> The resurgence of TB has been the big story in infectious diseases for a while now.
It's been a big story since the 1980s, IIRC. I remember in college in the 1990s a biologist friend explaining that TB was the greatest disease threat to public health and it was being completely ignored.
Frankly, it's hard to get worked up about it. Notwithstanding that it is a serious public health threat, there's a strong political rhetoric aspect to the discussion, both in the popular and professional spheres. It's unfortunate. In the 1980s and 1990s it was all about how Reagan decimated our public health infrastructure. The arguments aren't per se wrong, but it's difficult to gauge relevance and prioritization about the threat of TB given how part of the medical and scientific community seem to have been border-line crying wolf for 40 years. Discussion centers around absolute numbers. Tell me what the per capita relationship looks like, especially per capita among the populations most vulnerable to acquisition and disease, and what the long-term trends look like. I see this in a lot of other adjacent public health discussions tainted by political hand wringing, such as food insecurity, etc--lots of absolute numbers. But global populations are growing. The US, for example, grew by 80 million people, or 30%, between 1990 and 2020. That's not to deny that tuberculosis is a growing problem, but we have many problems. And the constant drum beat of alarm causes some parts of the community to (increasingly) react in counterproductive ways. From an individual moral standpoint, that's on them, but from an epidemiological and sociological perspective, maybe the professionals bear a little blame, too, at least in terms of communication. We could all do better.
Rubbish, on all counts. Public health discussion constantly gives rates and percentages, not just numbers. And “they’ve been warning us so many times” - well, I hope you’ve also given up on applying security updates to any software or hardware you manage, since those have been getting issued forever, they must be crying wolf too.
My point isn't that agencies don't report incidence; my point is about when the discussion surfaces how it's discussed in the popular press, including editorializations in professional outlet. Were incidence rate flat or down between convenient points of comparison, but absolute numbers up, and an outbreak like Kansas happen, we'd be discussion absolute numbers. And even when incidence is up, the absolute numbers always headline. It's a subtle criticism I'm making, but I think an important one.
Nonetheless, while for 40 years TB has been discussed as a grace looming threat, note how absolute cases and incidence dropped steeply over most of that time. And while the drop has largely stopped, the US now has one of the lowest incidence rates in the world. But my takeaway is supposed to be that the US' TB measures are woefully broken because the drop has stopped?
The point is that if we'd put in a bit more effort 40 and 30 years ago, there would be 0 cases today (and if we put a bunch more effort in now, there will be 0 cases in 20 years). TB is awful, but it is curable and preventable. It's current existence in the world is a policy choice of the past few decades, and eradicating it is a choice we can make today.
It's been a big story since the 1980s, IIRC. I remember in college in the 1990s a biologist friend explaining that TB was the greatest disease threat to public health and it was being completely ignored.
Frankly, it's hard to get worked up about it. Notwithstanding that it is a serious public health threat, there's a strong political rhetoric aspect to the discussion, both in the popular and professional spheres. It's unfortunate. In the 1980s and 1990s it was all about how Reagan decimated our public health infrastructure. The arguments aren't per se wrong, but it's difficult to gauge relevance and prioritization about the threat of TB given how part of the medical and scientific community seem to have been border-line crying wolf for 40 years. Discussion centers around absolute numbers. Tell me what the per capita relationship looks like, especially per capita among the populations most vulnerable to acquisition and disease, and what the long-term trends look like. I see this in a lot of other adjacent public health discussions tainted by political hand wringing, such as food insecurity, etc--lots of absolute numbers. But global populations are growing. The US, for example, grew by 80 million people, or 30%, between 1990 and 2020. That's not to deny that tuberculosis is a growing problem, but we have many problems. And the constant drum beat of alarm causes some parts of the community to (increasingly) react in counterproductive ways. From an individual moral standpoint, that's on them, but from an epidemiological and sociological perspective, maybe the professionals bear a little blame, too, at least in terms of communication. We could all do better.