Photo: David Gough/IRIN
TB patients waiting in a hospital in Khayelitsha, Cape Town


LONDON, 17 February 2012 (IRIN) – A hundred years ago there was no way to treat tuberculosis (TB) except with rest, fresh air and nutritious food. Forty years later the discovery of antibiotics transformed treatment and TB has been a curable disease for more than half a century, but the disease still kills nearly 4,000 people a day. The goals set by the World Health Organization (WHO) to halve the incidence of TB by 2015 and eliminate it as a public health problem by 2050 seem far out of reach.

Mario Raviglione, the head of the WHO Stop TB department, told a meeting of TB experts in London on 15 February: “The incidence is coming down at one percent or so a year, which will ensure TB elimination in several millennia, in my perception.” 

TB is a disease often associated with poverty because latent infections are more easily activated by malnutrition and lowered immune systems, and more quickly passed on in badly ventilated, overcrowded living conditions. As people in Western Europe got richer, ate better, and housing conditions improved, TB became increasingly rare, even before there were effective drugs to treat it. 

Now there is interest in seeing whether a new generation of social protection schemes, aimed at reducing poverty and often using cash transfers to the poorest, can be harnessed to bring down the rate of TB in developing countries. 

Brazil has achieved a steady decrease in TB and has halved the death rate since 1990, despite not achieving the conventional benchmarks for a successful control programme. 

Draurio Barreira, who coordinates Brazil’s national programme, told the meeting: “To control TB they say we need to detect 70 percent of those infected, treat and cure at least 85 percent of those… and have default rates not bigger than 5 percent. In Brazil we haven’t reached many of these standards, but we have had very good indicators in TB for more than 15 years. So how we can explain that?”

He attributes the achievement to political commitment. “The big news was the transformation of social policy… by a real increase in minimum wage, and cash transfer programmes for the poor – in the last sixteen years poverty in Brazil decreased by 67 percent.” And, just as in Europe in the 1800s, as poverty declined, TB declined as well.