Paul Thorn has seen the monster that's coming for us. He's been in a hospital bed with it. It attacked his body and nearly drove him out of his mind.
Ten years later, he's cured of the multi-drug-resistant tuberculosis that attacked him in a hospital in London. Seven people died in that outbreak. He's the only survivor. What makes his survival more impressive is that he was already infected with HIV.
The monster that came after him began in Sao Paolo as the ordinary TB, which is quite treatable. That patient didn't finish his drugs, so his TB became drug-resistant. By the time Mr. Thorn breathed it into his lungs in a British hospital, the monster had developed resistance to the drugs.
Multi-drug-resistant TB isn't a death sentence for everyone who gets it. With isolation, with many months of pills and injections and the nasty side-effects they produce, it can be cured. Mr. Thorn dealt with the headaches, nausea, diarrhea, paranoia, confusion and one pill that made him feel "quite mad."
Now, he writes about surviving TB and HIV -- the human immunodeficiency virus. He was in Ottawa to speak to non-profit organizations and parliamentarians last month. On the same day, the World Health Organization released its annual TB report. The good news is that rates of TB appear to be falling worldwide, although the raw numbers are still going up.
If the spread of TB is slowing (if this isn't just a glitch in detection) that would mean the world has already met one of its targets under the Millennium Development Goals, long before the 2015 deadline.
Canada has actually been a quiet leader on the tuberculosis front, notably supporting the Global Drug Facility to expand access to high-quality TB drugs. We can take some of the credit for those falling rates.
You knew there was a "but" coming. Here it is: drug resistance threatens all of that success. This is from the WHO report: "Facilities to diagnose and treat MDR-TB, including extensively drug-resistant TB (XDR-TB), are not yet widely available; the scale of the XDR-TB problem globally is not yet known." We don't even know how big the monster is.
We do know that in South Africa, death rates among people who get XDR-TB are around 80 per cent. We could pull down those death rates with proper resources, but that wouldn't change the fact that XDR-TB is extremely difficult to cure. It's the scary future of this old disease.
Already, XDR-TB has been found in 28 countries, including all the G8 countries. Canada has had at least two cases of XDR-TB, one in 2003 and one in 2006. During those years, Canada also had at least 71 cases of MDR-TB, the monster Paul Thorn battled.
Just as we've created superbugs by misusing antibiotics, we've created drug- resistant tuberculosis through shoddy treatment programs. When patients stop taking their pills too early, the bacteria develop resistance. What doesn't kill TB makes it stronger.
The Red Cross recently warned the TB threat to Western Europe is the highest since the Second World War. This is a problem that was getting better, but now it's on the cusp of getting worse. We, the wealthy and privileged, created this threat for ourselves by neglecting TB outbreaks in Russian prisons, South African townships and Canadian reserves.
"I don't need to tell you that disease knows no borders, but my case illustrates it very nicely," says Mr. Thorn. "Human beings are united because of the air that we breathe, despite all our differences."
For a long time, he was angry at the way he contracted the disease. But he acknowledges that in the global picture, he "won the geography lottery." He had help taking the mountains of pills and getting through the side-effects. He can understand why people stop taking their drugs: "In your own mind, there's every reason why you should stop, because they make you feel so miserable."
In Africa, where TB and AIDS dance on graves together, the real need is for support systems like the one Mr. Thorn had: Laboratories, counsellors, drugs and help for families to get them through the treatment process. Since TB travels in the air, the only way to prevent transmission is to cure it -- and cure it properly.
"Drug resistance is avoidable," says Mr. Thorn. "It's a man-made problem and it requires a man-made solution."
Humans, especially first-worlders, are strange animals. We get nervous about avian flu, mad cow disease and West Nile virus. There were about nine million new cases of TB in 2005, killing 1.6 million people. Drug-resistance is threatening to make those numbers explode. And yet we still aren't nearly nervous enough about that.
Kate Heartfield is a member of the Citizen's editorial board. E-mail:
kheartfield@thecitizen.canwest.com
© The Ottawa Citizen 2007
