New Internationalist

Medicine

Issue 272

[image, unknown] New Internationalist Issue 272

Illustrations: DAVID LAZO AGUILAR

Deadly ambition

Bacilli and viruses live for fame and stardom. Every young germ aspires to bring down a Liberace or to be chased by Dustin Hoffman on the silver screen.

So pity the poor, ordinary tuberculosis bacillus. This boring bug has been around for millennia. It's been found in ancient Egyptian mummies and in the bones of South Americans who lived in 3000 BC.

Tuberculosis has seen better days. Mycobacterium tuberculosis used to be the disease of celebrities, killing off legions of famous poets, writers and musicians. Kafka, Thoreau, Keats, Poe, Orwell, Chekov and Chopin were all afflicted with the disease. It was the AIDS epidemic of our grandparents' generation with an added terror: this incurable disease travelled through the air.

But then, about 35 years ago, scientists discovered an almost perfect cure. If administered properly, this combination of medicines proved to be nearly 100-per-cent effective in obliterating TB bacilli from the lungs. The entire course of treatment -known as 'directly observed treatment, short-course', or DOTS - now costs as little as $13 in some parts of the world. It is considered to be one of the world's most cost-effective public-health interventions.

It seemed that TB's career was over for good.

But don't believe the reviews. The drugs have yet to be put to exten sive use throughout the world. Consequently, the TB epidemic never went away and has actually worsened, killing millions each year.

So why are people surprised to learn that TB kills more children, teens and adults than any other infectious disease? Why do they shake their heads in disbelief when they discover that TB kills many times the number of people who die from AIDS each year? Why are they shocked to discover that a third of the world's population - nearly two billion people - are infected with the TB bacillus? Why has this terrible germ still not been featured in a Benetton ad?

To answer these questions, we decided to ask the TB bacilli themselves. Through new - and otherwise useless - technology funded by a $2.5 billion grant from the National Institute of Health, it is now possible to communicate with TB bacilli.

TB Bacilli agree to talk to Johannes Chlamydia on the eve of their world tour

Illustrations: DAVID LAZO AGUILAR NI: We are surprised to find you here. Everyone told us that you had gone away.
Doug the Bug: That's a big myth. Every year we and our friends kill nearly three million humans. In the past decade we've caused over 80 million people to be sick, cough up blood and suffer with fever. We've been hard at work, but nobody pays any attention to our tragic performances.
Sherm the Germ: Yeh, our old friends, The Plague, travelled to India and killed 54 people last year. They caused pandemonium and mass evacuation.
Doug the Bug: The Ebolas visited Zaire and were an instant front-page success. During the time it took them to kill just 200 people we extinguished a quarter of a million lives. But nobody noticed us.
Phyllis the Bacillus: That's because Ebola bleeds them from the outside. The camera crews love it. We only bleed them to death from the inside.

NI: So fame continues to elude you?
Kim the Mycobacterium: We think we have figured out why our careers have hit hard times. Nine out of ten of us live in economically developing countries. Life is easy there and nobody hassles us. Many of those countries haven't invested in the effective and ridiculously cheap TB-control systems that can make our lives miserable. China, Tanzania, Vietnam and Nicaragua are among the few exceptions. I pity the poor bugs still trying to live there.
Doug the Bug: So the problem is, although we're causing lots of suffering, nobody pays any attention to our horrendous accomplishments in the South. No media coverage, no charity auctions and no protest marches. Nothing! It's as if we don't exist.
Phyllis the Bacillus: We decided we'd have to work harder to recapture the spotlight. We're doing a lot more travelling and trying to get booked in more cosmopolitan locations. The world is smaller now and it's easier to get around.

NI: What are your travel plans?
Phyllis the Bacillus: Romania for me. The deterioration of Eastern Europe's healthcare systems following the collapse of socialism is an open invitation to make a prolonged visit. Then it's on to Germany.
Sherm the Germ: I've been in England recently. Last Christmas I spent hours suspended, floating around in Heathrow, just waiting for someone with tickets to Bali or Honolulu to pass by and breathe me in. Instead I ended up in Birmingham.
Doug the Bug: I hear the United States is fun. Any country without a national healthcare system is an attractive place to raise a family. Besides, the dollar is quite favourable right now.

