Thanks to Greg Folkers for sending the link to this report in the European Respiratory Journal: A tale of two global emergencies: tuberculosis control efforts can learn from the Ebola outbreak. Excerpt:
In 1993, the World Health Organization (WHO) issued a press release announcing that tuberculosis (TB) was a global emergency, making it the first infectious disease to be declared as such. Although progress has been made, no country has eliminated TB and there are 3 million missed TB diagnoses each year .
The term global health emergency has since evolved and most recently, the term “Public Health Emergency of International Concern” (as defined by the International Health Regulations in 2005) was applied to the Ebola epidemic in West Africa, which has caused over 11 000 deaths . Ebola control efforts are now focussed on getting to zero cases.
Yet, while huge public interest has focussed on Ebola, TB is bereft of public attention despite causing 1.5 million deaths since the Ebola epidemic began a year ago.
The WHO End TB strategy boldly aims to end the global TB epidemic by 2035 and envisions zero deaths, disease and suffering . TB elimination is not a new concept but national preparedness plans are currently inadequate . Although the epidemic trajectory of an emerging disease such as Ebola differs from that of a chronic pandemic such as TB, the implications of delayed recognition, poor infection control and pressing diagnostic and therapeutic challenges provide many parallels between the two infections. Thus, TB control efforts could learn valuable lessons from the recent experiences gained during response to the Ebola outbreak.
Appropriateness of local and global health response The magnitude of the Ebola outbreak in West Africa highlights the challenges that countries with fragile health systems and volatile political situations face in mounting an appropriate local response to health crises. The absence of early warning systems for disease surveillance perpetuated the delay of WHO and others to recognise the scale of the disaster, resulting in a fragmented global response .
The TB epidemic in New York City in the 1990s is another example of the influence of socioeconomic policies on disease emergence and the importance of political commitment to control efforts. Overcrowding and social marginalisation in inner city areas resulted in a dramatic rise in TB incidence, but control efforts were not enhanced until the disease extended to middle-class suburbs . TB funding in New York has since been cut by over 50% and 2013 statistics revealed the first increase in TB cases since the 1990s .
However, although inadequate funding and delays in routing resources have impacted both disease epidemics, existing resource allocation must be optimised. Nigeria's success in curtailing Ebola offers lessons to TB control efforts.
Within days of the Liberian index patient being diagnosed with Ebola in Lagos, Nigeria's Ministry of Health activated an Ebola incident management centre (using facilities originally funded by the Gates Foundation to combat polio). There was rapid identification and follow up of the 894 contacts of the 20 Ebola cases, along with attention to infection control measures .
Nonetheless, since one potential unintended consequence of focussing health resources on a single disease is that other disease control efforts are compromised, if instead groups interested in different diseases including TB came together to use existing funding to improve health systems in developing countries, we would be better equipped to address both acute and chronic epidemics.