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andré picard

Over the centuries, it has had many monikers: white death, the white plague, the graveyard cough, phthisis and consumption, to name only a few.

But regardless of the name you give tuberculosis, it continues to evoke despair and horror.

While the ancient disease is now largely curable and no longer the universal scourge it once was (at one point, TB accounted for one in four deaths in the world), it still kills 1.8 million people a year and infects an estimated 10.4 million others.

Not to mention that more than two billion people – roughly one-third of the world's population – are infected with TB bacilli, the microbes that cause TB.

Worse yet, in an era where we are making tremendous advances battling infectious disease, TB incidence and mortality are on the rise.

If that were not bad enough, TB is getting harder to treat because of the emergence of antibiotic-resistant strains.

All in all, the World Health Organization's 2016 global tuberculosis report makes for some grim reading. It concludes the world is making "dismal progress" toward ending the global epidemic.

Yet, there are some glimmers of hope – chief among them that India is finally starting to take tuberculosis seriously.

One of the most startling figures in the WHO report is that India reported 480,000 TB deaths in 2015, up from 220,000 in 2014. At first blush, that may seem like a disaster, but it actually reflects the fact that data collection is improving, not that deaths are soaring.

The WHO has set a bold goal of cutting TB deaths by 90 per cent and new TB cases by 80 per cent between 2015 and 2030, and it is clear that will be impossible unless India, which has one-quarter of all the cases in the world, takes a leading role.

"India really needs to wake up to the enormity of the epidemic in the country," says Madhukar Pai, director of global-health programs at McGill University in Montreal.

Of the 10.4 million new tuberculosis cases worldwide in 2015, 2.8 million were in India. More than 40 per cent of those go untreated. This is particularly troubling because a person with active TB can infect 10 to 15 others in a year. (TB is caused by Mycobacterium tuberculosis, a pathogen that spreads through the air when people cough, sneeze or spit. Descriptors such as "white death" refer to the fact TB sufferers often have a ghostly, anemic pallor as they waste away.)

While TB is curable in most cases, the treatment isn't easy. The standard treatment is a six-month course of four antimicrobial drugs.

With MDR-TB (multidrug-resistant strains), it is even more onerous: a regime of 14,600 pills over two years, along with eight months of painful injections. Unsurprisingly, most people don't complete their treatment, which further fuels the spread of MDR-TB and increases the chances of more resistance developing.

Across the world, there are an estimated 580,000 cases of MDR-TB, including 79,000 in India and 53,000 in China. If we return to an era in which there are no effective drug treatments for TB, we are left with sanatoriums and quarantine, ineffective and costly approaches, and not realistic in a world where cases are counted in the millions.

In recent years, there have been tremendous strides in bringing down mortality and incidence of HIV-AIDS and malaria, but there has not been the same success with the third big global killer: tuberculosis. That is ironic given that TB is the only one with a cheap, effective cure.

But there are political reasons for this. AIDS and malaria are concentrated principally in Africa, in some of the world's poorest countries, where there has been a massive influx of donor aid, public and private.

While TB is also a disease of poverty, it tends to be concentrated in middle-income BRICS (Brazil, Russia, India, China, South Africa) countries and the response depends on domestic funding.

Most countries do a poorer job at dealing with inequality and poverty domestically than internationally. Canada is no exception; in this country, tuberculosis exists and spreads almost exclusively in isolated indigenous communities and in homeless shelters.

Of course, tackling the scourge of TB will require money. The WHO estimates that $8.6-billion (U.S.) annually is required for prevention and care, and $6.6-billion is currently being spent.

That's a big gap, but the shortfall needs to be met, lest we allow the white death to stalk the planet anew.

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