Wednesday, March 24, 2021

Surprise! It's #WorldTBDay

Kate O'Brien, Alexis Cosse, and Cindy Levin share a
zoom screen to meet with Congress on World TB Day

Have you ever almost forgotten to observe a holiday? Like, it comes around every year, but sneaks up on you when you're not paying attention? Those times can leave moms scrambling to reserve a Passover brisket or making a late-night CVS run to fill some last minute Easter baskets. Well, I've got my eye on those two events, but today snuck up on me. Today is World TB Day!

Luckily, my RESULTS colleague Crickett Nicovich asked me to fill in for her World TB Day congressional meetings because she (having NOT forgotten the annual event) was double-booked. No problem! I did not want to forget to take action on this day, which brings attention to one of the most neglected diseases on Earth. Among all the global health issues I cover, tuberculosis is the one I most want to talk about in this moment. Why? Because TB sits at the intersection of great need, great injustice, and great opportunity.

Why does TB have its own day?

The UN SDG logo with 
"End TB" in the center

Even though most Americans think the world got rid of TB long ago, it is a leading infectious disease killer. Only in November 2020 did COVID-19 surpass tuberculosis. Nonetheless, TB is still reigns supreme in low and middle-income countries. In 2019, an estimated 10 million people were sickened by this bacteria-driven illness and 1.5 million were killed by it. Now? Well, the data isn't all in yet, but modeling suggests disruptions in diagnoses and care during the pandemic have caused an increase that will cause an additional 6.3 million to contract active cases and an additional 1.4 million to die in 2021.

Like COVID-19, tuberculosis is an airborne disease. Unlike COVID-19, there is no effective vaccine for adults yet. The most common vaccine used for it is most effective for children, but that means TB hits people ages 15-45 (young adults, parents, and breadwinners) particularly hard. 

So, why doesn't anyone talk about TB the way we focused on COVID-19? Because it is a disease of poverty. Even though it is present in wealthy countries, it doesn't affect their citizens very much at all. This is the "injustice" part. It runs rampant in low-income countries and has hot-spots in impoverished areas of middle-income countries. When a disease no longer affects wealthy countries, our governments tend to ignore problems that greatly affect the global South, Black and Brown populations, and impoverished nations. 

It is both a major consequence and a driver of poverty. The reason RESULTS got involved at all with tuberculosis years ago is because the organization was working on microcredit loans for women in extreme poverty. The biggest reason women couldn't pay back loans was because TB sickened them and they couldn't work. If we can stop TB, we can remove a major barrier keeping millions of people trapped in poverty and allow them to rise out of poverty with dignity.

TB in the United States

My meetings today were a crash course in tuberculosis education from a patient perspective. Kate O'Brien and Alexis Cosse were my partners. Kate suffered through TB as a pregnant mother in New Jersey in 2014 with an active case that ultimately cost her a lung.  Alexis' daughter was adopted from Ukraine after surviving Multi-Drug Resistant TB as a six-month old baby. She required extensive care during her recovery involving months of pills and in-home visits. Both women described their surprise back when they first learned that TB was such a problem worldwide and realized that it is in every state in the U.S., too.

Kate, Alexis, and Cindy in Zoom windows
talking to Senator Josh Hawley's aide
The majority of TB cases in the U.S. are "latent" and can exist without causing a body any problems. But a life change can cause the disease to activate and become highly contagious. There are about 9,000 active cases reported annually in the U.S. In a meeting with Senator Josh Hawley's aide, Kate said, "When my immunity changed because of my pregnancy, my latent TB changed to active. At least 13 million Americans have latent TB and there are a lot of things that can cause it to 'wake up.' Medication for diabetes, rheumatiod arthritis, Crohn's disease, Lupus...anything that lowers your immunity can trigger an active case. Aging can do it, too, which is why we see it in elder care facilities.

Alexis helped her daughter recover from TB in the United States, but the international adoption opened her eyes to the vast problem worldwide. She told Senator Roy Blunt's aide, "To think that we have this highly infection disease sitting as an isolated pocket's just a fools folly. Any disease is a global disease. But this can be a beatable disease and a conquerable situation."

Why push on TB now?

While COVID-19 has set back progress on TB, it is also the reason this moment is so promising. The world has woken up to the reality of pandemics. We all know firsthand what sacrifices we pay as individuals and nations when we are isolated and unable to function. If we can turn that empathy into political will, we can move mountains. 

But emotional empathy isn't even the biggest reason to invest more now. Technical advances are available that we had only dreamt of before. We now know how quickly the world can move to develop safe, effective vaccines when we focus attention and resources on it. Plus, we have exciting possibilities to make progress on TB and COVID-19 simultaneously.  The highly communicable, airborne nature of TB made all of our previous investments applicable to fighting COVID-19. TB programs have been the backbone of the COVID-19 response because they placed needed, trained personnel and equipment in strategic locations around the world. As we continue to build back, we can fight both of these diseases together. For instance, India is starting to scale up a procedure that will test for both TB and COVID-19.  

What can YOU do to end TB?

You can help our dream team of TB advocates by contacting your members of Congress. After all, we can't be everywhere at once! Tell your U.S. representatives and your two senators that we need a bold, increased commitment to fill the gaps from 2020 and continue our progress. In all of our meetings today, we asked our elected officials to commit to $1 billion for bilateral USAID TB programs and $225 million for the CDC's TB program. This will help us live up to the promises made by the U.S. and other nations of the UN to treat 40 million people with TB, including 1.5 million with drug resistant TB, and provide preventative treatment for 30 million people. Ultimately, hitting all those goals will bring us closer to a future day when no one has to worry about missing out on advocacy for World TB Day because it will only be a celebration of the day we ended tuberculosis!