Everything is Tuberculosis

About every 20 seconds, someone dies from tuberculosis, despite the availability of an effective treatment since 1943. Tuberculosis (TB) remains a significant global health challenge.

Tuberculosis (TB), once romantically portrayed in Victorian England as consumption, is an illness typically affecting the lungs and caused by the bacterium Mycobacterium tuberculosis. The rod-shaped bacteria settle in the lungs, grow, reproduce, and can spread to other body parts through the bloodstream. Drug-resistant TB (DR-TB) is a concerning variation, where the bacteria become resistant to certain drug treatments.

TB is only spread by people with active TB, who experience symptoms and are contagious, unlike those with inactive TB. Despite advancements in TB research, including vaccines and diagnostic tools, progress has been slow due to insufficient funding and attention.

The Seattle Tuberculosis Research Advancement Center (SEATRAC) is working to address this issue by training the next generation of TB researchers and promoting new research areas. SEATRAC's director, Dr. Chetan Seshadri, witnessed firsthand the unmet needs of TB patients while working as a physician in India and Africa.

“I thought I could spend the rest of my career as a physician trying to apply these second-rate tools, or I could take a step back and be part of an effort that's trying to make things better for the providers,” Seshadri said. “And I think that was kind of my inspiration [to become a researcher], even though I had no background in research.”

Effective treatment for TB has existed since 1943, when Selman Waksman, Albert Schatz, and Elizabeth Bugie identified the first TB antibiotic, streptomycin. The BCG vaccine, developed in 1921 by Albert Calmette and Jean-Marie Camille Guérin, prevents TB in infants. However, its effectiveness wanes over time and does not protect adults.

“What we need most is a highly effective TB vaccine,” said Dr. Adrienne Shapiro, SEATRAC consultant and UW assistant professor, in an email. “The vast majority of the 1.8 million people who died of TB last year were vaccinated with BCG as babies, and it's just not enough.”

Seshadri recently discussed the stagnation in TB research with bestselling author and YouTuber, John Green, during a March 28 event for Green’s new book, “Everything Is Tuberculosis.” Green argues that health care inequities and stigmatization contribute to this stagnation.

“We think of tuberculosis as biological, but I would argue it's as much of a social phenomenon as it is a biomedical one,” Green said in an interview with The Daily. Green and Seshadri also discussed how funding cuts to the National Institutes of Health (NIH) and United States Agency for International Development (USAID) are affecting people with TB.

“Funding cuts to USAID interrupted critical clinical trials for new, better diagnostic tests for TB and also new treatments for TB,” Shapiro said in an email. “We were so close to having the results from some of those trials, but when funding was cut, much of that progress was lost.”

SEATRAC has also experienced federal funding setbacks, potentially leading to the suspension of some activities. Seshadri has voiced concerns about the impact of the Trump administration's actions on TB patients worldwide. He hopes that John Green's book will inspire more people to care about those affected by the disease.

“He's such a talented, eloquent writer and speaker … that he chooses to put that energy to this, it's an absolute blessing,” Seshadri said. “He could do anything he wanted, but he chooses this. So I've got nothing but admiration.”

As this article was read, approximately nine people died from TB. Organizations like Partners In Health and TBFighters continue to combat health care inequities and provide assistance for TB patients. The Trump administration's actions, through funding cuts, have put millions of people with TB at risk of treatment interruptions and the development of more severe cases.