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At Kaneshie Polyclinic, a health center in a hardscrabble neighborhood of Accra, the capital of Ghana, there is a rule. Every patient who walks through the door \u2014 a woman in labor, a construction worker with an injury, a child with malaria \u2014 is screened for tuberculosis.<\/p>\n
This policy, a national one, is meant to address a tragic problem; two-thirds of the people in this country with tuberculosis don\u2019t know they have it.<\/p>\n
Tuberculosis, which is preventable and curable, has reclaimed the title of the world\u2019s leading infectious disease killer, after being supplanted from its long reign by Covid-19. But worldwide, 40 percent of people who are living with TB are untreated and undiagnosed, according to the World Health Organization. The disease killed 1.6 million people in 2021.<\/p>\n
The numbers are all the more troubling because this is a moment of great hope in the fight against TB: Significant innovations in diagnosing and treating it have started to reach developing countries, and clinical trial results show promise for a new vaccine. Infectious disease experts who have battled TB for decades express a new conviction that, with enough money and a commitment to bring those tools to neglected communities, TB could be nearly vanquished.<\/p>\n<\/div>\n<\/div>\n
\u201cThis is the best news we\u2019ve seen in tuberculosis in decades,\u201d said Puneet Dewan, an epidemiologist with the TB program at the Bill & Melinda Gates Foundation. \u201cBut there\u2019s a gap between having an exciting pipeline and actually reaching people with those tools.\u201d<\/p>\n
A recent visit to the Kaneshie clinic revealed both the progress and the remaining barriers. Despite the clinic\u2019s policy of screening everyone for TB, which most often attacks the lungs, by asking a few questions about coughs and other symptoms, patients streamed into the single-story, cement-block building and were sent for care without any such queries. A member of the TB team, it turned out, was on holiday, another was on maternity leave and a third was out sick. That left just two, who were busy processing tests and doling out drugs.<\/p>\n
So no one was screened, not that day or any other day in the previous week.<\/p>\n
\u201cIt is a good policy, it works well when we can do it, but personnel is a problem,\u201d said Haphsheitu Yahaya, the tuberculosis coordinator at the clinic.<\/p>\n<\/div>\n<\/div>\n
When the screening policy is working, new medications \u2014 the first to come to market since the 1970s \u2014 can be taken as just a couple of pills each day, rather than as handfuls of tablets and painful injections, the way TB treatments have been delivered in the past.<\/p>\n<\/div>\n<\/div>\n
Those diagnosed with drug-resistant TB receive medication to take for six months \u2014 a far shorter time than previously required. For decades, the standard treatment for drug-resistant TB was to take drugs daily for a year and a half, sometimes two years. Inevitably, many patients stopped taking the medicines before they were cured and ended up with more severe disease. The new drugs have far fewer onerous side effects than older medications, which could cause permanent deafness and psychiatric disorders. Such improvements help more people to continue taking the drugs, which is good for patients, and eases the strain on a fragile health system.<\/p>\n
In Ghana and most other countries with a high prevalence of TB, the drugs are paid for by the Global Fund to Fight AIDS, Tuberculosis and Malaria, an international partnership that raises money to help countries fight the diseases. But contributions to the agency have been getting smaller with each funding round. Countries fighting TB are concerned about what may happen if that funding ends. Currently, the treatment for adults recommended by the W.H.O. costs at least $150 per patient in low- and middle-income countries.<\/p>\n
\u201cIf our patients had to pay, we would not have one single person taking treatment,\u201d Ms. Yahaya said.<\/p>\n
Still, there has been progress in recent months in making the medicines more affordable, and prices may soon drop further. After prolonged pressure from patient advocacy groups, the United Nations<\/a> and even the novelist John Green, who devoted his widely followed TikTok account to the issue<\/a>, Johnson & Johnson has lowered the price of a key TB drug in developing countries. The company also agreed last month not to enforce a patent, which means generic drug companies in India and elsewhere will be able to make a significantly cheaper version of the medication.<\/p>\n<\/div>\n<\/div>\n And for the first time in more than a hundred years, there is real hope for an effective vaccine: A promising candidate called M72, developed by the pharmaceutical company GSK with financial backing from the Gates Foundation and other philanthropies, is now in the last stage of clinical trials.<\/p>\n