Cape Town, South Africa — Alice Ndlovu has tuberculosis but, relatively speaking, she is one of the lucky ones. Hers is a strain that responds to the best medicines available, which also happen to be the cheapest. At 28, this single mom knows that without treatment she would likely die, leaving her child to face the orphanage in a country that already has a million orphans. “I still have six weeks’ treatment to go, but hopefully that will be the end, and I’ll be home. I will see my son grow up,” she told me at her home in a poor suburb of Cape Town.
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At least a quarter of the world’s population — overwhelmingly concentrated in poorer regions of the world — is infected with TB, which generally lies dormant until the carrier’s immunity is impaired by another disease. (Often, this is HIV.) Without treatment, about half of the patients with active TB will die. According to the World Health Organization, TB claimed 1.7 million lives in 2009, most of them in Africa.
The standard treatment for TB is long and complicated: It requires that patients take antibiotic combinations, at least 15 pills per day, over a six-month period. The side effects of treatment are unpleasant, including fever, vomiting, jaundice, and blurred vision. If treatment is stopped too soon or skipped, the bacteria that are still alive can become resistant, leading to a form of TB that is much more dangerous and difficult to treat. And in malnourished or weak patients, drug-resistant strains of TB can quickly become fatal.
Resistance-driven drug failure is largely due to patient noncompliance with the regimen prescribed. When patients start to feel better, they often stop taking the medicine before the TB is completely overwhelmed by the drug. As a result, the still-living strain develops resistance. This problem is not unique to the developing world. In fact, the same process is the primary reason that Western health-care systems are plagued by “superbugs.” But in Africa, inconsistent drug availability and inferior drugs that fail even when the patient completes the course of treatment compound widespread patient negligence.
Over the past few years, my research team has sampled the critical first-line TB medicines, Rifampicin and Isoniazid, from a dozen African and Asian cities. In the worst locations, such as the Congo, up to 30 percent of all TB drugs are substandard, with an average of about 8 percent across poorer markets. The drugs were underdosed in some way — some were falsified products, being passed off as something they were not, others were degraded due to poor storage. But the largest problem is sloppily made drugs, made by legal manufacturers in Africa, China, and (to a lesser extent) India. These underdosed drugs are harming patients and building drug resistance.
Aside from the health burden, the financial cost of treating TB is astounding. The total drug cost for the cheapest treatment is about $60, which is reasonable even for the poor in many countries. But treatment for resistant cases consists of a bigger range of less-effective drugs with more severe side effects for a period of two years, most of it spent in the hospital. This treatment costs no less than $15,000.
TB and malaria are diseases that the world medical community have had the ability to eliminate for decades. The reason both are still with us today has less to do with cost than politics.
Every 45 seconds in Africa, a child dies from malaria, yet we continue to ban DDT, the single most effective weapon against the cause of the disease, because we worry about its effect on birds. You would think the needless death of 700,000 black children every year, because of rabid environmentalism, would make the papers, but it doesn't.
You've probably already read the research done by Dr. Paul Farmer and Dr. Kim(?) in Lima, Peru on MDR TB and the treatment modalities that they found effective. Part of the problem initially was the resistance they met with from the World Health Organization and their insistence that patients follow a drug regimen that was actually producing MDR TB. Dr. Farmer founded Partners in Health, headquartered in Boston, and he has been successful in not only treating TB, but setting up medical facilities to do so, as well as providing numerous other medical services, in Haiti, South America and parts of Africa. He loves to discuss infectious disease with anyone interested. Get in touch with PIH, and I can assure you that he'll get in touch with you.
Perhaps the greatest crime against humanity is the banning of DDT. Rachel Carson became an uber hero for her borderline pseudoscientific work Silent Spring. I cannot necessarily blame her for writing but I do the politically activist scientific community that allowed her fiction to become mainstream environmental gospel. The global warming fantasy only costs us billions of dollars, but the environmental pseudoscience has lead to the deaths of untold millions from malaria, dengue, yellow fever and other vector borne diseases.
The environmental crowd view these as useful deaths because they are doting acolytes of Ehrlich’s Population Bombed Out theories equating every less human provides a more sustainable environment for the blessed elite to occupy.
The environmental sots are not alone in their willful hubritic driven destruction. NGOs across the globe funnel billions of dollars in effort to help the less fortunate of the planet in reality they are only funding the regimes that allow these tragedies to persist. TB is an entirely manageable illness with a functioning public health infrastructure. But any infrastructure needs a stable government, something never to be found in these corruptocratic wastelands of the 3rd world. Some minute local good is accomplished by the NGOs but their hard begged for monies mostly goes to fund the egos of the western rich and line the pockets of the 3rd world political elites.
Sounds crazy but likely if the NGOs went away, the corrupt regimes meet their fate and at some point functional local systems could arise from which they would eventually coalesce and be supported with gentle expertise allowing the locals to build viable infrastructure themselves creating an economic nidus from which expanded development could occur in these blighted lands.
