A little known fact is that Tuberculosis (TB) is the deadliest infectious disease in history.
Yet there is a commonly held view, even amongst some in my own profession, that TB is a disease of the past, killing off Romantic poets and Dickens characters. In the grand scheme of all the ills of London, it is hardly considered to be a contemporary public health concern.
Equally, the other commonly held view of TB (sometimes known as consumption) is that it is a disease that happens ‘somewhere else’, in far flung deprived areas of the world.
The World Health Organisation estimates that one in three people on the planet, around two billion people, are infected with the bacteria that cause TB.
TB has yet to be consigned to London’s past. In fact, it is very much present here.
Nearly forty per cent of all UK cases are in London, which retains the dubious title of ‘TB capital of Western Europe’. In 2013, there were more new cases of TB diagnosed in London than of HIV.
The scale of the challenge we face in tackling TB is the reason why the London Assembly Health Committee launched a city wide investigation earlier this year.
The infectious disease targets weakened immune systems. People with diabetes are up to three times more likely to develop TB, while people living with HIV are up to fifty times more likely to develop it. Poor diet, drug or alcohol dependency, even chemotherapy, can all lower the body’s ability to fight off TB.
Treatment can be physically and emotionally exhausting. During our investigation, we spoke to people who were currently undergoing treatment for the disease. They described their TB diagnosis as very frightening. Some talked powerfully about the social stigmas that surround TB, using terms like ‘filthy’ to describe the disease, and ‘guilt’ at possibly passing it to their friends or family. They also spoke of the loneliness and isolation of being unable to talk openly about their illness.
The stigma that surrounds TB is fuelled by misconceptions about the disease and those who are unfortunate enough to contract it. This can lead to people not seeking help when they develop symptoms, making it harder for clinicians to diagnose and treat the disease effectively.
We need to find ways to overcome this stigma, by talking openly about the threat of TB in London, but also by reassuring people that if treated correctly, TB can be completely cured.
Achieving this would not be the end of the matter however.
There is also the risk of new, drug-resistant forms of TB. Already almost one in ten cases in the UK is resistant to at least one front line drug. The misuse of antibiotics and the difficulty of following a long treatment programme, particularly for vulnerable groups such as homeless people, will make TB treatment all the more challenging and expensive in the future.
In other cities across the world, governments are starting to recognise the need for new drug and treatment options, but developing these will take substantial time. Public Health England has named TB as one of its key strategic priorities, as the situation in London continues to cause great concern.
The Mayor, local boroughs and the NHS in London will all need to jointly tackle this ongoing public health threat and confront the issues, both clinical and social, that make our city and its inhabitants vulnerable to TB.
This disease needs the same level of profile and awareness as HIV and AIDS, because without it, TB will become even more prevalent and harder to treat.
The London Assembly Health Committee is keen to hear from you, if you or someone you know has been affected by TB. You can submit your views to firstname.lastname@example.org until 1st September.