Thousands of years after Tuberculosis ravaged ancient cultures stretching from Greece to Egypt, more than a century after the bacillus responsible for the disease was first identified and decades after the first antibiotic-based treatments appeared, TB continues to thrive. In 2005 the disease was diagnosed in 9.2 million more people, almost exclusively in the developing world, and 1.7 million people died from it. More alarming is a growing subset of TB cases, estimated at half a million, that are resistant to more than one of the handful of anti-TB drugs. While they still make up only 5% of the total annual TB burden, these cases of multidrug-resistant and extensively drug-resistant TB are mushrooming, fueled by the surge in AIDS and by health-care systems that have ignored the threat of TB for too long.
But it doesn't have to be this way. TB is an entirely preventable and treatable disease. And the drug-resistant strains beginning to emerge in Africa, Russia, China and India, say experts, are epidemics of our own making. Unlike HIV, the tubercle bacillus succumbs to powerful medications. But these drugs are not where they need to be, and when they are, spotty monitoring and poor health infrastructure make it hard to ensure that patients take their daily doses for the six months that are needed to eradicate the infection--all of which encourages drug-resistant strains to survive and keep the disease going. "We are still in denial about how bad this problem is and how much worse it's going to get," says Dr. Jim Kim, head of social medicine at Harvard Medical School.
Over the past five months, TIME's James Nachtwey has documented the resurgence of TB in seven countries. Turning back the epidemic will require not just newer and more effective drugs but also better ways to detect the disease and a renewed commitment to expanding existing TB-treatment programs. In June the World Health Organization (WHO) recommended a new, rapid test for TB that can provide results in as little as two days. But for most TB-ravaged nations, adopting the technique will require upgrading lab facilities. That's not easy, but it's something WHO hopes will ultimately help these countries battle not just TB but other infectious diseases as well. TB bacilli have adapted over millenniums; to control the scourge, we must adapt too.