By Fran Kritz, NPR

The ancient scourge of tuberculosis for years was the deadliest infectious disease. Then SARS-CoV-2 came along and grabbed the notorious title of #1 killer: In 2020, COVID-19 was responsible for 3.5 million deaths worldwide vs 1.5 million for TB.The 2024 Global Tuberculosis Report, published last week by the World Health Organization, puts TB back in the top slot with 1.25 million deaths in 2023 compared to 320,000 COVID-19 deaths. There's also been an increase of hundreds of thousands of new TB cases in 2023 compared to the year prior.

The 1.25 million TB deaths in 2023 is down from 2022’s number of 1.32 million (which that year was second to the COVID toll). But it's still indefensibly high, say public health leaders.

“The fact that TB still kills and sickens so many people is an outrage, when we have the tools to prevent it, detect it and treat it,” said Tedros Adhanom Ghebreyesus, WHO director-general, in a statement issued on October 29.

According to the report, approximately 8.2 million people were newly diagnosed with TB in 2023 — the highest number since WHO began global TB monitoring in 1995 and a “notable increase” from 7.5 million people newly diagnosed in 2022.

TB sleuths are trying to figure out the reasons behind the increase. Anand Date, global TB branch chief at the Centers for Disease Control and Prevention, says population growth may account for the increase in cases last year -- and that it may take until the 2024 to find out if that is so or if the leap in 2023 reflects an undercount of annual TB totals during the pandemic.

“Disruptions to TB programs during the height of the pandemic led to more people going undiagnosed and untreated for TB. [And] guidance to shelter in place may have also limited the spread of TB, says Yogan Pillay, who heads efforts to improve TB program delivery at the Bill and Melinda Gates Foundation (which is a funder of NPR and this blog).

COVID-19 did trigger a new setback in the effort to control TB. But most of the reasons the infection persists are frustratingly well-known, says Lucica Ditiu, executive director of the Stop TB Partnership. There's too little money for research, treatment. and patient care needs. And there's stigma that can keep the most common victims of TB, impoverished people including migrants and sex workers, from seeking help or being offered treatment.

In addition, health conditions like malnutrition, diabetes and smoking that can exacerbate TB and keep medications from being fully effective, says Luke Davis, a TB and HIV specialist at the Yale School of Public Health. “TB is unusual,” says Davis, in that most people who are exposed to the bacteria won’t progress to infectious TB. Only about 10% do, and they are usually among the world’s poorest people often with poor health to begin with, which exacerbates their condition.”

So what's the solution?

And that brings us to the Tedros point. The world knows how to vanquish TB — but is not doing a good job.

Money reigns as perhaps the biggest obstacle to conquering tuberculosis. A spokesperson for WHO tells NPR: “Compared with global funding targets for TB set at the 2023 U.N. high-level meeting on TB, there are large funding shortfalls for TB research as well as prevention, detection and treatment services. To close these gaps, more funding is needed from both domestic sources in the countries most impacted by TB and from international donors.”

Global funding for TB prevention and care decreased in 2023 from $6 billion in the three previous years to $5.7 billion and remains far below the yearly target of $22 billion, according to WHO.

What would more money bring? WHO cites expanded rapid diagnostic testing as critical. Then treatment can start sooner. And people wouldn’t have to travel long distances to a clinic then wait for days for the results.

Increased funding would also help reimburse families for lost wages and food and travel expenses incurred as they go for treatment. Those costs keep some patients and their families from seeking care.

The WHO report and other investigations also say that countries burdened by TB also have to step up and spend more money on prevention, diagnosis and treatment. A report by MSF/Doctors Without Borders published last month, for example, found that, only 5 out of 14 countries have adapted their guidelines — based on WHO recommendations -- to initiate TB treatment in children when symptoms strongly indicate TB disease, even if bacteriological tests are negative.

And increased funding would speed up the pace of research says the CDC’s Date. Funding for TB research has stagnated at around $1 billion per year, constraining progress, according to WHO. The target at the U.N. meeting: $5 billion per year by 2027. “The world also has the most promising R&D pipeline of new TB tools in decades,” says Pillay. “What’s needed now is greater investment to deliver on the promise of that pipeline and ensure patients and those at risk of TB have affordable and equitable access to these tools when they are available.”

Vaccines in the works

Pillay says there are more than a dozen TB vaccine candidates in clinical trials, including one whose late stage (stage 3) clinical trial is sponsored by the Gates Medical Research Institute. The trial began recruiting patients last March. That vaccine candidate is called M72/AS01E and if proven effective would be the first new TB vaccine in 100 years. The lone TB vaccine available now is not predictably effective in adults, and can cause a false positive result on TB skin tests.

But even an effective vaccine won’t do that much good if there aren’t funds to purchase it for countries impacted by TB. Janeen Madan Keller, deputy director of the Global Health Policy Program at the Center for Global Development, based in Washington, D.C., says that while Gavi, The Vaccine Alliance, pays for [a variety of] vaccines in some of the poorest countries such as Afghanistan, Burundi and the Democratic Republic of the Congo, some countries with high rates of TB are middle income countries, like Indonesia, and no longer eligible for support. Ahead of a TB vaccine’s approval, says Keller, there needs to be a better match of policy and funding.

“Often it seems that when we find a way to help vanquish TB,” says Lucica Ditiu, “we also find another barrier.”

Fran Kritz is a health policy reporter based in Washington, D.C., and a regular contributor to NPR. She also reports for the Washington Post and Verywell Health. Find her on X: @fkritz

The new guidance comes after blood tests for 115 farmworkers in Michigan and Colorado showed that eight workers -- or 7% — had antibodies that indicated previous infection with the virus known as Type A H5N1 influenza.

