Global TB Control: Persisting Problem, Shifting Solutions

Tuberculosis, popularly known as TB, is a disease that has affected mankind for millennia. Robert Koch discovered the germ that causes TB over a century ago. Largely a disease of poverty, resource-poor countries carry most of the global burden of TB today. Although present in all parts of the world, TB declined speedily as socioeconomic conditions in the industrialized countries improved — even before drugs to cure it were discovered. Investing in TB control therefore raises an important question at the outset: why spend when the problem is known to disappear with socioeconomic development? Clearly, the price of not investing is too high. In addition, the reality is more complex: the perceived disappearance of TB from rich countries can be virtual rather than real. The notorious TB bacilli remain dormant in the human host only to resurface and multiply when the surrounding environment becomes favorable to them — weakening of body defenses due to any reason and poverty-related factors in general. Moreover, the tools for tackling TB available today allow us to diagnose and treat but not prevent it effectively from occurring. A disease that thrives among poor countries, persists in poorer settings among rich countries, and flourishes when economies and social conditions deteriorate can truly be called a barometer of development. Appropriately therefore, global TB control is among the targets and indicators to measure the progress toward the MDGs of 2015 (United Nations Statistics Division 2007; Dye et al. 2006).