External aid flow vs. Deaths from infectious and parasitic diseases.

NI: Why is it that most governments and aid agencies don't seem to take you very seriously and continue to allow you to go about your own business?
Phyllis the Bacillus: That's because we suffer from an additional image problem. Not only are we found primarily in developing countries, but most of our victims are poor people. They can't afford TB medicine or proper treatment.
Doug the Bug: But we are in the process of trying to change that. We're beginning to recognize that it's not how many people you kill, but who you kill that's important.
Sherm the Germ: Exactly! The London press ignored us when we infected hundreds of homeless people. Only when we infected a few badgers on the Prince of Wales' estate did they start talking about us.

NI: So you intend to attack more celebrities?
Yvonne the Infection: We've been infecting sports stars, movie stars, musicians and politicians for years. The problem is, when they get sick they can easily afford treatment. Likewise, the élite members of governments aren't personally worried about us. Cancer or heart attacks worry them more. They spend public money on expensive medical equipment and hospitals to take care of the diseases that threaten themselves and their families. So far, knock on wood, they've continued to ignore the inexpensive strategies that could put us out of business for good.
Phyllis the Bacillus: But we think we've found a way to recapture the spotlight.
Doug the Bug:
We've been working real hard at becoming drug-resistant! Once the middle and élite classes can no longer cure us, they'll make a great deal of commotion and we'll be back in vogue.

NI: How do you intend to accomplish this?
Kim the Mycobacterium: TB bacilli throughout the world have learned how to hide in specific parts of the lungs during treatment. If the patient doesn't faithfully take all of his or her medicines for the entire six months, our strongest germs can survive in these hiding places and multiply in new 'multidrug-resistant' forms. The same medicines will no longer be effective the next time around. Then our new army of super bugs can fly out of the lungs and infect others when the host coughs, sneezes or even talks.
Phyllis the Bacillus: Fortunately, most health workers don't watch to make certain their patients are really taking their medicines.
Yvonne the Infection: So far our strategy has been very successful. We've become multidrug-resistant in thousands of people around the world, thanks to those governments who don't pay attention to treating us properly.
Phyllis the Bacillus: And someday soon we'll get our first big celebrity victim.
Sherm the Germ: Yes! Someone like Pavarotti! We'll have him bellowing out legions of deadly bacilli into the air when he sings!
Doug the Bug: Imagine the headlines!
Sherm the Germ: People wearing oxygen masks when they go out in public!
Doug the Bug: Benefit concerts for the mTB on MTV!
Kim the Mycobacterium: It will take at least a decade before researchers discover and test new medicines to fight multidrug-resistant TB.
Doug the Bug: And even then we'll be safe. They'll make the same mistake and fail to properly provide these medicines to poor people.

NI: Surely governments have learned from the AIDS epidemic and will not allow themselves to get tricked again by you nasty germs.
Phyllis the Bacillus: Don't underestimate humanity's apathy about the fate of low-income and disenfranchized groups. HIV had years to spread because the humans who control resources didn't care about the fate of gay men, IV drug users and Africans. We're using the same tactic. By the time middle-class citizens and movie stars start dying of multidrug-resistant TB, it will be too late to stop us!
Sherm the Germ: Our comeback is ensured!

Johannes Chlamydia is an ethical chiropractor specializing in the teleological suspension of public policy in Copenhagen, Denmark.

Illustrations: DAVID LAZO AGUILAR

ACTION

You can help prevent TB's return to stardom by contacting The Action Coalition, a grassroots advocacy network utilizing the Internet to mobilize a response to the global TB epidemic.

The Action Coalition,
19 Grant Avenue, Takoma Park,
MD 20912, USA.
Tel: (301) 270 5565.
World Wide Web at http://action.org/tuberculosis.html

©Copyright: New Internationalist 1995


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