Lilly MDR: Tuberculosis - A Workplace Epidemic

Tuberculosis is one of the world's oldest diseases. A serious epidemic in many developing nations, it is becoming more prevalent in Europe and North America. Here, leaders of some of the world's foremost healthcare organisations speak to CEO about the need for an urgent response to disease in the workplace, regardless of location.

Over a third of the world's population, around two billion people, are infected with tuberculosis (TB). The disease can be spread through coughing, laughing and even singing. Hundreds of years ago TB, also known as consumption, meant death, but that is no longer necessarily the case. For Rosemary Bryant, president of the International Council of Nurses (ICN), it is an outrage that TB has been curable for over 50 years and yet two million people die of it every year. "This is the equivalent of ten jumbo jets crashing every day. You would have to offer some serious answers if you were in charge of that airline," she says.

While developing countries tend to be the hardest hit, TB exists everywhere around the world. The majority of cases are reported in countries such as China, India, Russia and South Africa. However, regions such as Europe and North America are also affected.

In May of 2010, a 12-year-old in Baar, Switzerland, was diagnosed with TB, followed by 16 of the child's classmates. In December 2009, a 23-year-old woman flying from Poland to Chicago had a persistent cough from a harder to cure form of TB called multi-drug resistant TB (MDR-TB).

While there were no reported cases linked to the incident, those who sat close to the woman on the plane were contacted by the Centers for Disease Control and Prevention (CDC) to see if they had contracted the disease. Around the same time, the first case of the worst form of TB, extensively drug resistant TB (XDR-TB), was reported in the US.

Global reach

TB is an illness that can strike people of any age, race, gender or social class. "In a globalised world, any disease is just as far away as the next flight, "says Otmar Kloiber, secretary general for the World Medical Association (WMA). "There is no safe place and no country is immune. TB is something people in all countries should be concerned with." In addition to national borders becoming almost non-existent, so have those in the business sector.

"The World Health Organsation estimates that $13bn is lost annually due to a decline in work performance from TB."

According to Bryant, the increasing migration of workers raises the potential for the disease to be transported anywhere in the world. "It makes sense for companies to promote good health such as a healthy diet and quitting smoking and to respond positively to those in the workforce who are unwell to ensure they have access to services and can return to their duties as soon as possible," she says.

In a globalised work environment, borders become more blurred. While TB may not be considered a health problem in Europe or North America, there are areas of these continents that have high concentrations of the disease. In 2008, the CDC released a report on TB in the US. The results showed that during that year, almost 13,000 cases of TB were reported in the country, the equivalent to about four cases per 100,000 people. Hawaii, California, Alaska, Texas, and New York reported the highest number of cases. In Europe, there were almost 480,000 cases of TB reported in 2009. This number accounts for 5% of cases reported worldwide. Both regions had the majority of TB cases reported in the 25-44 age group, with men generally the most susceptible.

Worldwide, cases of TB and MDR-TB appear to be comparatively lower in Europe and North America. This has led people to believe that there is no need to implement programmes to help stop the spread of the disease. For Eric de Roodenbeke, director general of the International Hospital Foundation, this attitude has cost lives, and will continue to do so unless people become aware of the situation. "Infectious, airborne diseases such as TB know no borders. This means that companies need to sit up and take notice that TB is a disease that can affect not only production, but the bottom line as well," he says.

The World Health Organsation (WHO) estimates that $13bn is lost annually due to a decline in work performance from TB. This shows that companies are being affected by the disease. Like any illness, there is no way of knowing when TB will surface, or how many people will become infected with it. However, because of the perception that TB is no longer a problem, many necessary precautions, especially in the workplace, are not taken. "There is no way of knowing what course an infectious, airborne disease will take," de Roodenbeke adds. "Therefore, diligence and vigilance should always be exercised." Kloiber agrees. "Tuberculosis is still an urgent problem; people must realise that it is a serious global threat. To overlook it would mean to turn away from those who are suffering," he says.

Collective solution

Eli Lilly and Company has philanthropic programmes to help combat TB and MDR-TB worldwide. The Lilly MDR-TB Partnership works with over 20 global organisations including the International Hospital Federation, the International Council of Nurses and the World Medical Association. These organisations have found that TB knowledge is often not adequately addressed in the education of health professionals in Western societies. While it is no simple task, programmes are available to help healthcare professionals gain the knowledge needed to treat TB.

"The economic and social gains to society and humanity from investing in TB outweigh any loss from failing to act."

The ICN has instituted a Training-of-Trainers course, where nurses' capacity in the care and management of TB is upgraded. Almost 1,000 nurses have been trained as trainers since 2005 and they, in turn, have updated a further 18,000 nurses and other health workers about TB and MDR-TB. The IHF has trained over 140 hospital managers and over 200 hospital staff members on how to properly manage TB infection control. The WMA has also prepared free online TB and MDR-TB training courses in different languages based on WHO guidelines.

In addition to training professionals, many communities around the world need to understand what TB is and how it can be treated. "The social aspects of the disease must be addressed to ensure that patients have the best chance of recovery," says Bryant. "This means reducing stigma, improving access to diagnosis and treatment, and enabling people to maintain their economic independence."

The importance of this message is echoed by Kloiber: "TB care, treatment and control is a good investment for our future; if we don't do it now, and don't do it thoroughly, the economic and social consequences are likely to be unbearable." Investment in TB education can save money and lost productivity. According to the National Foundation for Infectious Diseases, if TB becomes drug resistant, treatment can cost up to $250,000 a patient and, in some cases, can be incurable. This is exponentially higher than the cost of treating regular TB.

However, when proper precautions are taken, for every dollar spent on TB prevention, a country saves $3-4. "The economic and social gains to society and humanity from investing in TB outweigh any loss from failing to act," says de Roodenbeke. "We need continued and increased investment to make diagnosis and treatment more efficient and we need investment in front-line services to ensure that our current tools are available and used effectively," adds Bryant.

For those companies wishing to invest in TB control in the workplace, there is information available to help them get started. Through the Lilly MDR-TB Partnership, the World Economic Forum has developed a toolkit explaining the steps companies can take to ensure the management of TB in workplace.

The programme is based on principles established by the International Labour Organisation and the WHO. A few of the guidelines that are easy and cost-effective to implement recognise that TB is a workplace issue, and that there is a need to create awareness, ensure non-discrimination and to develop a sustainable network of TB programme partners.