World Tuberculosis Day. There Will Be More Pandemics… There Are More Pandemics!

[This article was originally published in Spanish in La Vanguardia.]

I have been listening (with mild irritation) to numerous national and international experts telling us that we have to start now to prepare for the pandemics of the future. They go on to explain that, while we don’t know when the next pandemic will emerge, we do know that it will. We must invest in science, they explain, to develop our capacity to respond more effectively to these pandemics that will strike us at some future, unpredictable time. While you will understand that I am the last person to contradict them, I would like to make a point about health threats and our collective efforts to put an end to them.

We are already living with pandemics that our globalised society has not been doing enough to combat; in fact, I would even go so far as to say that what has been done is ridiculously little in light of the research capacities generated in record time to fight COVID-19. Malaria, HIV and tuberculosis are good examples of pandemics that represent a serious public health problem in many countries and a considerable burden on social and economic development in many parts of the world. So, not only must we prepare for potential future catastrophic pandemics, we must also do much more to control the serious current pandemics.

Not only must we prepare for potential future catastrophic pandemics, we must also do much more to control the serious current pandemics. Malaria, HIV and tuberculosis are good examples.

Today, 24 March, is World Tuberculosis Day, when we commemorate the day German scientist Robert Koch announced his discovery of the pathogen that causes tuberculosis. Sadly, it is just that: the commemoration of a historic event that encourages us to survey the current situation, always beset by new health emergencies and new priorities. It is inexplicable that a public health problem dating from the palaeolithic era continues to kill some 1.4 million people every year. In 2020, which I hope will prove to be the worst year of the COVID-19 pandemic, SARS-COV-2 infection caused 1.82 million deaths. This figure is definitely an underestimation of the real number of deaths caused directly by the disease and it does not include indirect deaths.

While it is true that comparisons are odious, it is no less true that, if we want a more just and equitable world, all the world’s governments must invest their efforts (once and for all) in the fight against the other great pandemics, such as tuberculosis, that exact a toll in human life every year greater than that of COVID-19 in 2020. When COVID-19 has ceased to be a problem, tuberculosis (and the other major pandemics associated with poverty) will continue to plague humanity. Seen from this perspective, COVID-19 is like an acute injury that will eventually heal while tuberculosis is an open wound continuously spurting blood.

And why has hardly anything been done about tuberculosis? In this case, I use the phrase ‘hardly anything’ to describe the very small effort made compared to the resources we have shown can be mobilised in the case of the COVID-19 crisis. I can answer that question myself by paraphrasing James Carville: “It’s poverty, stupid”. Tuberculosis, like so many other major pandemics today, is a disease linked to poverty. The poorest countries disproportionately suffer the consequences of major pandemics (including COVID-19). In high-income countries, these ‘other major pandemics’ are no longer important public health problems.

And why has hardly anything been done about tuberculosis? Tuberculosis, like so many other major pandemics today, is a disease linked to poverty

Indeed, there are colleagues in my own faculty (medicine!) who think that there are no more cases of tuberculosis in Spain. (Approximately 4,500 cases are diagnosed every year.) The economic and health development of these countries is the key factor perpetrating the belief that malaria, tuberculosis and HIV are minor public health problems or even that they have been solved. These countries—the very ones with the capacity to dedicate greater resources to research and disease control—have other priorities. There is little incentive for the pharmaceutical industry to get involved because of the lack of a market offering attractive profits. The countries in need of improved vaccines, treatments and diagnostic tests for tuberculosis are precisely the ones (as ever) that lack the money they would need to compensate the pharmaceutical industry for the investment they have to make in advance. Nor do such countries have the cash to cover the cost of basic research or costly clinical trials themselves.

It is not only worrying that we have invested so little in the fight against these plagues. There are grim predictions about the impact of the COVID-19 pandemic on the control of diseases like tuberculosis. One study has estimated that there will be an additional 1.4 million deaths from tuberculosis between 2020 and 2025. This, together with decreases in the diagnosis and treatment of these patients, could represent a setback of some 12 years in our slow progress against tuberculosis.

A few days ago, I spoke to Margarita del Val and voiced my concern about the neglect of national tuberculosis control programmes and even research into this disease. She sounded a note of hope. She told me that she believed that all the knowledge generated by the massive scientific effort undertaken to combat COVID-19 will be partially applicable to the fight against other major infectious diseases and that the negative impact of COVID-19 will be compensated by the faster development of tools against other infections. I hope she is right!

There are grim predictions about the impact of the COVID-19 pandemic on the control of diseases like tuberculosis. It could represent a setback of some 12 years in our slow progress against tuberculosis

One thing is very clear: we do not have to wait for the next pandemic to strengthen and increase our commitment to research in infectious diseases and their determinants, epidemiological surveillance, and vaccine production capabilities, all the things that COVID-19 highlighted, all the things that will have to be fixed to correct our serious mistake of believing that infectious diseases were a problem of the past.