Many of us assume that tuberculosis (TB) is an old disease that we killed off ages ago. This is, sadly, simply not true. 3,800 people around the world die from this curable disease every day.
It gets worse. While most TB can be easily cured with cheap TB drugs, drug-resistant tuberculosis is on the rise. Drug-resistant TB must be treated with very expensive "second-line" drugs that have nasty side effects. Around 440,000 people develop drug-resistant TB every year, with some TB strains becoming resistant to even these tougher second-line drugs. To say this is worrying is an understatement.
So where in the world can you find the highest rates of drug-resistant tuberculosis? I'll give you a clue - it also happens to be one of only two regions in the world where the number of new HIV cases continues to rise every year. It's not Africa. It's not South America or even Asia. It's the European region.
Surprised?
TB kills seven people in the European region every hour, and the region is home to the highest documented rates of drug-resistant TB in the world. In addition, 1.4 million people in the region are currently living with HIV but less than a quarter of those who need treatment can access it. Eastern Europe and Central Asia make up the bulk of the burden, but diseases don't respect borders, and the UK has noted increasing rates of drug-resistant TB over the past few years.
A report released this week by leading global health organisations (including RESULTS UK) has found that a significant reduction in global funding to Eastern European and Central Asian countries looks set to undermine the progress that's been made against the world's leading infectious disease killers.
The Global Fund to Fight AIDS, TB and Malaria is the largest and most important international donor for TB and HIV in the European region, yet because of funding shortages and changes in eligibility criteria, Eastern European and Central Asian countries will not have the resources they need to aggressively fund their disease epidemics.
What does this mean in practice?
Take Belarus, for instance. According to a recent article published in the European Respiratory Journal, multidrug-resistant TB (MDR-TB) - specifically defined as TB that is resistant to the two most powerful TB drugs - was found in over one third of TB patients. Furthermore, three out of four of previously treated patients had multidrug-resistant TB. By treating these people we not only save their lives, but also halt the spread of the disease as someone on treatment stops being contagious.
The Belarusian Government estimated that its TB control budget would have to triple in size in order deal with the high number of drug resistant patients. They had planned to apply to the Global Fund for a grant to supplement their current TB budget, of which they fund 95% themselves.
Unfortunately, due to changes driven by funding shortfalls at the Global Fund, Belarus was ineligible to apply to the last grant round. While Belarus remains committed to finding the necessary resources to fund their disease response, it is clear that they will be unable to scale up to the level required without external help. And inadequately funding TB and HIV programmes will inevitably lead to rising rates of disease and more drug-resistance.
While the current situation is much more serious in Eastern Europe and Central Asia than in the UK, this is an issue we should all be concerned about - not just because of the tragic human cost of this disease, but also because we all breathe the same air. Tuberculosis does not respect borders.
So what can we do?
We must support the control of TB where it is worst. So if the Global Fund is not able to fill the gaps in TB control, it's critical that the European Union steps up with targeted investments in the health of its Member States and its neighbours.
This will make a very real contribution not only to the health of those directly affected, but also to the health of Europe and the UK, and is a critical investment to help bring about the ultimate end of TB - for real, this time.