LIKE HUMANS, microbes now can cross international borders and vast distances with jet-borne speed. That's the not-so-hidden subtext of rising concern by U.S. and international public health authorities about the rapid spread of tuberculosis through poor nations. Last year, according to World Health Organization statistics, TB killed more people than in any other year on record; drug-resistant strains are appearing, especially in Russia, but also in poverty-stricken neighborhoods of some U.S. cities.
Congress last year reallocated $35 million to TB-eradication efforts. Last week Rep. Sherrod Brown (D-Ohio) said he and Montgomery County's Rep. Connie Morella will push for $100 million. This is a fraction of the estimated $1 billion needed for eradication, but it might encourage other countries to donate as well.
Money is not the only issue. Attacking TB requires daily treatment with multiple drugs for as long as two years -- and patients who stop taking the drugs once they feel better merely become petri dishes for drug-resistant strains as the remaining microbes mutate. This means that one-time blitzes, of the kind that have been so effective for polio vaccination of children, not only do not help stop the disease but often speed the development of more virulent strains.
The World Health Organization, which has come under criticism in recent years for focusing on conventional treatment without attending to the resistance issue, now says any expansion of worldwide TB control programs must be done slowly and carefully. Experts say all new efforts will follow a strategy called Directly Observed Treatment, which assigns each patient a health care worker (not necessarily highly trained) to hold him or her accountable for sticking to the treatment. This is expensive, and local governments are not always pleased to focus intensive efforts on a few districts rather than spread inadequate care thinly. Public health groups need to resist such pressures. This is one case in which the politically attractive quick fix will make matters worse.