TB: The unheeded warnings

March 13, 1992

Q.: What happens when you cut the supports from a program to quell a deadly epidemic? A.: You get the problem back, in spades. That is what happened with tuberculosis, a plague that once sent health agencies into overdrive all over the world. It could have been prevented.

Physicians in New York were some of the first to see it coming. At Harlem Hospital, in one of the nation's poorest communities, health workers saw TB rates jump 50 percent from 1979 to 1980. They called for new funding, saying the situation could easily get out of control. In 1982, the American Lung Association warned the U.S. Congress that some states had dropped all tuberculosis funding, as if the problem, largely under control, had gone away. The association urged $15 million in new funding, but the Centers for Disease Control got only $1 million. Infection rates inched upward.

By 1988, the price tag had gone up to $154 million. But the Centers for Disease Control got only $73 million, less than half the requested amount, for a planned five-year program. TB cases kept rising, bringing down many people who could have been protected from the dread killer.

The problem is that tuberculosis poses more of a social challenge than a scientific one. Since the 1950s, antibiotics have made the disease curable for 98 percent of its victims. But it takes months of work to corral it. First health workers have to find those infected, who may not know they are carriers because the bacterium causing it often lies semi-dormant in a healthy person. Next, workers must visit sufferers and make sure they keep up the required dosage regimen. Failure to take the medicine regularly permits the bacteria to survive, and it comes back later in a much more virulent form.

In the poorest inner-city areas, where public-health programs are typically stretched thinnest, early-1980s cutbacks in health-care programs allowed tuberculosis to gain a foothold that expanded dramatically. When AIDS struck these same communities, tuberculosis erupted with a vengeance.

What must come now is increased attention to tuberculosis' resurgence. Federal moneys make up about 20 percent of the United States' total TB budget. The rest is state and local government money, difficult to increase because of revenue shortfalls. That's a recipe for disaster. TB, a bacterial disease, can spread more easily than the AIDS virus. If inner cities and other poor areas become repositories of TB, it won't be long before the disease escapes into many other areas.

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