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How We End TB

2024-03-12 · explainer · John · 5:14 · watch on YouTube

Topic: Global development (also: Health) · mode: Explainer · tags: timely hook, civic or action cta, heavy topic

Ahead of a Capitol Hill visit and a Thursday announcement about his family's fight against tuberculosis, John argues that TB, the world's deadliest infectious disease, can be ended as the US once did, through Salmaan Keshavjee's search-treat-prevent (STP) strategy, and that the barrier is resource allocation, not knowledge.

What is said

The parts of the video and what is said in each (★ — how much it matters to the video).

00:00:00 — Capitol Hill trip, Thursday announcement, TB as the deadliest yet curable infectious disease

  • ★★ John says later this week (week of 11 March 2024) he will be on Capitol Hill in Washington, D.C. to discuss tuberculosis with members of Congress, senators and their aides. — 00:00:00 · United States Congress, tuberculosis
  • ★★★ John says there will be a major announcement on Thursday about his family's efforts to fight tuberculosis. — 00:00:00 · tuberculosis
  • ★★ John says tuberculosis remains the world's deadliest infectious disease, even though we know how to end it. — 00:00:00 · tuberculosis
  • ★★ John says TB is generally curable on an individual level with a four-to-six-month regimen of four different antibiotics. — 00:00:00 · tuberculosis

00:00:29 — How the US nearly ended TB deaths: great-uncle Stokes, 1900 hospital beds, 99% decline

  • ★ John's great-uncle Stokes died of tuberculosis in 1930, when TB was still one of the leading causes of death in the United States. — 00:00:29 · tuberculosis, United States
  • ★★ John says that in 1900 the US had almost as many hospital beds for TB patients as for all other health problems combined. — 00:00:29 · tuberculosis, United States
  • ★★★ John says TB is still a problem in the United States, but its death rate there has fallen by over 99%. — 00:00:29 · tuberculosis, United States
  • ★★★ John says we know how to end TB as a society because we have done it before. — 00:00:29 · tuberculosis

00:00:58 — The STP strategy: search (diagnosis, x-ray vans, GeneXpert), treat, prevent (preventive therapy)

  • ★★ John recommends a TED talk, linked below, in which Dr. Salmaan Keshavjee argues that the key to ending TB boils down to the acronym STP. — 00:00:58 · tuberculosis
  • ★★★ Search, the first step: John says we need to find people with TB and diagnose them correctly. — 00:00:58 · tuberculosis
  • ★★★ John cites the WHO estimate that of the 10 million people who will get sick with TB this year (2024), about 4 million will never be diagnosed. — 00:00:58 · tuberculosis
  • ★★ John says experts estimate that for every year a person lives with active untreated TB, the infection spreads to between 5 and 15 more people. — 00:01:27 · tuberculosis
  • ★★ John says people with TB go undiagnosed because they simply lack access to accurate screening and testing. — 00:01:27 · tuberculosis
  • ★★ John says that from the 1950s the US built x-ray vans and sent them across the country offering everyone free chest x-rays to identify TB cases, and it worked. — 00:01:27 · United States, tuberculosis
  • ★★ John says today there are accurate but still frustratingly expensive tests like GeneXpert that can tell within a couple of hours whether someone has TB. — 00:01:56 · tuberculosis
  • ★★ John says funds and systems are needed to deploy those technologies where most needed, actively screening for TB to find the 4 million missed cases. — 00:01:56 · tuberculosis
  • ★★★ Treat, the second step: John says everyone diagnosed with TB should be able to receive curative treatment appropriate to their particular infection. — 00:01:56 · tuberculosis
  • ★★ John says most treated people stop being infectious within a week of their first antibiotics, so treatment both saves lives and stops chains of infection. — 00:02:26 · tuberculosis
  • ★★ John says TB treatment needs many pills over many months, but the disease can be cured: with available treatment and support, people will almost always be cured. — 00:02:26 · tuberculosis
  • ★★★ Prevent, the final step: John says close contacts of anyone diagnosed with TB should be offered preventive therapy. — 00:02:52 · tuberculosis
  • ★★ John says the most common preventive therapy is pills once a week for 12 weeks, after which you never get active tuberculosis. — 00:02:52 · tuberculosis
  • ★★ John says the US has used preventive therapy for over 60 years, a key reason TB rates have plummeted there. — 00:02:52 · United States, tuberculosis
  • ★★★ John says it is long past time to stop arguing that preventive therapy is too expensive or complicated for impoverished countries. — 00:02:52 · tuberculosis

00:03:21 — We can't afford not to: economic return, resource allocation, health-system strengthening, maternal mortality halved in Sierra Leone

  • ★★★ John says we can't afford not to implement comprehensive STP strategies in high-burden communities: there is no excuse for over a million people a year dying of a curable disease. — 00:03:21 · tuberculosis
  • ★★ John says every dollar invested in TB care yields $43 in economic benefit, as more people can work and fewer are sick, dying or tending to the sick. — 00:03:21 · tuberculosis
  • ★★ John says we have known how to end TB since the 1950s; the challenge has always been resource allocation. — 00:03:50 · tuberculosis
  • ★★★ John says that to really address TB the whole health system must be strengthened so it can search for cases, treat those it finds and prevent future ones. — 00:03:50 · tuberculosis
  • ★★★ John says that work is hard, as seen in the fight against maternal mortality in Sierra Leone, but results are huge: maternal mortality there has halved since 2019. — 00:03:50 · maternal death, Sierra Leone

00:04:20 — The biggest bet of John's life, Thursday's announcement, the new TB Fighters newsletter, sign-off

  • ★★ John says he believes in the possibility of change because he has seen change, which is why he is going to Washington, D.C. — 00:04:20
  • ★★★ John calls this the biggest bet of his life: a bet that we don't have to accept a world where so many people die of a disease no one should die of. — 00:04:20 · tuberculosis
  • ★★★ John says that on Thursday (14 March 2024) he hopes to announce the beginning, and only the beginning, of that bet. (hedged) — 00:04:20
  • ★★ John asks viewers interested in upcoming efforts to fight tuberculosis to check out the new TB Fighters newsletter, available at the link in the description. — 00:04:49
  • ★★ John says the newsletter, built by people in Nerdfighteria, covers everything from Emily Dickinson's references to tuberculosis to how we will end the disease. — 00:04:49 · Nerdfighteria
  • ★ John thanks the TB Fighters in the community who built the newsletter and calls it really cool. — 00:04:49

In the description and comments

Threads in this video

Where the stories that moved here went next

Mentioned

Central: tuberculosis

Also: People: Emily Dickinson · Salmaan Keshavjee

Projects: TBFighters

Organizations: United States Congress · World Health Organization

Concepts: Antibiotic · infectious disease · maternal death · X-ray

Places: Sierra Leone · United States · Washington, DC

Products: GeneXpert

Only in the description or credits: Everything Is Tuberculosis · vaccine

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