REMEMBER when lots of people died of ordinary bacterial infections? Probably not, unless you were around before the 1950s. That鈥檚 when antibiotics stopped the rot, at least for the world鈥檚 better-off.
The bad news is those days are returning. Tuberculosis has broken free of antibiotic control, a fact that could affect us all. The bacterium that causes TB is staggeringly common, infecting one-third of humanity, lying in wait for a chance to erupt into disease. Last year it erupted in 9 million people and killed 1.6 million, putting it among the world鈥檚 biggest causes of death.
Since the 1980s, TB has been creeping back. It is, for example, the biggest killer of people with HIV. But only 12 per cent of TB sufferers also have HIV, so this is not the main reason for its resurgence. TB has thrived in the mushrooming urban slums of poor countries and grown among poor communities in rich countries as those nations dismantled public health systems designed to eradicate TB.
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We have not taken it lying down. The World Health Organization will report this week that rates of disease and death from TB have finally started to fall worldwide. The problem is that the fight has been waged with antibiotics, and inevitably resistance has emerged. The TB bug developed resistance to the most common drugs in the 1990s. Now, some strains 鈥� known as extremely drug-resistant, or XDR 鈥� have shrugged off many of the remaining anti-TB drugs. This week we report the arrival of CDR, or completely drug-resistant, TB (see 鈥淭he white plague鈥�). Doctors cannot hammer these bacteria with new drugs or vaccines because no companies have developed any. There are few profits in diseases of the poor.
At least today organisations such as the Bill and Melinda Gates Foundation are spending large sums to find ways to stop TB. Before any remedies emerge, however, XDR-TB will spread: research in China shows it does so just as easily as ordinary TB. This does not bode well. TB resistant to one or two drugs grew from a few cases in the 1990s to one-fifth of cases today. XDR-TB is likely to do the same. It is now poised to rip through the millions of African people who have HIV.
This is not just one more disease of Africans, though. While drugs take years to cure TB, they do make people non-contagious fairly quickly. If the drugs don鈥檛 work people will stay contagious longer. TB will escape its ghettos.
We thought we had beaten TB. Now it is back and we are almost defenceless. On every level this is because the world neglects diseases of the poor. At this point an editorial usually says what needs to change. You work it out.