Tuberculosis has receded from the U.S. public’s mind as a perceived threat yet it kills 1.8 million people globally each year. In a New England Journal of Medicine paper, author Dr. Ronald Bayer, professor of sociomedical sciences at the Columbia University Mailman School of Public Health and co-director of its Center for the History and Ethics of Public Health, writes that while this lack of attention in the U.S. is understandable given its substantial decrease in disease burden here, it jeopardizes the prospect of eliminating tuberculosis. Dr. Kenneth Castro, an internationally recognized TB expert from Emory University, was Dr. Bayer’s co-author.
[Photo: Dr. Ronald Bayer]
Recent data from the Centers For Disease Control and Prevention (CDC) reported over 9,000 new cases in 2016 of which 68 percent were in foreign-born persons. In addition to the cases reported by the CDC, there are an estimated 13 million residents with latent tuberculosis infection which will ultimately develop in approximately 5 to 10 percent of the people. Thus, the importance of targeting prevention efforts at people with latent infection is clear. However, the challenge in the U.S. remains how to more effectively identify people with the latent infection and ensure that they receive the recommended treatment. Dr. Bayer points out the ethical and policy challenges related to identifying and treating latent TB which could inadvertently stigmatize immigrant populations.
While many public health officials, health care providers, and activists are committed to reducing the number of tuberculosis cases in the United States the response is not where we would want it to be. Dr. Bayer contrasts the outreach on TB to the mass movement that occurred when AIDS activists called on political, organizational, and financial resources to correct what was considered an inadequate response in the earlier days of the HIV/AIDS outbreak. “Our failure to meet the challenge with adequate resources,” says Dr. Bayer,” is from the perspective of public health ethics unacceptable. It is an abrogation of the core principle of social justice.”