The very first recorded case of tuberculosis was contracted by an Egyptian woman named Irtyersenu, who died around 600 BC. Interestingly, her disease stumped modern experts and academics for over a century. Pathologists originally determined her cause of death to be ovarian cancer sometime in the 1820s. It wasn’t until the 1980s that anyone disputed this, pointing to inflammation in Irtyersenu’s lungs as worthy of investigation.
In 2009, scientists finally determined the true cause of death when they found tuberculosis organisms in samples of tissue from all over Irtyersenu’s body. This discovery made her the first known victim of tuberculosis (commonly referred to as “TB”) ever described. Unfortunately, TB is still a deadly and rampant human affliction, claiming the lives of 1.7 million people in 2016 alone.
What Exactly Is Tuberculosis?
TB might be more common than you realize with an estimated one in three people on the planet infected with the mycobacterium that causes TB, a sort of precursor to the full-blown disease.
For the most part, these mycobacteria are contained in our lungs as harmless and dormant but potential precursors to active disease. Sometimes, when our immune systems are weakened enough, these dormant bacteria awaken and lead to active disease, usually infecting the lungs and, if unchecked, spreading to other parts of the body. This can cause a wide range of ailments, including genital TB, bone TB, and TB meningitis.
Nevertheless, in its most simple and original form, TB affects the lungs and causes symptoms such as a chronic cough, usually accompanied by a mixture of saliva, mucus, and blood from the respiratory tract known as “sputum,” as well as fever, night sweats, and weight loss.
One would think that one of the oldest and deadliest infectious diseases would have prompted prolonged efforts at a cure — and one would be correct, to an extent. The Bacillus Calmette-Guérin, (a.k.a. BCG) vaccine is one of the most commonly used vaccines in the world, and is used to specifically protect against tuberculosis. While vaccines are used preventatively, the only cure for active TB infections are antibiotic drugs.
While there is a cure and a vaccine, approximately 10 million people still contracted TB last year, many of whom died as a result of their affliction. The vast — and I mean vast — majority of fatalities as a result of TB occur in developing countries, with a wide disparity between infection rates in the US vs infections rates in many Asian and African countries, for example.
Socioeconomic Cause, Physical Effect
Paula Akugizibwe’s “The Exploitative History of One of the World’s Deadliest Diseases,” published via How We Get To Next, dives into the history of TB and how its spread is linked inextricably to colonial and racist ventures. Similarly, it examines which factors continue to contribute to TB’s status as a disease of poverty. She focuses tuberculosis in South Africa and its relationship to the colonial gold-mining industry, beginning in the early 1800s.
“By the early 19th century, TB was the cause of one in four deaths in England. The disease was so prominent in society that it became romanticized, influencing literature, music, and fashion trends. In contrast, rates of TB had been relatively low—by some accounts, nonexistent—in South Africa and other countries in the region during the same period.”
This was due, in large part, to the return home of English gold miners from South Africa. The process of mining gold produces toxic dust that contains particulate matter called crystalline silica. Without proper knowledge or preventative safety measures, men would inhale this dust in the mines, putting them at increased risk of TB.
“When white miners were diagnosed with TB, they were often referred to sanatoria supported by the mining companies and the government; black miners were instead simply returned to their home villages,” writes Akugizibwe. “This controversial repatriation system was a major channel through which TB was spread around the region—and it transferred the costs of the disease from the mining industry to the communities from which miners came.”
Unfortunately, because Johannesburg and South Africa presented a central hub for the economy, the disease spread beyond its borders quickly as workers from neighboring African countries and territories traversed the border back and forth for migrant work. While this slowly grew to become a pandemic, officials opted to keep mines open, positioning white workers in supervisory positions where the risk of disease was minimal.
Akugizibwe quotes Dr. Rodney Ehrlich of the University of Cape Town’s Centre for Occupational and Environmental Health Research. “It’s not ideological to say that [the mining sector’s] profits were maintained at the expense of black miners’ health,” he says.
Unfortunately, this plight isn’t unique to South Africa. India is currently dealing with its own occupational lung disease epidemic stemming from work in construction and mining, and they are not alone.
“You can substitute different diseases in different countries, but you are likely to see similar impacts on health as happened with circular migration in Southern Africa,” Ehrlich says. “Structural influences prevail, including huge inequalities within and across borders, because that is how our global society is organized.”
U.N. Resolution and Political Solution
Over time, a cure for TB was developed — but, because TB is a “disease of poverty,” there really isn’t a “market” for the cure, and it still tends to run rampant in developing countries. As such, tuberculosis research hasn’t come very far since the mid-1900s.
“While we’ve known how to treat TB for more than 40 years…the cocktail of drugs hasn’t developed much in that time, and the way to diagnose it has barely changed since the early 1900s,” writes Abigail Higgins with VOX.
This is bad news for the world, as TB left unchecked has given rise to multidrug-resistant (MDR) TB, and extensively drug-resistant (XDR) TB, two types of drug-resistant tuberculosis. While this has prompted new research, new medicines, and new money put toward TB research, there still is no silver bullet technology or cure that will help to stem the tide of TB.
As a result, the World Health Organization recently met in New York on September 26 to conduct its “first-ever high-level meeting on tuberculosis (TB)” with an aim “to accelerate efforts in ending TB and reach all affected people with prevention and care.”
The WHO website states that “the high-level meeting should result in an ambitious Political Declaration on TB endorsed by Heads of State that will strengthen action and investments for the end TB response, saving millions of lives.”
Fortunately, Akugizibwe agrees that this may be the only appropriate response.
“The factors governing investments in strengthening countries’ health care systems are incredibly complex, stretching across finance, infrastructure, education, and many other sectors,” she writes. “They are influenced by geopolitical hierarchies. They bring up murky questions around “governance and accountability,” whose answers differ from place to place. They lead us, once again, to the conclusion that global health problems need political solutions.”
This is a good start, but it remains to be seen whether it will actually be enough.