Tuberculosis: Treatable, Yet not Affordable
This month, the World Health Organization (WHO) released its Global Tuberculosis Report for 2023. The report, which covered how the tuberculosis epidemic has progressed in the last year, revealed several alarming insights about the prevalence of tuberculosis in the modern world. Despite its preventability, 2022 saw 7.5 million tuberculosis diagnoses, the highest number since 1995. This is especially puzzling as tuberculosis vaccines are used in most developed countries. However, a lack of access to these inoculations in countries with less established medical institutions has led to unnecessary outbreaks of the disease.
With the shadow of the COVID-19 pandemic still looming, tuberculosis has grown to become the second leading deadly infectious disease. At the UN’s September General Assembly, tuberculosis was discussed during that month’s High-Level Week. The UN is taking rising tuberculosis numbers seriously, given that the High-Level Week mandates higher levels of attendance than all other assembly weeks. Previous pledges to increase access by 90% to tuberculosis care as well as to ensure the availability of a new vaccine were reinforced. The world’s recent experiences with COVID-19 might lead some to expect that this urgency centers around the difficulty of curing or treating the disease, but the opposite is true — tuberculosis has been preventable and curable for years.
So what has made a disease that we have near-full ability to combat so threatening? Two factors are at play. Firstly, new strains of tuberculosis — as with any disease — are appearing, but they are becoming more resistant to basic antibiotics. The newest strain has been dubbed “drug-resistant” because of its ability to withstand the usual rifampicin prescription. Rifampicin was the “first line” of treatment for tuberculosis and the first step many had to begin fighting their infection. Now, though, the treatment is of little help, since the drug-resistant strain makes it largely ineffective. According to WHO, this means that around 410,000 people were left without basic medication for immediate care as of November 2023. This has disproportionately hurt areas of economic disadvantage.
Tuberculosis has largely been resurfacing in economically underprivileged areas within the Western Pacific, Africa, and Southeast Asia. In these locations, there is no longer an affordable and readily available treatment, meaning many infections end up spreading when they shouldn’t. While there are options available to treat new strains in wealthier areas, regions with lower levels of economic strength are feeling the brunt of a financing gap. According to WHO, $5.8 billion was spent in 2022 to cover treatment and diagnosis of tuberculosis, but $13 billion was needed for adequate coverage worldwide. For countries that have the money to spend, this gap is imperceptible. Those who can pay for their healthcare in a private medical system have access to other options, but in countries like Ghana, tuberculosis has become a looming threat.
This is largely due to the ever-prominent impact of wealth in determining medical accessibility. A tuberculosis diagnosis was already a dangerous prospect, but given the rise of drug-resistant tuberculosis strains, access to treatment has become a matter of privilege. According to the New York Times, Ghanaians are largely unable to pay for treatment. What access to medication that exists is currently provided by the Global Fund to Fight AIDS, Tuberculosis, and Malaria. Hapsheitu Yahaya, a hospital tuberculosis coordinator interviewed by the Times, stated “If our patients had to pay, we would not have one single person taking treatment.” Ghana’s wealth inequality is becoming health inequality.
There is a bright side, though. A new vaccine is in development that would specifically protect adults and teenagers from tuberculosis, given that existing tuberculosis vaccines are meant for infant use. This might alleviate the crisis in countries where vaccination at birth is not typically available. Furthermore, bedaquiline — a more expensive drug often used to successfully treat tuberculosis — might be available for use in less developed countries very soon. Johnson & Johnson, who hold the patent rights to the medication, recently signed an agreement with the non-profit Global Drug Facility. This agreement enables the non-profit to supply generic versions of bedaquiline to countries and communities in need. This could be the first step towards reducing the deadly impact of tuberculosis.
But one question remains: will medication developments reach the people whom they are designed to reach? Even if a new vaccine is developed and successfully combats the disease, how will the world enable its use in areas that cannot afford it? While it is promising that bedaquiline’s development means it will be available for more widespread use, the cost of the necessary six-month treatment is $272. This is a significant cost to individuals who reside in countries with lower levels of economic development. Without infrastructural changes that allow for both household incomes to rise and for medical treatment to be more accessible, these new changes could have very underwhelming effects. The wait to see a quantifiable improvement will be a difficult and deadly one.
(Photo Credit: National Child Welfare Association, Accessed through Library of Congress, Access Date: December 5th, 2023)