decline, surprisingly, a century before any medicine was to be discovered; the inexplicable decline is attributed to socio-economic development there.
3. Advent of the two elementary diagnostic tools:
In 1882, Sir Robert Koch finally uncovered its causative agent – a germ, and thus armed mankind with its first-ever diagnostic tool – sputum smear test – key to diagnosis even today in India.
Soon thereafter, in 1895, X-ray – the second diagnostic tool – was invented.
Thus, clinical diagnosis of TB became possible with bone chilling certainty. Even so, there was nothing man could do about it. There was no cure yet. All he could do was to helplessly watch gradual consumption and soundless approach of … death.
4. Era of chemotherapy:
At long last, from 1944 through 1966, five effective anti-TB drugs appeared in rapid succession. To this day, man fights TB with the same five drugs. The more evolved Western nations promptly and sensitively kept embracing the best drug combinations. As a result, already on slow decline there, TB started dramatically vanishing from the West – towards 1970s.
5. Then, the sadistic switch off:
With success stories inundating the western media, the world was deluded into believing that finally the war on dreaded TB had been won. Scientists were euphoric. Global R&D – ongoing mainly in the multimillion-dollar western labs – was unceremoniously dropped. Momentum built over decades came to a grinding halt. The international community simply turned a blind eye to this development, ignoring and thus deserting the poor world still visibly and ceaselessly burning; 95% of cases and 98% of global deaths from TB occur in the poor developing countries. History of TB-control presents a classic example of double standards, exposing international hypocrisy.
However, story doesn’t end there.
6. Intermixing of human populations:
Jet age brought about a thorough intermixing of human populations through mass transportation of armies, refugees, tourists and immigrants. Invasion of the glittering West by Asians and Africans – often carriers of dormant germs – facilitated re-sprinkling of the seeds of TB therein.
7. Around 1980’s, HIV/AIDS emerged in the West; a person infected with this virus was soon recognized to turn out to be highly inflammable to TB, once exposed to the bacillus.
Smuggling in of dormant TB germs by outsiders in to complacent western societies increasingly contaminated with HIV set the stage for resurgence of TB in the West. The crunch came in early 1990s, when New York was hit with an unprecedented epidemic of tuberculosis. This was probably the turning point; attitudes seem to have changed overnight. The WHO broke decades of stoic silence. ‘TB is a global emergency’ it declared in 1993 – more, it is suspected, out of panic for the elite westerners than roused by some newfound human compassion for the smoldering poor world.
8. Even science favors the rich, neglects the poor:
However, the vacuum inserted in to R&D timeline between 1970 -1993 was inerasably recorded in history and couldn’t be wished away; it would forever haunt mankind.
On the other hand, unfazed and unconcerned, human mindset was progressively changing – becoming more materialistic and commercial. Man was lustily chasing the daze of dollar – his pied piper. As it turns out, commercialism has proved far more infectious than mycobacterium tuberculosis. Gone are the days when scientists couldn’t easily be mesmerized with greed.
Jonathan Salk, the great researcher, stubbornly refused to patent polio vaccine, saying it would be like patenting the sun.
Not any more.
Modern scientist could easily be seduced in to spending his gifted human life sub-optimally – in wayward directions – in pursuing research over trivial issues that concern a handful of wealthy individuals, thus impoverishing human race.
Bulk of profit for the drug industry accrues from tiny but affluent fraction of the globe – North America, Japan and Western Europe. And today, profit comes first – not people.
Possibly, about 90% of health R&D, therefore, is for the rich. Even science is not truly universal; it is heavily tilted in favor of the rich and the mighty. A study* (1) found only 11 compounds for tropical diseases out of the 1223, discovered from 1975 – 97. Sadly, a measly 10% of research caters to the poor who constitute a whopping 90% of human population. And why not? Who would care to toil thanklessly, when barely 5% of the 16 million persons currently sick with TB can afford to pay for the treatment?
9. Lackadaisical attitude of the international agencies:
While billions are systematically collected and frittered away by international agencies in the name of poor man’s maladies, the saga of TB uncovers a concealed conspiracy of silence and inaction, exposing terrible mismanagement and an insatiable human greed. The divine mission of TB eradication stands reduced to a lucrative buzzing industry; the deeper the crisis the bigger the spoils. Human has acted virtually as a scavenger on its own race.
In stark contrast, the reaction of international organizations to calamities concerning the West is on an altogether different plane. The swift and awesome response to the recent SARS outbreak of 2003, that posed a tangible threat to elite westerners, displayed ‘what is possible today ‘if’ the international community has the will to act’.
“A diagnostic kit for SARS took four months,” noted the president of Nobel Prize-winning organization MSF* (2). “We still don’t have one for TB”.
TB failed to muster in 8000 years what AIDS, a tangible danger to the West, seems to be generating with in mere 24 years of its identification!
TB figures at the rock bottom of the international agenda. Talk about equality! Justice! Human rights! Globalization!
Such biased attitude of the international community clearly works against the very spirit of universal declaration of human rights to which India too is a signatory.
The Nazis massacred over six million out of hate. Today’s civilized democracies prefer to kill out of benumbing indifference.
Despite endowed with millions of half-grown wonder molecules tucked in his research libraries, man simply refused to budge; he just wouldn’t kick start the work to find cures or vaccines for TB.
Result?
• Man is doomed to reluctantly continue the use of a weak, 83-year-old vaccine, called BCG, in the name of prevention of TB.
• As for the diagnosis, there is no new test to replace the 124-year-old sputum smear test, which forms the basis of the latest TB program (RNTCP) in India.
• For treating the sick, no new drug has been invented in 40 years. Worse, from the R&D pipeline, none appears imminent.