Ongoing epidemic remains among world’s deadliest

I am a GP in metropolitan Sydney. My patient, Rashid*, comes in today to talk about some recent stressors.
 
The man, who is originally from a developing country, has just received word that there is a steadily rising number of cases of an infectious disease in his hometown. His father has also recently tested positive and has no access to appropriate healthcare.
 
As the disease is highly infectious and easily spread through respiratory droplets, Rashid is worried that it will spread to the rest of his family.
 
It may sound all too familiar, but the disease is not COVID-19.
 
This is tuberculosis, an ancient disease that has stood the test of time.
 
While cases in Australia and many first world nations remain low, tuberculosis remains at epidemic proportions in developing countries, including our Pacific neighbours.
 
Despite advances in diagnosis and treatment, tuberculosis is one of the world’s deadliest infectious disease, even outranking HIV/AIDS and malaria among the world’s top 10 causes of death.
 
And while COVID-19 has now usurped tuberculosis as the deadliest single-agent infectious disease, the threat of tuberculosis has not been minimised. In fact, the COVID-19 pandemic has severely affected the global progress in tackling tuberculosis.
 
The diversion of resources to the current pandemic, as well as the lockdown measures, have significantly impacted the provision of tuberculosis diagnosis and treatment services in high-burden nations.
 
Tuberculosis treatment involves 6–12-month-long courses of multiple antibiotics, for which strict compliance is key for eradication. But, the decline in access to appropriate treatment in the past 12 months means that individuals are less likely to complete their treatment for active infections.
 
Many individuals with latent infections will also have reduced access to prophylactic treatment, which could increase their risk of progression to active disease.
 
More concerningly, the subsequent poor compliance to treatment is suspected to contribute to the rise of drug-resistant tuberculosis – a public health nightmare.
 
Aside from the drastic medical consequences of tuberculosis, the disease has potent adverse social and economic consequences with the loss of income and cost of treatment. These consequences mainly affect populations with existing poverty, further amplifying inequity and subsequently increasing the prevalence and burden of tuberculosis.
 
Poverty is widely regarded as a cause and consequence of this disease.
 
It is easy to ignore the ongoing threat of tuberculosis and its drug-resistant incarnation given that we rarely see it on Australia’s shores.
 
However, the low prevalence of tuberculosis in Australia does not alter the fact that our multinational patient population is still impacted by its ravages globally.
 
Like my patient, Rashid, we will be treating people who have a certain degree of connection to the disease overseas, as well as the additional challenges that arise with the COVID-19 pandemic.
 
Furthermore, the incidence of tuberculosis in our Aboriginal and Torres Strait Islander population is still six times higher compared to our non-indigenous population. This is a testament to the existing social disparity between the two groups and also an indication on how tuberculosis is greatly influenced by social determinants of health.
 
We can no longer afford to be ignorant. As doctors who hold a certain level of status within society, it is imperative that we lead the charge in advocating for awareness of this serious global health issue.
 
Today, 24 March, marks the World Health Organization’s World Tuberculosis Day.
 
We can start with educating ourselves and reaching out to patients who may be affected by tuberculosis. Given our background and education, we can also consider advocating for Australia’s continued support to tuberculosis research and development, as well as foreign aid to support developing nations’ health systems.
 
In my case, I have recently joined RESULTS, a non-partisan grassroot advocacy organisation, who are working with parliamentarians, other aligned organisations and the media to promote this cause.
 
As we approach the eventual and much-awaited end of the COVID-19 pandemic with the gradual rollout of the vaccines, it needs to be understood that other nations have an ongoing uphill battle with their own epidemics
 
The eradication of tuberculosis in these high-burden countries is impossible without the global efforts of more fortunate countries.
 
And if this COVID-19 pandemic has taught us anything, it is that with infectious diseases, it is not over until it is over for everyone.
 
*Rashid is a pseudonym that has been chosen to protect the identity of the patient.
 
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infectious diseases TB tuberculosis World Health Organization