Tuesday, 18 April 2017

Rebranding Tuberculosis

If infectious diseases were monsters, what would they look like? I imagine malaria would be a terrible mosquito-like creature made of bones, with a wickedly sharp proboscis and a throbbing gut of fiery red blood. Diarrhoeal disease would rise from a swamp of sewage, grinning with its skull’s jaw as it handed out cups of contaminated water to the unsuspecting. And tuberculosis? The biggest infectious disease killer in the world, with 1.8 million deaths from the infection in 2015 and 10.4 million new cases? I struggle to anthropomorphise TB and part of the reason for this is all thanks to the Victorians.

TB was the subject of a 19th century romanticisation that existed in direct opposition to the reality of the disease. Literature, operas, poetry and plays of the day were filled with references to TB, or consumption as it was commonly known, as something to aspire to. In Metzengerstein, Edgar Allan Poe writes: “I would wish all I love to perish of that gentle disease. How glorious! to depart in the hey-day of the young blood - the heart all passion - the imagination all fire - amid the remembrances of happier days - in the fall of the year - and so be buried up forever in the gorgeous autumnal leaves!” Sounds like a blast, doesn’t it?

When I started writing Catching Breath - The Making and Unmaking of Tuberculosis I wanted to cover this romanticisation of TB as an example of how the disease had left its mark on human culture. The poetic swooning! The tragic heroines cut down in the bloom of their lives! The feverous intensity of these martyrs to creativity and passion. Only, I don’t think it is possible to focus on this historical portrayal of TB without adding to the ‘TB is a disease of the past’ story, which I didn’t want to do. Catching Breath was about what has made TB the disease it is today and how we’re going to unmake it. So I left the 19th century romanticisation to other writers and tried to focus on the here and now.

I couldn’t get away from this disease of past thing, though. Whenever I mentioned TB to one of my non-scientist friends, I invariably heard something along the lines of ‘didn’t we already cure it?’. It felt like I was living in two worlds: one in which TB is an underfunded humanitarian disaster the full extent of which we still don’t fully grasp (the TB world); and one in which TB is a throwback to a bygone era that just doesn’t evoke all that much fear or concern compared to something like malaria or HIV, which most know are massive problems in world medicine (the everyone else world).

There’s a lot of great TB advocacy going on that gets across the true toll, but it’s taking its time to worm its way into the public perception of this disease among those living in low TB incidence countries. I think this harms TB control efforts. While TB is not a big problem in high income countries such as the UK, eradicating the disease is not going to happen without partnerships between those countries worst affected and richer countries like my own. And the ‘disease of the past’ stereotype does little to keep the reality of TB at the front of people’s minds.

I don’t think it’s any coincidence that HIV has gone from a death sentence to a manageable condition in just twenty years alongside a brilliant example of how infectious disease advocacy should be done. The HIV world succeeded in branding the infection as a modern monster that could be defeated, just so long as the funding and the political will was there to make it happen. Could we see the same for TB? I don’t know. It’s a difficult task as TB has spent a very long time twisting itself up with human lives. And in the past, the TB world hasn’t done the greatest job of convincing people that a) TB is a worthy opponent and b) it’s a fight we can win. Things are changing, though.

Catching Breath ended up as a scientific biography of TB that touches upon some of the ways in which the disease has shaped the various populations its encountered during its long history, minus the romance. My career as a scientist was all about finding ways to understand the TB bacillus in the hope that we might, one day, be able to truly turn it into a piece of history. For now, though, TB is very much here to stay.

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