XDR-TB is worse than Ebola, but we can act

I arrived home in Boston a few hours ago and was thrilled to see my 13-month-old son Joe toddling around our apartment. He got bigger during my 11 days in Cape Town and Pretoria.

Seeing Joe strong and healthy made me reflect on how lucky my family is and how unlucky many people in South Africa are. If you are born into poverty in Cape Town you are likely to be infected with TB and may die as a result.

Let me explain. On Monday morning, I spent a few hours with Dr. Kyla Comins at Brooklyn Chest Hospital and Task Applied Sciences. To me, Kyla is an incredible hero because she is risking her life to take care of patients with XDR-TB. This is an airborne disease which could infect and kill her.

Kyla and her colleagues are struggling with the “really, really poor access to (XDR-TB) treatment and poor outcomes.” At the moment, “less than 20%” of patients are completing treatment, due to a lack of availability of TB drugs. The rest may transmit XDR-TB in their communities and eventually die.

In my opinion, XDR-TB is a “ticking TimeBomb,” to quote Dr. Lee Reichman, that is worse than Ebola.  The reason is TB transmitted by an airborne route while Ebola requires you to be near a patient with vomiting or diarrhea. That means you can be sitting on an airplane, in an Uber, or in a hotel lobby and if a person with XDR-TB is coughing nearby you can catch XDR-TB, a disease with mortality approximately that of Ebola. TB also has a long latency and infectious period, which Ebola does not.

XDR-TB is also worse than Ebola because it is an invisible, silent killer. Ebola is a screaming, obvious killer. Ebola leads to massive media attention and financial resources because of the hysteria that it generates.

But TB spreads in poverty, in the shadows. It leads to stigma and denial, not to media attention. It is neglected, even when huge amounts of transmission occur. Even though the international TB conference was held in Cape Town, we couldn’t get mainstream media outlets in America to cover the story.

Think about Albert Camus’s famous novel, The Plague. XDR-TB is sneaking up on us and we need to act, just like the HIV activists did in How to Survive a Plague.

The US government pours billions of dollars into the Ebola response because of the panic hyped by the media. Fear gets Americans to buy newspapers and watch the television. However,  TB advocates struggle to obtain even the money we need to end nosocomial XDR-TB transmission.

TB isn’t a major priority of the US Government, Dr. Jennifer Furin made clear, because it isn’t on their radar. Meanwhile, the US spends trillions of dollars on our broken health care system, ineffective military spending, etc.

Americans should start thinking of XDR-TB as “Ebola with wings” and we must act, now. The solution isn’t to close our borders. The solution is to take TB seriously, as TB Proof is doing and I have frequently described on this blog. We must prevent TB transmission everywhere it is occurring.

I want this blog entry to end on a positive note. Before I left Brooklyn Chest, Kyla introduced me to one of her patients. He had just completed a long course of treatment for XDR-TB but was likely to have been cured.

We can address this emergency. Please support TB Proof and our colleagues around the world who are trying to end the spread of TB. (Disclosure: I am a member of TB Proof).

With Kyla in the gardens next to Brooklyn Chest Hospital
Outside the locked XDR-TB unit where Kyla takes care of patients.
On my airplane flight home.
From Brooklyn Chest Hospital


From Brooklyn Chest Hospital


Dr. Lee Reichman

“It was great to meet you also, Phil, and thanks so much for introducing yourself, as well as for your generous depiction and reminding your audience about TIMEBOMB, which I am most proud of but which has been largely forgotten. It is also a pleasure to be introduced to your writings which I sincerely find very compelling.

As we discussed, I suspect that TB is long forgotten probably because it isn’t sexy.  The antidote to this situation is advocacy, but it has to be a unique,  compelling advocacy by persons with a distinct  passion, which you are amply demonstrating. I am not sure of your time commitments, but the main TB advocacy organization on a volunteer basis is STOP TB USA, that I would suggest you get to know and if possible become involved with.  They will be meeting in conjunction with the UNION North America meeting, last week of February in Denver.  I’ll be glad to provide introductions if desired.Please keep up the  great work, and don’t hesitate to call upon me if there is any assistance I can provide!


Kathryn Snow

Enjoyed your post, but it raises an issue I think about a lot – how we can raise awareness of TB as a global health issue, without causing anti-migrant hysteria. The UK has failed catastrophically at this – the Murdoch press there has run a scare campaign stoking fears that eastern European and south Asian migrants are “bringing TB back to the UK”. Not exactly the awareness we want to raise, since it just increases support for oppressive migration practices, rather than control in high burden settings! I’m not sure what the answer is on that one – maybe we need to look to HIV activism yet again to see how it’s done. Food for thought, anyway!


 Thanks so much for visiting my website! Writing and reading blog posts does take time and we all know that time is in short supply. You and I will both get much more out of this blog if it leads to dialogue. If you found my post useful and wouldn’t mind leaving a brief comment or sharing on social media, I would be grateful. Or if you’re shy about Tweeting but are willing to email me a comment that I can post anonymously or send an anonymous Surveymonkey, that would be great. My posts are generally written quickly, so if you find any factual or grammatical errors, please do let me know. Best regards, Philip Lederer


3 thoughts on “XDR-TB is worse than Ebola, but we can act

  1. I think you are right. I recall when we at WHO called MDR-TB “Ebola with wings”: it was 20 years ago during an outbreak of Ebola in DRC. However, people did not appreciate it as they thought it was undermining another tragic disease. Regardless, TB remains neglected relative to its burden and the suffering imposed to humanity. This is the n.1 infectious killer. Deaths are decreasing at about 3.5% per year thanks to serious interventions to care for people with TB by many countries, but those due to HIV/AIDS are decreasing much faster thanks to widespread use of ARVs and major and fully justified investments by the international community. We are speaking of 8 billion USD per year compared to 1 billion for TB for two diseases that kill at the same level. In addition, TB care is considered as a no-brainer even by economists based on studies showing that for each 1 USD invested there are gains in productivity of over 40 USD. In short, there is something wrong and nobody can justify rationally the lack of sufficient investments against the top killer that is curable and preventable, and even the most cost-beneficial intervention in public health as shown by various investigators inclouding those of the Copenhagen Consensus and the World Bank. in short, we must never stop raising the issue and fight for more domestic and international investments against TB. Every single day we should wake up and think about this injustice until we have corrected it. There should be no rest and no complacency. Until we have corrected this injustice.

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