Set in earlier eras, these powerful dramas engage our political moment.

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You'll be holding your stomach you''ll be laughing so hard.

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The Sargasso Sea Commission and Inter-American Sea Turtle Convention signed an MOU aimed at “more effective conservation of sea turtle species and the habitats that they utilize.” A spokesperson said, “During the Inter-American Sea Turtle Convention [IAC] 16th Consultative Committee of Experts Meeting, Dr. David Freestone, Executive Secretary of the Sargasso Sea Commission, and Verónica […]

The first volume of Eden of Witches releases on Nov. 12.

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The internet is reacting to comments made by Donald Trump during a COVID-19-related press briefing held yesterday. Trump claimed that the virus could be treated by bringing "light inside the body" or injecting a disinfectant. Thankfully medical professionals were quick to denounce these claims, and people on the internet have since been creating some excellent memes on the matter. 

This should go without saying, but please don't inject yourself with disinfectant, y'all.

Discover how to effectively clean and disinfect cutting boards at home. This article provides step-by-step instructions, recommending safe and natural cleaning agents to ensure a germ-free kitchen. Explore our best tips for extending your cutting board’s lifespan today!

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Avoiding Duplicate URL’s From Being Crawled The canonical tag was introduced in 2007 and tells the search engines what should be indexed. By allowing the search engines to know the preferred page it eliminates duplicate page indexing. E-commerce or large websites usually run into more issue’s surrounding duplicate indexing problems. This is due to multiple […]

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Have you ever had a personal word of the year before? Did you choose the word? Or did a word choose you? I don’t choose my word of the year. It comes to me, generally in December or January, and sometimes it surprises me. It’s something that’s been happening for me for the last seven […]

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Explores how the Institute for Research and Innovation in Social Services (IRISS) promotes the delivery of cost effective social services in Scotland that will support the achievement of positive outcomes for people accessing support. It identifies a number of principles that underpin the work of IRISS and suggests how these facilitate innovative evidence-informed practice. The approach to evidence-informed practice comprises four pillars of activity. The first pillar focuses on improving awareness and access to evidence and is exemplified by the Learning Exchange, the IRISS Insights series, and audio and video recording. The second pillar refers to strengthening the evidence base and is discussed in the context of work on self-directed support. Improving skills and confidence to use evidence forms the third pillar and is represented by work on data visualisation and peer support for self-evaluation. The final pillar is embedding evidence in organisations, through co-production, creating spaces to test and challenge evidence, and through the development of evidence-based products. Supporting people to share knowledge, learn from each other and to collectively produce new knowledge and solutions is an innovative approach but also one which should be cost-effective. Pre-print. Published in Evidence and Policy, 2014 (10)4 as Embedding research into practice through innovation and creativity: a case study from social services

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Systematic review produced by the EPPI-Centre in 2015.This systematic review aimed to evaluate the effect of HAART and ARV monotherapy on liver disease progression and liver-related mortality in individuals co-infected with HIV and hepatitis C, including in patients with haemophilia.

The ‘Dementia: More Than Just Memory Loss’ report, was published in 2016, and set out some of the key issues affecting people with dementia in Wales, in particular: • A widespread lack of knowledge and understanding of dementia amongst professionals and the wider public. • A lack of flexibility to effectively meet the needs of people living with dementia and their carers. • A lack of co-operation between services creates unnecessary difficulties and barriers for people living with dementia and their carers. The authors of the report called for a range of actions to address this, and there has been some progress, however, despite a range of changes across society at a policy, practice and community level, there is still a long way to go to transform services and drive the cultural change needed to effectively meet the needs of people affected by dementia.  The author of this report has consistently focused on the importance of meaningful outcomes for people with dementia and their carers, to ensure that their lives have value, meaning and purpose. This is fundamental to ‘Rethinking Respite’ and to delivering the Welsh Government’s vision of ‘a dementia friendly nation that recognises the rights of people with dementia to feel valued and to live as independently as possible in their communities as outlined in the new Dementia Action Plan for Wales. 

Side Effects
di: fantasynight

This is the time of year we think about overindulging on rich and elaborate foods. We also open our doors to family and friends to celebrate winter holidays. That's why you've always wanted to impress them with a delicious home made cheese cake. There are plenty of classic recipes on the internet that involve cream cheese, sugar, eggs, and flavoring, but the process is rather delicate. If you've tried before and had a less-then-perfect result, The Takeout will troubleshoot for you with the 12 most common mistakes in baking cheesecake. If you've never made a cheesecake before, so many possible mistakes may intimidate you. Relax, I've made cheesecake a few times and it's not as difficult as you might be led to believe. Even when it isn't perfect, it's still cheesecake, and that's a wonderful thing.

But if you have perfected the art of baking a cheesecake, you might want to take it up a notch and make Japanese cheesecake, which is the light and airy soufflé version. The Takeout has you covered with instructions for that, too. Now you'll be ready to really impress your holiday guests.   

(Image credit: Alice Wiegand)

George Takei really sucks—and he's proud of it!

The Star Trek legend and Internet darling had the prefect response this week for a Facebook troll trying to bring him down.

He shared a screenshot of the exchange with the caption: "Sorry, couldn't help myself.‪ #‎Trollololollol‬"

BOOM!

Takei is known for his epic Internet takedowns, so mark this one down as another win for Sulu.

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I completed Mass Effect 2 a couple of days ago for the first time. This article contains spoilers…

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While we primarily think of viruses as targeting their attacks against us, they are also in constant competition with each other.