The Long Road to End Tuberculosis

This lecture from John Green is a great full summary on the history of TB https://www.youtube.com/watch?v=7D-gxaie6UI

He's also publishing a book about it https://www.penguinrandomhouse.com/books/312472/everything-i...

Recently, John Green lobbied to get certain pharma companies to lower the price of tests and vaccines

https://www.scientificamerican.com/article/how-advocates-pus...

Tuberculosis is not a medical problem, it's an inequality and access problem. Tuberculosis is fully solved in advanced countries yet less developed countries still suffer from it. Pakistan has 260 death per 100k capita, the US has 2.6. The highest 5 countries have at least 600 per 100k capita.

Oh hey, I had TB. It sucked. I had to be proper quarantined for 3 months, felt like shit for a whole year and a half, and nearly died because I didn't realize I had any symptoms. I thought I was just tired and depressed all the time because I hated my job, and then one day I collapsed from what I thought was a heart attack.

I was/am otherwise healthy and must have just drawn the short straw (or it was a very long dwelling infection from a trip abroad years earlier). I really wish we vaccinated for it like Europe. I'd have taken the little scar on my arm for reducing the already small chance of dealing with that shit.

I almost lost a former partner to this disease. Totally changed my life.

One of my first projects at my development consulting job was a site build for an org working on vaccine candidates, which a decade later, unfortunately haven't crossed the finish line.

So with a fairly personal connection with the disease, and the nonzero chance I could one day develop it myself, I have a personal interest in seeing progress in the space.

I saw an IAVI update the other day stating TB research is currently only funded to the tune of 1 billion a year when they need 6. 10.5 million infections a year reported. Remember the countries where the disease have the biggest impact have limited diagnostic abilities outside of cities and politically, these countries are very quick to pretend the problem is solved when the reality is that TB started speeding up again in the covid days because the care programs for patients then was put on pause.

If you wanna change the world and aren't just out for VC cash, go design a mobile X-Ray unit to take into villages, work on an AI model to diagnose from imagery, and work on figuring out how to speed up the testing because a MGIT machine needing power 24/7 is not the type of equipment you can always get in the places the disease impacts.

Figure out how to get those little mycobacteria suckers to divide quicker in agar (my limited biology education tells me mess up the mycoic acid synthesis without killing it?) and then get people a positive result in 3 days instead of 3 weeks. Remember: the very good blood test (quantiferon gold) is banned in the largest country in the world because it comes back positive for the 1/3 of the population latently infected.

A mystery not mentioned in the article: why is TB so unusual in places like the US? The US does almost nothing to control TB. We don’t vaccinate. We don’t routinely test (except in special cases, but those cover very little of the population). We don’t treat latent cases unless they somehow get noticed. And yet the incidence of symptomatic TB is low, and there’s no sign of TB developing resistance to whatever the US is accidentally doing right.

Elections have consequences, I just hope the incoming administration isn't actually going to roll things back on vaccines, etc. Otherwise, we may end up with upticks of diseases previously mostly eradicated (at least here in the US).

It would help if greed would stop being an obstacle.

It’s relieving that at least other branches of vaccine development are not under the information regime as with COVID.

“However, environmental bacteria complicate the picture. If present before vaccination, memory immune cells primed to destroy the environmental relatives might cross-react with and neutralize the BCG strain before it has a chance to set up an immune response against itself and M. tuberculosis.”

Nobody cared if one already had covid before administering the vaccine and since the vaccine came late many have had a previous infection already. The new mRNA vaccine utilities the body to produce the actual pathogen and with already existing immunity from a previous infection one’s immune system starts to attack the mRNA modified cells and pathogen product.

> TB remains the deadliest infectious disease on Earth, killing about 1.2 million people every year.

I would guess, in 2024 Covid killed more than 1.2 million people. I guess many people are assuming that Covid was a temporary disturbance, and will attenuate in the coming years. But what if it doesn't but will keep at about the current levels from year to year for a long time.