History of TB policy shows need for care, investment equity in developed, developing countries

In a 200th anniversary article for the New England Journal of Medicine, Salmaan Keshavjee of the Department of Global Health and Social Medicine at Harvard Medical School and Paul Farmer of Partners in Health "seek to elucidate the reasons for the anemic response to drug-resistant tuberculosis [TB] by examining the recent history of tuberculosis policy," they write. The authors outline the history of TB drug development and how the disease became resistant to myriad drugs, and write that by the 1970s, "[t]uberculosis, whether caused by drug-susceptible or drug-resistant strains, rarely made even medical headlines, in part because its importance as a cause of death continued to decline in areas in which headlines are written. They continue, "In the United States, federal funding for tuberculosis research was cut; consequently, drug discovery, development of diagnostics, and vaccine research ground almost to a halt."

"But tuberculosis, which persisted in settings of poverty, could not be hidden away for long," Keshavjee and Farmer write and discuss the emergence of multidrug-resistant TB (MDR-TB). They examine how the medical policy responses for detection, diagnosis and treatment differed in the U.S. and under the WHO's leadership worldwide and note that by the end of the 1990s, efforts were made "to encourage and learn from pilot projects for treating MDR tuberculosis," and "[t]his coincided with a grant from the Bill & Melinda Gates Foundation to scale up treatment of MDR tuberculosis [worldwide] and to change global policy." According to the authors, "The history of divergent policies for combating drug-resistant tuberculosis shows that decades of clinical research and effective programs in high-income settings did not lead to the deployment of similar approaches in settings of poverty." They conclude, "Stinting on investments or on bold action against tuberculosis -- in all its forms -- will ensure that it remains a leading killer of people living in poverty in this decade and the next." NEJM also includes a timeline of TB history (9/6).