As a Canadian physician working in Africa in the early 1980s, Richard Menzies expected to see terrible hardship. But even he was shocked by what he found in the tiny southern state of Lesotho. “Tuberculosis is the number 1 killer there,” he says grimly. “They have a 33-per-cent mortality rate—it’s unbelievable.” Menzies went on to become an epidemiologist and respiratory specialist at the Montreal Chest Institute, and until the mid-1980s he believed that Canada, at least, was winning its fight against TB.
But when Canadian numbers stopped declining in 1987—they have remained at about 2,000 new patients annually since then—Menzies became concerned. In addition to recent surges in the Far North, TB cases are clustered among Canada’s immigrant communities, which account for more than half of the national total. And that, Menzies notes, is because too many other countries are losing the battle against TB: in the early 1990s, the rate of new cases in some African nations leaped by a stunning 300 per cent to 400 per cent. The increase was close to 30 per cent in parts of western Europe—and 20 per cent in the United States. By April, 1993, the Geneva-based
World Health Organization had declared the spread of TB a global emergency. The health watchdog now predicts that, by the year 2004, four million people will die of TB annually—unless governments do much more to treat and contain this ancient killer. “We cannot afford to turn our backs on this disease,” Menzies warns. “TB is very tenacious.”
To many health officials, lack of vigilance is at the heart of the TB epidemic. The advent of powerful antibiotic treatments in the 1960s lulled many doctors into complacency, and convinced governments to reduce funding. But TB has proven almost impossible to eradicate. Anywhere there is overcrowding, poor nutrition and inadequate medical care, TB is likely to flourish. AIDS, which greatly increases susceptibility to TB, is also fuelling new outbreaks, WHO officials estimate that one-third of the world’s population is now infected with the bacterium that causes TB—and that between five to 10 per cent are likely to develop the disease.
Health officials are particularly concerned about new drug-resistant strains. Although TB can be cured in 99 per cent of cases, patients must continue treatment for at least six months, and often up to a year or more.
Many, however, stop taking their pills as soon as they begin to feel better, giving partially treated bacterium the chance to mutate into antibiotic-resistant strains. When a major outbreak hit New York City in the early 1990s, an aggressive containment program was severely hampered by the fact that onequarter of the patients proved resistant to drugs. Although TB cases in New York subsequently declined, at least one resistant form of the bug has since found its way to Denver, Miami, Atlanta and Paris.
In an effort to stem the tide, WHO recommends a new approach to treatment, which requires health professionals to watch patients swallow their pills. A recent study in rural China using this method achieved a 90-per-cent cure rate, compared with about 50 per cent in previous Chinese programs. The cost of directly observed treatment in developing nations is about $15 per patient. Dr. Anne Fanning, director of tuberculosis services for Alberta Health and a longtime activist for TB control, believes that Canada has a duty to support such programs. “The World Bank has already said this is the most cost-efficient way to control TB,” she says. “If we want to do some good, this is the way.”
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