If only TB was as sexy as Ebola

All geared up for dealing with Ebola
All geared up for dealing with Ebola
Boston University

The world was briefly alarmed, or, well, the media has tried to sound the alarm, when it was reported that the usually deadly Ebola virus had spread from its confines in tropical sub-Saharan Africa to Canada when a man who had been in Liberia returned very ill to Saskatoon, Saskatchewan.

Holy Hot Zone Batman!

Wait, never mind. Canadian health officials have since said that the man who fell ill with the symptoms of severe hemorrhagic fever – massive internal bleeding caused by the infection basically melting down your insides – doesn’t appear to have Ebola. I doubt the man, who remains surrounded by health workers in masks and protective clothing given he still has one of the other kinds of horrible hemorrhagic viruses, will be much relieved.

Nor will many of those living in Guinea or anywhere else near the latest outbreak of this made-for-Hollywood infectious bug be relieved. Nearly 60 people have been reported killed from the infection in this West African outbreak, out of about 80 diagnosed.

And, to come full circle, if this BBC report is correct, maybe the Canadians should hold off celebrating their lack of an Ebola diagnosis if the outbreak in Guinea that looks like Ebola may be something else entirely. Whatever it is, if this is the same disease, it’s bad.

But not that bad really, if you look at its actual impact. Ebola and its brethren big-bleeder fever bugs do cause very dramatic and horrible diseases. Ebola is a relatively newly recognized deadly hemorrhagic virus (having been discovered only in 1976), but its threat to our health is still so far pretty miniscule.

Ebola virus
Ebola virus
Wikimedia

Ebola breaks out now and again, kills most of those who come into direct contact with it (or with others who are infected), and then burns itself out fairly quickly as well. Nobody fully knows why this bug is so bad at spreading itself around, but it tends to kill off its chances to spread as well as it kills off the unfortunate few who do become infected.

Let’s contrast that with tuberculosis. It just so happened that it was World TB Day around the same time this latest Ebola outbreak gained global attention. Did you get freaked out by TB? No? Well, maybe you should be.

It still seems to surprise people when they learn that tuberculosis infects one of every three people on the planet. Yep. One of ever three human beings on Earth carry TB. Most are not sick; they just carry it around encapsulated in a weird little nodule in their body that can remain dormant for decades. Once TB breaks out, it’s very good at infecting people. That’s why 33 percent of us are infected.

Oh, and TB is a much better killer than Ebola. The annual death toll from TB today, according to the World Health Organization, is second only to AIDS – estimated to be about 1.3 million or so. Nearly 10 million people fall ill with TB every year and, if they’re lucky, are treated for months with not-so-great drugs that eventually clear the bacteria from the body.

If they’re not lucky, as an increasing number of TB sufferers are these days, they develop a drug-resistant form of tuberculosis that is either very difficult to treat – taking years rather than months – or impossible to treat. These versions of TB are called, respectively, MDR-TB (multi-drug resistant TB), XDR-TB (extremely drug resistant TB) or TDR-TB (a controversial designation, totally drug resistant TB).

About 450 000 people were diagnosed with MDR-TB worldwide in 2012, many of these cases caused by lack of access to appropriate or complete treatments. More than half of the MDR cases were in India, China and Russia. Nearly 10 percent of these 2012 cases developed into XDR-TB, the WHO reported.

On March 24, TB day, numerous organizations vied for your attention to this massive global health threat. The media employed various standard techniques aimed at making a chronic problem newsworthy – from ‘localizing’ the global threat, to new scientific findings about the disease to the good news approach:

AP Washington state seeing more TB cases

Mercury News Santa Clara County has more cases than most U.S. states

Wall Street Journal Tuberculosis afflicts more children than previously thought

Voice of America One million children infected by TB annually

New York Time China reports gains in fighting tuberculosis

Did any of these story angles get much traction? Not so far as I could tell. Despite the massive and increasing threat TB poses to all of us, everywhere, a small outbreak of a fairly obscure, if deadly, viral disease stole the show.

What we need, in addition to a good TB vaccine and better drugs, is some way to make this looming threat a bit sexier and scarier in a way that works in prime time. A serious re-branding scheme needs to be launched, beginning with a name change. Tuberculosis is a terrible word and somehow fails to ignite the imagination. Consumption was cool – for the 19th century – and I have no idea how to even pronounce TB’s original name ‘phthisis pulmonalis.’

For this global health threat, the main innovation needed to inspire the public may have to come from not from Latinate-prone scientists, health experts or epidemiologists but from marketing and media relations consultants. Lots of organizations change their name for strategic and marketing reasons (though I’m still not sure why PATH keeps reminding people not to call it the Program for Appropriate Technology in Health, since nobody really does anymore … until PATH reminds them of the original reason why it’s called PATH).

So … I’d like to call upon all Humanospherians to suggest a new name for this scourge – aimed at making TB as popular a topic as celebrities in rehab, pet pictures, explosions, stupid criminals or overpaid athletes. I’ll start: Apocalyptosis?

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About Author

Tom Paulson

Tom Paulson is founder and lead journalist at Humanosphere. Prior to operating this online news site, he reported on science,  medicine, health policy, aid and development for the Seattle Post-Intelligencer. Contact him at tom[at]humanosphere.org, follow him on Twitter @tompaulson and/or send a comment below.

  • Jamie Rosen

    Tom – Great piece! I could not agree more about tuberculosis. Did you ever get a chance to watch the two-minute trailer for EXPOSED: http://www.aeras.org/exposed? It’s also worth noting that efforts are underway to ‘re-brand’ tuberculosis, so hopefully we’ll soon be on the right track with helping people understand this ‘apocalyptosis’ disease.

  • Marina

    Not to undermine the disease burden that TB creates – but isn’t the real fear of Ebola its ability to mutate into an airborne illness rather than the threat of its current form? So our response (both through healthcare and the media) isn’t just to the 80 sick people, but the 2 million who breathe the same air in Conakry (and everybody they’ll come into contact with)? And Ebola isn’t exactly taking over headlines – at a time when we get news alerts whenever debris is found in the Indian ocean, I haven’t received one about a virus that’s killed almost 100 in only the current epidemic.

    Ebola represents what some might call a success – a potentially devastating epidemic has been (relatively) successfully contained and casualties have been relatively low. Health workers tend to outbreaks with an abundance of precaution, including executing care and containment with barrier methods and bleach.

    Instead of hinting that the measures to address Ebola are excessive – shouldn’t we be be applauding the response? Simultaneously as we call for similar evidence based approaches to treating more widespread illnesses, of course. We of course need greater access to TB treatment and prevention, but it shouldn’t come at the cost of preventing a global Ebola outbreak.

    I see two potential explanations for why this virus is “so bad at spreading itself around” A) because it’s relatively new, which might mean its relatively unadvanced and B) because we might just be really good at limiting the spread. Perhaps it’s neither of these, but the limited contagion relative to TB isn’t a great argument when you consider the difference in response to the two diseases. This is exactly what you’re criticizing, but isn’t the real harm of media to global health the disparity in attention between TB and David Letterman retiring, versus the disparity in attention between TB and Ebola?

    • Joel

      “I see two potential explanations for why this virus is “so bad at spreading itself around””

      I see one explanation as to why it is “so bad at spreading itself around” -. Mycobacterium africanum.