Complacency is once again inconveniencing New Yorkers. Years of neglect have resulted in a massively inadequate response to an absolutely fixable problem. But instead of taking care of business, the politicians bicker, try to out-talk the other or, worst of all, simply ignore the problem.
You may think I’m going on again about Gov. Andrew Cuomo, Mayor Bill de Blasio, and New York’s famously neglected subways.
What I’m actually worried about are presidents and prime ministers around the world and their chronic malfeasance in failing to deal with tuberculosis (TB)—a scourge that still kills almost two million people around the world each year and is now back with a vengeance in New York City.
I was the Director of the Bureau of TB Control at the New York City Department of Health during the 1990s when multidrug-resistant TB broke out in the Big Apple. It was the result of years of neglect – little funding, a dismantling of the TB program, unawareness of physicians to “think TB” and, most importantly, a lack of will from top political leaders. And it cost taxpayers well over a billion dollars to get TB back under control in New York.
The number of people with TB rose silently in New York City during the 1980s, and peaked in 1992, a toxic mix of drug-resistant TB, multiple hospital outbreaks, and the fact that TB is fueled by HIV which was also skyrocketing. It was a war zone on multiple fronts, with the need to simultaneously address issues such as homelessness; crowded jails and prisons; people with HIV whose weakened immune system made them vulnerable to TB infection and disease; and old, poorly designed hospitals that fostered TB outbreaks, compounded by an overlay of public hysteria.
What finally contained the outbreak in New York was a strong and sustained response from local, state and national leaders. And that is precisely what is missing from the global stage as TB continues to ravage millions of people in Africa, Asia, Eastern Europe, and Latin America. Because it’s airborne and does not discriminate between business travelers or tourists, rich or poor, until we cure TB everywhere, we will continue to see TB pop up anywhere, including downtown Manhattan.
Just as I had to fight political disregard to fix the last TB outbreak in New York, I now travel the world urging presidents, prime ministers, members of Congress, parliamentarians and other political leaders to take TB just as seriously as their health ministers do. We need the countries where TB is most rampant to commit their own national resources on the scale required by the global TB emergency – it is now the most commonly reported infectious disease in the world. But it is also in the interests of the United States, Europe and other areas where TB has been mostly contained to step up their commitment to end TB. If they don’t, it is simply a matter of time before they will have to confront TB again.
I understand how complacency emerges. We are facing many truly global problems that demand attention and resources but seem like potentially endless quagmires. Problems can seem far more prevalent than solutions.
But that is not the case in the fight against TB. We have a cure, we are reducing treatment time for the worst forms of TB, and we are getting closer than ever to a vaccine that works against all forms of TB. Moreover, if we can stop TB from taking out the most economically productive people as it most often does, we can help lower-income countries rise up out of poverty.
None of this will happen, however, unless we change the “business as usual” approach to TB. We need more political commitment from the very top and more funding to turn what’s possible into reality.
People are rightly frustrated when they know a problem can be fixed but nobody steps up to fix it. When the financial cost seems high, inaction looks easier and our political leaders kick the can yet again down the road. It is time to demand better. We need a subway that gets us to work on time and we need the political leadership required to save people from a global epidemic that is preventable and curable. Both are imminently doable unless the current set of political leaders continue to pick complacency over action.
In September, the heads of states, including from countries most affected by TB, will meet at the United Nations General Assembly. TB will be featured during this gathering at a high-level meeting that will call for action. TB’s time is now; let’s not squander the opportunity.