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23rd March 2016

Turning the tide against TB

TB kills three people per second. In small towns like Firozabad, the dreaded lung disease is a hazard of daily life – but there is reason for hope

The Indian town of Firozabad hosts a network of small family business making artisanal glass bangles based on time-honoured traditional techniques handed down through the generations. It may sound romantic but the reality is far from idyllic.

While glass-making has been a household craft for as long as anyone in the town can remember, it comes at a cost. People of all ages work with glass and chemicals 15 hours a day for less than €1.50 per shift. And the price of handling these hazardous materials and spending all day by a furnace is workers’ health.

‘I have been a doctor in this city for more than 30 years now,’ says Dr Surinder Pal Singh Chauhan. ‘Most of the patients that I get for chest and lungs disorders are those who work in glass-bangle units.’

It may sound like a scene from the industrial revolution – before labour laws and safety standards became the norm – but Dr Singh Chauhan describes India in 2016.

‘They mostly suffer from tuberculosis or other fatal infections of the lungs and chest.’ His testimony offers an insight into the impact of tuberculosis – or TB – on the modern world.

TB is an infectious disease, spread by bacteria, which primarily affects the lungs. Left untreated, it kills around 50% of those infected. But the disease is not exclusive to the developing world. At the end of the 20th century, experts thought TB had been successfully defeated in most Western countries thanks to antibiotics as well as improved healthcare and living conditions. Yet it has returned to European cities – often in a form that is resistant to treatments.

To mark World TB Day, the World Health Organisation is calling for fresh commitments and action in the global fight against a disease that affects 9 million per year, causing 1.5 million deaths. That’s 1.5 million people. Gone. The campaign to Stop TB estimates that the disease kills three people per minute.

So how do we win?

It’s a huge challenge but there is reason for optimism. Technological advances promise progress in three key areas: prevention through vaccination; swift and affordable diagnosis; and new treatments for those who are infected.

One of the big problems with diagnosing TB is that it takes time. The bacteria that cause the disease can take weeks or months to grow in the lab. Then scientists can figure out what type of TB is present, allowing doctors to choose the right treatment.

But researchers around the world have been working on ways to cut diagnosis time dramatically. A study earlier this year showed that a new kind of magnifying device could allow doctors to diagnose TB much more quickly.

Another new tool provides hospitals with free access to a website that will tell them which antibiotics to use. This is valuable information because some forms of TB are resistant to certain antibiotics. Using the wrong medication not only misuses scarce resources but also wastes valuable time, delaying the patient’s recovery.

One-time treatment

Even when the right drug is used, treating TB takes months and can be very uncomfortable and inconvenient. As a result, patients often do not stick with their prescribed treatment.

But what if several months’ worth of drugs could be administered in one go? Researchers are developing a new drug implant that would slowly release a six-month supply of antibiotics.

The drug delivery system would be implanted under the patient’s skin. This one-time intervention removes the risk of patients leaving treatment programmes before they are complete.

The really smart part is what happens to the implantable device after the course of antibiotics is finished. Rather than having to perform another surgery to remove the device, it simply biodegrades, forming non-toxic substances that can be resorbed by the body.

TB is an enormous problem that will require new thinking from right across the healthcare and technology system. But progress is possible – offering hope to the millions of people in places like Firozabad where TB is a daily threat.