by Kevin Hurley

t seems someone forgot to tell Mycobacterium tuberculosis (the tuberculosis bacterium) that a new millenium is around the corner. Four-thousand-year-old diseases against which the human body has developed natural immunities, antibiotics, and vaccines are supposed to be thing of the past. In spite of our tremendous efforts and research, however, the once-dreaded disease tuberculosis (TB) is back. Moreover, it appears that the disease has brought along some very nasty friends, such as a new strain called multidrug-resistant tuberculosis (MDR TB), which is completely immune to both our natural immune responses and the medicines that normally treat TB. Note that TB is one of the most communicable diseases of all time—it can be contracted primarily through the air or through skin wounds and even via tattoos and circumcision.

Before twentieth-century medicine, nearly the entire human population had been exposed to TB in one form or another, yet only some 5 to 10 percent of the population developed the disease (which led to certain death). In 1924, however, the Bacillus Calmette Guerin vaccine pointed the way toward the first antibiotics produced in 1944. From 1953 through 1984, TB cases in the United States declined by approximately 5 percent per year. TB was easily eradicated worldwide in less than fifty years. In half a century, the scientific world had seemingly eliminated a deadly disease to which 90 to 95 percent of the world had spent thousands of years developing a natural immunity.

Researchers and hospital patients soon found out, however, that diseases can develop their own weapons against our vaccines and other cures. New strains of many bacterial diseases have swiftly multiplied through the human population. TB, for example, has adapted so well that between 1985 and 1991 the number of cases increased by 20 percent, developing powerful new strains that cannot be treated by existing vaccines or antibiotics. In 1995, the World Health Organization (WHO) has declared TB a global emergency, the first disease ever so designated by this council. Its scientists predict that between 1995 and 2005, three-hundred million people will contract TB, with possibly more than fifty million people of whom will contract MDR strains.

Now, before we begin buying our protective biohazard suits there are two things to recognize. The first is that the rise of TB seems to be correlated with the AIDS virus. In fact, some researchers have linked the emergence of MDR TB with HIV. In 1990, the WHO reported that 4 percent of TB cases worldwide were opportunistic infections brought on by HIV which otherwise not occur. By the year 2000, the WHO predicts that this rate will increase to 14 percent. In some regions in Africa, 30 percent of all TB patients are HIV infected, and HIV will account for nearly 10 percent of all TB deaths in Asia by 2000. As Michael Fumento’s article notes, AIDS cases are decreasing in the United States, which probably explains the lack of media coverage on TB. (Because tuberculosis is the leading infectious killer of AIDS victims, the lack of TB deaths confirms the rarity of AIDS victims in the U.S.)

The second thing is that although there is no vaccine or antibiotics for MDR TB now, there is a treatment for the new strains. It is called Directing Observing Treatment Short-Course (DOTS). Developed by the WHO, it essentially places the responsibility for a cure on the health system and rather than the patient. TB patients tend to feel better after just a few weeks of treatment and often stop taking their antibiotics, yet it takes several months to the rid the whole body of TB bacilli. DOTS treatment is requires health-care personnel to make sure that all TB patients take all of their medications until they are cured and all bacilli have been eliminated. It is the only TB-control strategy to produce 85 percent cure rates consistently. Unfortunately as of 1997, only 35 percent of all TB patients lived in countries where DOTS was available. This may bring on a highly dangerous scenario. MDR TB usually kills its host, but only after allowing the victim a few years of life—in which to spread the lethal germs to family members and the community. The number of infections and deaths could rise very rapidly.

While activists in Seattle attack free trade, the most infectious and deadly disease in the world is freely moving across all borders and into the United States. There have already been breakouts in New York City, but health officials were able to quarantine the patients and use DOTS to avert a major crisis. Unless we want to wait another two thousand years for our bodies to develop the natural immunities to fight MDR TB, such steps will become increasingly necessary even in the previously safe United States.

Kevin Hurley is a freelance writer in Indianapolis.

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