About the Director

Fighting the White Plague

Ann M. Ginsberg, M.D., Ph.D., Christine Sizemore, Ph.D., and Anthony S. Fauci, M.D.
National Institute of Allergy and Infectious Diseases
National Institutes of Health

The World Health Organization estimates that 1,500 people die each hour from an infectious disease. More than a third of these deaths are due to a deadly triad of three diseases: the acquired immunodeficiency syndrome (AIDS), tuberculosis (TB) and malaria. We are reminded of these grim facts today, World TB Day 2001, as the public health community focuses on one of the “big three” infectious killers.

It was on this date in 1882 that Dr. Robert Koch announced the discovery of Mycobacterium tuberculosis, the bacterium that causes TB, or the “white plague” as it was then known because of the markedly pale appearance of TB sufferers. Dr. Koch’s discovery was the first step toward developing tools to control the disease. Today, we acknowledge his accomplishments and those of innumerable other researchers, physicians and public health workers who have battled TB. At the same time, we renew our collective resolve to defeat a scourge that remains one of the greatest threats to human health.

Although we have effective drugs to cure most cases of TB, the disease is still ravaging much of the world, especially Africa and Southeast Asia. Other regions, particularly Eastern Europe, are suffering numerous TB outbreaks. Worldwide, TB deaths are increasing for the first time in almost 40 years. TB now kills 2 million people per year -- even more if one includes the almost 20 percent of HIV-infected individuals who die with active TB. One-third of the world’s population is infected with M. tuberculosis, and one in ten of these people will develop active TB at some point during their lives. Perhaps most worrisome, new strains of M. tuberculosis resistant to standard anti-TB drugs are spreading throughout the world, making a cure far more costly and often impossible.

There are diverse and compelling reasons to aggressively address this epidemic. The huge toll in suffering and death, particularly in developing nations, demands action on humanitarian grounds alone. Furthermore, TB, as well as AIDS and malaria, threaten the economic development and political stability of many of the world’s most vulnerable nations, some of which are of strategic interest to the United States. Apart from the enormous global impact of the TB epidemic, the disease also has important implications domestically. According to provisional data from the Centers for Disease Control and Prevention, there were 16,372 reported cases of TB in the United States in 2000; an additional 10 to 15 million people in this country are infected with M. tuberculosis and may develop active TB at some point in their lives. Multi-drug-resistant TB has been reported in 43 states and the District of Columbia since 1988. The Institute of Medicine’s recent report, “Ending Neglect: The Elimination of Tuberculosis in the United States” cautions against complacency regarding TB, reminding readers of the increase in U.S. TB cases that occurred in the late 1980s and early 1990s, costing New York City alone more than $1 billion over a five-year period to control. We are at a critical juncture, the IOM report argues, and should commit to eliminating TB as a public health problem.

This is an achievable goal, both in the United States and, ultimately, worldwide. We are fortunate to be in an era of unprecedented scientific opportunity. Of particular note, the recently available sequence of the entire human genome will allow unique insights into the body’s ability to respond to pathogenic microbes such as M. tuberculosis. In addition, the availability of the genomic sequence of M. tuberculosis will provide access to new targets for diagnostics, therapeutics, and vaccines as well as important information concerning the genetic basis of resistance of the microbe to anti-TB drugs.

The development of a safe and highly effective TB vaccine is a critical research focus, as currently available TB vaccines have limited efficacy. The National Institutes of Health together with other agencies of the Department of Health and Human Services have developed a blueprint for TB vaccine development, and a number of promising TB vaccine concepts are in various stages of development. These research efforts should be sustained and accelerated. Concurrently, anti-TB drugs must be made available -- and properly administered -- to people with TB in all nations, and new antibiotics developed to cure tuberculosis and prevent transmission of drug-resistant TB.

Ultimately, better control and even elimination of TB worldwide will require a marriage of modern scientific advances, classical public health measures and the strong commitment of the international community. History will judge us harshly if we do not capitalize on unprecedented opportunities and act aggressively to rid the world forever of this ancient killer. Let us use World TB Day as a reminder of this critical responsibility.