THE BLOG

What Can We Do About Tuberculosis? What Would Pasteur Do?

10/25/2011 04:03 pm ET | Updated Dec 25, 2011

This afternoon I hopped off the train from London in Lille, France. Lille is a small town full of beautiful architecture, art, theater and people who this afternoon responded to my heinous French language skills with kindness and grace.

As I wandered around Lille at dusk I thought about Louis Pasteur. When Pasteur was named dean of the new Faculty of Sciences at the Université Lille in 1854, he opined, "Dans les champs de l'observation, le hasard ne favorise que les esprits prepares."

Okay, I didn't think this in French. I thought, "In the field of observation, chance favors only the prepared mind."

Eight years after telling it like it is, Pasteur fully formulated the germ theory of tuberculosis (TB), an infectious lung disease that can be transmitted simply by an infected person coughing, talking, laughing or breathing.

This got me thinking about New York and Texas.

Recently an unidentified person in Long Island, New York was diagnosed with TB. The school and the Suffolk County Health Department informed parents and staff quickly and screened for TB in all students and faculty.

In a similar case in a Texas high school 128 students tested positive for TB. There was shock in both cases that this "rare disease" could be allowed to spread. But TB is not rare. The germ that causes TB lives in one-third of the human population. And though it is completely curable and was well understood by a scientific giant like Pasteur, TB continues to take a life every 20 seconds. TB remains the leading killer of those with weakened immune systems due to HIV/AIDS and is a fully-fledged global epidemic.

In the New York case, some parents were angry that the TB-infected person had come into contact with 400 people at a school. One outraged mother angrily accused, "Shame on that person."

But that shame is misplaced.

People who have TB are often unaware of their infectious status or are misdiagnosed. Children are particularly susceptible to TB because their still-developing immune systems are less robust and common ways of diagnosing TB are especially ineffective in children.

A TB vaccine exists (Bacille Calmette Guerin, or BCG) -- named after Albert Calmette, a French bacteriologist and Camille Guérin, a veterinarian. BCG was developed right here in Lille at the Institut Pasteur de Lille in 1908 and it has saved lives -- but it is old and not always effective; only protecting from some forms of TB, such as TB meningitis. BCG also becomes less effective over time, typically wearing off with age.

And it was invented in 1908!

Diligent scientists are working on developing a new and more effective vaccine, but such work is under resourced, as is access to treatment and testing worldwide for TB.

Those students and others in New York and Texas were fortunate to have access to health programs in which testing, diagnosis, and treatment for TB isn't difficult. But millions of people, especially children, around the world do not have access to these resources. TB is a top 10 killer of children worldwide. It's estimated that one million children develop tuberculosis each year -- and more than a quarter of a million die.

This year the International Union Against Tuberculosis and Lung Disease (the Union) is holding its annual meeting in Lille -- which is how I ended up here. Perhaps coming to Lille was an effort to come back to the start and reflect on how far we have come, how many lives science has saved from TB. At one point in history, TB was the biggest killer of people in London. Now most people in London -- except for those who work in healthcare -- are probably unaware that TB still takes nearly two million lives every year.

Perhaps having the Union conference in Lille will also serve as a chance to reflect on the shame of the continued gross underinvestment by world leaders in this global health scourge.

This shame is well placed.

"Chance favors the prepared mind" means that using and creating evidence -- investing in better technology, more effective drugs, more accurate diagnostic tests and a vaccine that works all of the time in adults and children will not happen by chance. It will happen through investment and focus.

We won't stop TB in New York or Texas or London or Lille while it continues to spread elsewhere.