We need people – people like those in TB Alert, who are focused and ambitious and care for people at grass roots in the UK, India and Africa. Dr Lucica Ditiu, Executive Secretary of the Stop TB Partnership
In 1854, Hermann Brehmer introduced the concept of fresh air, good nutrition and isolation in sanatoria, in an attempt to cure TB for the first time. This model was based on his own experience of successfully recovering from TB, after spending time in the clear air of the Himalayas. Treatment in sanatoria, and a gradual improvement of living conditions, started a slow decrease in TB cases in the 1900’s. This fall in cases accelerated dramatically as innovations in diagnosis and treatment were born out of this new, scientific age.
In 1882, Robert Koch discovered M. Tuberculosis; in 1895, Wilhelm Konrad Röntgen discovered X-rays; and in 1908 Albert Calmette and Camille Guérin built on Louis Pasteur's principle of vaccination to develop the Bacille Calmette-Guérin vaccine against tuberculosis.
In 1944, Schatz, Bugie, and Waksman reported their discovery of the first medication shown to be effective against Mycobacteria tuberculosis, Streptomycin. This was a huge step forward, though the benefits of Streptomycin were limited by its toxicity and the ability of TB bacteria to develop resistance. Then, two years later, para-aminosalicylic acid (PAS) – a new medication developed by Jörgen Lehmann, began to be used alongside Streptomycin. Again, the benefits of PAS were short lived, as Mycobacterial resistance developed to this medication as well.
In 1951, scientists at Germany’s Bayer Chemical, and two US pharmaceutical companies, Squibb and Hoffmann-La Roche all discovered Isoniazid – at the same time. Isoniazid proved to be powerful, safe, and inexpensive.
Following this, Sir John Crofton, a TB expert at the University of Edinburgh, proposed that a combination of these three medications could completely cure TB if used from the outset of an individual case. This radical approach, which halved TB notifications in Edinburgh over a three year period, was initially met with disbelief, but Sir John's findings were soon replicated in a large scale international trial. As a result of combined therapy, sanatoria closed and earlier interventions to attempt to treat TB, such as thoracoplasty, became obsolete.
In the mid-1960s, modern ‘short-course therapy’ was introduced, using the newly available Rifampicin and the reintroduced Pyrazinamide – an old, toxic medication that was given a new ability to treat TB under the combined therapy model. This remains global gold standard treatment today. Though effective, there are more people infected with Mycobacterium tuberculosis in the world than ever before.
The opportunity to eradicate TB was simply never realised, in part due to the inherent limitations of current TB tools for prevention, diagnosis and treatment; the failure of national and international policy for TB control; and the arrival and spread of HIV.
Today, cases of TB are declining on a global scale, in part due to the enormous efforts made towards preventing the spread of HIV. Yet TB remains one of the leading infectious disease killers around the world and increasingly, the emergence of drug-resistant strains of TB, threatens a return to a time when we were unable to control TB.
Find out more: