Earlier this month, a high school student in Joliet, Ill. tested positive for a highly contagious disease that has claimed more lives than any other throughout human history.
Many mistakenly believe this pathogen was eradicated decades ago. It not only still exists but is thriving, especially in some of the poorest countries around the world. The ability to monitor this disease, save lives and protect the health of Americans grows weaker by the day as the U.S. deprioritizes international funding to combat it.
It’s tuberculosis. Since its diagnosis in 1882, it’s killed more than a billion people — more than malaria, HIV/AIDS, smallpox, influenza, cholera and the plague combined.
Tuberculosis has taken the lives of notable figures such as Eleanor Roosevelt, Andrew Jackson, George Orwell, Frederic Chopin and Charles IX, among others. And it’s still being transmitted in astonishing numbers today.
Over 1 million people worldwide died from TB in 2023. Ten million had active symptoms the same year, including nearly 10,000 Americans, a number that’s been climbing steadily since the COVID-19 pandemic.
The U.S. Centers for Disease Control and Prevention estimates nearly 13 million people in the U.S. have “latent TB infection.” Up to 10 percent will develop active TB if they aren’t treated.
Despite TB’s existence for over 4,000 years, there’s still much we don’t know about it.
In his book “Everything is Tuberculosis,” author John Green gives a vivid account of the unpredictable way patients in poor countries react to TB infection. Some who are untreated or mistreated die within a few months; it kills others slowly, subjecting them to years of unspeakable pain and suffering.
Tuberculosis can also remain dormant for decades, even across a person’s entire lifetime.
A vaccine for TB provides some protection for infants and children, but is less effective for adults and adolescents. Leaders of every Western nation should question their priorities when, after a century-and-a-half, we still don’t have a modern vaccine that can prevent infection from the world’s largest pathogenic killer.
Green’s book chronicles the inherent challenges that poor countries, where transmission rates are disproportionately higher, face in fighting the disease.
These include widespread drug resistance to TB treatment, as patients are often prescribed the wrong drug regimen to treat their symptoms over and over again. Others stop taking their prescriptions altogether once they begin to feel better, which, akin to antibiotics, can lead to drug efficacy intolerance and the development of multidrug-resistant tuberculosis.
Additional factors, including deficiencies in early TB detection, which increase rates of disease transmission, and malnutrition, promote the disease’s unabated spread in densely populated areas.
Successful therapies to fight tuberculosis have been available for nearly 75 years, yet it remains the deadliest infectious disease around the globe. Over 150 million people have died since a cure has been found. Why?
Underinvestment in health care systems and limited access to treatment and services are to blame. Many countries simply don’t have the resources to cover the cost of proven treatments or the type of accurate testing that can diagnose TB early. And most patients who live in those countries can’t afford the drugs or the transportation required to receive medical services far from home.
Despite these challenges, global efforts to prevent, treat and test for tuberculosis in regions with high rates of infection have helped to save nearly 80 million lives over the past 20 years. Historically, the U.S. has been a major backer of these endeavors, contributing nearly half of all international support in 2024 alone.
Now, the U.S. is backing away from this commitment.
Cuts at USAID have halted TB diagnosis, service and treatment support around the world. The U.S. has also withdrawn from the World Health Organization, impacting the ability to track and monitor its worldwide spread in real time.
What’s more, a major U.S. program to combat tuberculosis that launched in 2023 is now in jeopardy due to delays in reauthorizing the President’s Emergency Plan for AIDS Relief while thousands of federal workers are being let go at U.S. health agencies. Important TB vaccine research at the National Institutes of Health is at risk of being suspended, too.
We should be investing in active monitoring, research and services, not decreasing or eliminating funding for tuberculosis control and treatment. If we pull away, it will fuel the spread of tuberculosis around the world and increase America’s exposure to infection.
As cases of measles — which the U.S. eliminated back in 2000 — rise across America, we should be mindful that other diseases, like tuberculosis, are lurking around the corner.
And our best shot at defeating them is to continue supporting measures to stop their transmission, both here at home and abroad.
Lyndon Haviland is a distinguished scholar at the CUNY School of Public Health and Health Policy.
