The Tuberculosis Challenge in the 1980s and 1990s: A Report on Global Health and Sustainable Development Goals

Introduction

In the late 1980s, tuberculosis (TB), a disease that has afflicted humanity for over 9,000 years, was widely believed to be on the path to elimination. Advances in understanding its causes, screening methods, and effective antibiotic treatments fostered optimism. By the mid-20th century, TB rates had dramatically declined in the United States and Europe due to improved living conditions and nutrition, with deaths falling by over 90% in the US by the late 1980s. However, this optimism was challenged as TB cases and deaths began to rise again in the late 1980s and early 1990s.

Historical Context and Significance

Tuberculosis was once a leading cause of death, responsible for up to one-quarter of deaths in the US and Europe during the 19th and early 20th centuries. The resurgence of TB in the 1980s highlighted the complexity of infectious diseases and the need for sustained global health efforts aligned with the Sustainable Development Goals (SDGs), particularly SDG 3: Good Health and Well-being.

Factors Contributing to the Resurgence of Tuberculosis

1. The Emergence of the HIV/AIDS Epidemic

The HIV/AIDS epidemic, which began in the 1980s, significantly impacted TB incidence and mortality. Individuals with HIV have weakened immune systems, increasing their susceptibility to active TB from latent infections. This intersection of diseases underscored the importance of integrated health strategies under SDG 3.

• HIV-positive TB patients had higher rates of mortality; in 1993, nearly half of TB patients with known HIV status in the US were HIV-positive, accounting for 82% of TB deaths.
• By the year 2000, HIV-positive individuals, representing only 0.5% of the US population, accounted for half of TB deaths.

2. The Rise of Drug-Resistant Tuberculosis

Drug-resistant TB emerged as a critical challenge, undermining the effectiveness of standard antibiotic treatments discovered in the 1950s. These resistant strains are more difficult and costly to treat and have lower treatment success rates, complicating efforts to achieve SDG 3 targets.

• Drug-resistant TB cases require more expensive and prolonged treatments.
• Treatment success rates for drug-resistant TB remain significantly lower compared to drug-susceptible TB.

3. Higher Rates of TB in Foreign-Born Populations

Increased migration from high TB burden countries to low-burden countries contributed to higher TB rates among foreign-born populations. This factor highlighted the need for global cooperation and health equity, aligning with SDG 10: Reduced Inequalities and SDG 17: Partnerships for the Goals.

• In the US during the 1980s, TB rates among immigrants were nearly four times higher than among native-born residents.
• Changes in immigration laws and increased migration from high TB prevalence regions contributed to this trend.
• Similar patterns were observed in European countries such as the Netherlands and Scandinavia.

Global Recognition and Response

Despite effective screening and treatments, the global TB burden was severely underestimated due to lack of comprehensive data, particularly in low- and middle-income countries. The World Health Organization (WHO) conducted the first global TB burden estimate in the early 1990s, revealing:

1. Approximately 8 million new active TB cases in 1990.
2. Nearly 3 million TB deaths in 1990, more than double the number of reported cases.

In 1993, the WHO declared tuberculosis a “global health emergency,” emphasizing the urgent need for coordinated global action consistent with SDG 3.

Progress and Continuing Challenges

Since the 1990s, significant progress has been made:

• TB deaths have decreased from approximately 2.6 million in 2000 to 1.3 million in recent years.
• Improved data collection and monitoring have enabled targeted interventions and resource allocation.

However, TB remains a major global health challenge, particularly in lower-income countries, reflecting ongoing gaps in health equity and access to care, which SDGs aim to address.

Lessons Learned and the Importance of Data

This resurgence of tuberculosis illustrates two critical lessons for global health and sustainable development:

1. The necessity of high-quality data: Accurate, timely data is essential to understand the scale and distribution of health challenges and to inform effective policy and resource allocation.
2. The risk of complacency: Progress is not guaranteed; continuous monitoring and responsiveness are required to prevent backsliding in disease control efforts.

These lessons are vital for achieving the SDGs, particularly SDG 3, and ensuring that no one is left behind in the fight against infectious diseases.

Conclusion

Despite early optimism, tuberculosis remains a significant global health threat. The resurgence in the late 20th century was driven by complex factors including HIV/AIDS, drug resistance, and migration patterns. Addressing TB effectively requires sustained global cooperation, robust data systems, and equitable health interventions aligned with the Sustainable Development Goals. Continued commitment is essential to overcome this preventable disease and fulfill the vision of good health and well-being for all.

Acknowledgments

We acknowledge the valuable contributions of Saloni Dattani, Edouard Mathieu, and Simon van Teutem in the preparation of this report.

1. Sustainable Development Goals (SDGs) Addressed

1. SDG 3: Good Health and Well-being
   • The article focuses on tuberculosis (TB), a major global health issue, and its resurgence in the 1980s and 1990s.
   • It discusses the impact of HIV/AIDS on TB rates and deaths, highlighting the intersection of infectious diseases.
   • The article emphasizes the need for global efforts to eliminate TB and improve health outcomes.
2. SDG 10: Reduced Inequalities
   • The article highlights higher TB rates among foreign-born populations and immigrants, pointing to health disparities.
   • It discusses how migration from high TB burden countries affects TB incidence in richer countries.
3. SDG 17: Partnerships for the Goals
   • The article stresses the importance of global cooperation and data sharing to address TB effectively.
   • The need for international efforts rather than isolated national programs is emphasized.

2. Specific Targets Under the Identified SDGs

1. Under SDG 3: Good Health and Well-being
   • Target 3.3: End the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases.
   • Target 3.8: Achieve universal health coverage, including access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.
   • Target 3.b: Support the research and development of vaccines and medicines for communicable and non-communicable diseases that primarily affect developing countries.
2. Under SDG 10: Reduced Inequalities
   • Target 10.2: Empower and promote the social, economic and political inclusion of all, irrespective of migration status.
3. Under SDG 17: Partnerships for the Goals
   • Target 17.6: Enhance North-South, South-South and triangular regional and international cooperation on and access to science, technology and innovation.
   • Target 17.18: Enhance capacity-building support to developing countries to increase significantly the availability of high-quality, timely and reliable data.

3. Indicators Mentioned or Implied to Measure Progress

1. TB Incidence and Mortality Rates
   • The article refers to the number of new active TB cases and deaths over time, including historical data and trends in the United States and globally.
   • These indicators measure progress toward ending the TB epidemic (Target 3.3).
2. TB Treatment Success Rate
   • Success rates of TB treatment, especially for drug-resistant TB, are discussed and shown in charts.
   • This indicator reflects quality and effectiveness of health services (Target 3.8).
3. HIV Prevalence Among TB Patients
   • The share of TB patients co-infected with HIV and the impact on mortality are highlighted.
   • This indicator helps monitor the intersection of HIV/AIDS and TB epidemics (Target 3.3).
4. TB Rates in Foreign-Born Populations
   • Higher TB incidence among immigrants compared to native-born populations is noted.
   • This indicator can be used to assess inequalities and target interventions (Target 10.2).
5. Availability and Quality of Data
   • The article stresses the importance of comprehensive and reliable data on TB burden globally.
   • Indicators related to data availability and quality support SDG 17 targets on data and partnerships.

4. Table of SDGs, Targets, and Indicators

Source: ourworldindata.org