Tuberculosis, a bacterial infection that affects the lungs, kidneys, bones, lymph nodes, and brain, can be greatly exacerbated by factors such as poor sanitation and high population density (slides 3 and 35). In fact, such factors are largely what made 19th Century America so susceptible to the disease. With immigrants coming to the United States in large numbers, tenements were extremely crowded, and their working conditions were poor (slide 49). 18,000 people even lived in cellar apartments with mud floors (slide 50). To make a bad situation even worse, there were oftentimes not any windows or ventilation (slide 53). With 8,000 to 9,000 annual deaths attributed to tuberculosis at the tie, most such deaths came in the poorest and most unsanitary areas of the city (slide 56).
Such problems still exist today and still increase susceptibility to tuberculosis. An additional, newer problem that also increases susceptibility is HIV (slide 97). However, a larger problem today when it comes to tuberculosis is drug resistance. Currently, there are 10 drugs approved by the FDA for use against tuberculosis. Patients receive multiple drugs and are to take these drugs exactly as prescribed. The problem lies in that some patients stop taking the drugs too early, leading to reinfection as well as the remaining live bacteria becoming resistant to the drugs (slide 92). For this reason, many patients are put on directly observed therapy (DOT), wherein the care provider personally observes the patient taking the medication until the treatment is complete. This has been shown to improve adherence and reduce drug resistance and treatment failure (slide 93).
With these factors being known at this point, why are we still facing a problem with tuberculosis today? The Lancet Commissions cites some reasons for this. For one, insufficient investment and political will: “Efforts have been hampered in low-income countries because of a failure to recognize the profound negative economic impact of the pandemic and to advocate for increased donor financing in high-burden” (p. 6). They also cite broken care cascades and poor quality of care, failure to optimize private sector engagement, failure to target resources at hot spots, drug resistance, and more. Thus, as partial solutions, they advocate using ‘network optimization and big data analytics to ensure all patients have access to services’ and ‘improving quality management to ensure high-quality service delivery’ (p. 14). They also suggest prioritizing high risk groups, as well, in order to find cases more quickly and hopefully reduce transmission (p. 17).