TB Incidence Rate
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IN THE SMALL, DUSTY, DISTRICT HOSPITAL IN TEMEKE, TANZANIA, head nurse Sarah Wilson Ochogo is carrying out her morning ritual. She drags a table outside the hospital's tuberculosis
(TB) unit, sets out big, white, plastic bottles of pills, and opens a pencil-lined ledger that tracks her patients, their
drugs, and their doses. By seven, more than 100 patients are lining up. They place their green patient cards under a stone
near the table, and sit down on wooden benches to wait until Ochogo calls their name, gives them their medication, and watches
while they take it. By a bit after nine, the patients are off to their daily routines—drawing water, tending crops, or just
getting by the way people always have in Africa. And all of them, with luck, are one more day closer to curing their TB.
Throughout Africa—indeed, throughout the world—the same ritual is taking place, as healthcare workers deliver TB drugs to
millions of patients spanning countries, languages, and cultures. It's called DOTS—"directly observed short-course treatment"—and
it is the internationally recommended strategy for TB control, put forth by the World Health Organization (WHO). Patients
in DOTS take a two-month daily course of the antibiotics rifampacin, isoniazid, pyrazinamide, and ethambutol, followed by
either four months of rifampicin and isoniazid, or six months of isoniazid and ethambutol.
Certainly, the DOTS strategy aims high: to ensure that patients take their drugs in the same, correct way and for the full
course of treatment. That's partly to ensure that they recover—but partly to protect against half-completed treatment that
gives rise to mutated, drug-resistant strains of the disease, which are more difficult and expensive to treat.
From AIDS to TB
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When we think of TB epidemics, we tend to think of the past, especially the great epidemic that swept Europe in the 19th century.
But in fact, TB is one of the world's great killers again: Two million people die each year from the disease. WHO estimates
that more than two billion people worldwide, or one third of the world's population, carry at least a latent TB infection.
And the AIDS epidemic is making it worse. TB accounts for a third of AIDS deaths worldwide; the co-infection is commonly referred
to as the "deadly duo." In 2004, an estimated 14 million people were living with dual HIV and TB infections. Seventy percent
of them were African.
Drugs are available and cheap—a six- or eight-month course of treatment procured through generic Indian manufacturers costs
about $10. The guidelines for DOTS administration are well known. The supply-chain management for the procurement and administration
of the drugs is in place, with tight controls to prevent diversion. There's just one problem: It isn't working. Millions have
died and millions more are dying. And in the past few years, pharma companies have discovered that there is a real role for
them to play in fighting TB. Several factors play into that realization:
- Globalization is transporting diseases from one part of the world to others. That has already happened with TB in New
York City, where infected immigrants are thought to have contributed to the resurgence of the disease in the late 1980s.
- TB is a death accelerator of AIDS patients, making it a global health priority, and a target of the United Nation's Millennium
Development Goals. The public and other stakeholders will likely exert pressure on the industry to contribute its technical
and public-health expertise.
- The growing number of bacteria resistant to today's TB therapies has given pharma a clear-cut role of bringing its unique
skills in drug discovery to the table.
- Academics and nonprofits are settling into a new way of partnering with industy that allows them less costly and risky ways
to participate in the search for new TB drugs.
- Governments and other third parties will increasingly look to pharma's infrastructure initiatives, many of which were established
to fight AIDS, to help manage the TB burden.
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