Fundraising for TB elimination

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Need for Fundraising

Discovery of TB-bacillus in 1882 was a landmark event. Excited by this discovery, next ask was to find a cure. Individuals who contracted TB included rich and the famous. Clamour for effective treatment was at a record high. Bernard Shaw depicted this in his famous play – A doctor’s dilemma. In this play, doctors need to ration expensive but futile remedies for TB. Before discovery of TB-bacillus, list of such remedies included arsenic, sulphur, human or animal excreta, blood-letting, charms, royal touch and prayers. Obviously, these did not work. TB elimination required new cures and fundraising efforts.

Fresh air, sunlight and good-food

A few years before the discovery of TB-bacillus, a German Botanist named Herman Brehmer (1826-1889), spent time in Himalayas, to cure himself of TB. Fresh air, rest and high-altitude were his remedies for a successful cure. A few years later, in 1857 he established first sanatorium in Europe. Fresh-air, sunlight and good food were among the first antimicrobials. Neils Ryberg Finsen, (1860-1904) scientifically demonstrated benefits of sunlight. He used natural light phototherapy to show improvement in tuberculosis of skin. Finsen received Nobel Prize for this discovery in 1903. Sadly, he died of Neimann Pick disease the very next year.

Discovery of TB-bacillus, and reported benefits of light exposure, in absence of any other available treatment at that time, saw a rush for stay in expensive sanatoria. While rich could get themselves funded, poor were left behind. Philanthropists started building more frugal sanatoria for the poor. Tuberculosis, lung, and sanatorium associations were forming in various countries, beginning in France 1891, Germany 1895, Belgium 1898, and Italy in 1899. Aim of these associations was to increase awareness about TB, and to identify ways and means to cure the diseased.

Fundraising needs a symbol

Funding poor for a sanatorium stay, was a key initial effort to “cure” TB. We needed a “crusade against TB”. This crusade required a strong symbol. In an international TB conference held in Berlin (1902), French physician Gilbert Sersiron proposed a symbol of medieval crusades – Cross of Lorraine. This cross became a symbol of the new, organised anti-tuberculosis ‘crusade’.

Crowdsourcing

In 1904, an innovation by Einar Holboll a Danish postmaster, changed the concept of raising money for TB. His assistants developed Christmas penny-seals to raise money for children with TB. These seals were without a postal value, but looked like postal stamps. Activists encouraged patrons to buy these seals for charity, and affix them on mail.

In 1907 by Emily Bissell, a red-cross activist, adopted this method of raising money in the US . Her initial effort was to raise funds for a TB-sanatorium in Delaware. Subsequently idea of such annual Christmas seals became common.

From seals to stamps

Various countries issued charity postal stamps in 1890s, initially for Red-cross, and thereafter for child-health. In early years of 20th century, many countries in Europe combined postal and TB-charity stamps. These postal stamps collected a charity-amount additional to the postal value. Postal departments, passed on this additional amount to the National TB associations. All such charity stamps have two denominations, one for postage and other as a TB-surcharge. Various countries that issued such stamps included Netherland in 1906, France in 1920, Belgium in 1926, Spain in 1937, and Finland in 1947. Countries continued to issue such stamps till 1960s. Thus, nations incorporated charitable purpose of Christmas seals, in postal stamps.

Changing usages for TB-funds

Initially fundraising for TB was to promote the sanatorium movement. Next set of treatments that became popular in late 1800s early 1900s was surgery – creation of artificial pneumothorax, or lobectomy. Clamour for sanatoria continued till after Second World War. Their contribution to TB-care declined only after the Madras experiments, that proved that home-based care is as good as sanatorium based care. Many sanatoria evolved to TB-hospitals, dispensaries, and TB-research institutes after the Second World War.

Roentgen discovered X-rays in 1895. Thereafter we used charity funds to , improve diagnosis of TB. X-ray units were setup and X-ray based screenings were conducted, especially in military personnel. In 1906, Charles Calmette and Camille Guerin developed anti-TB vaccine (known as BCG vaccine after Calmette and Guerin). This vaccine was first deployed in France in 1921, and mass BCG vaccination campaigns were launched. BCG vaccine was found to be particularly effective in children.

Drug therapy for Tuberculosis

There were no effective drugs to treat TB till 1940s. Penicillin and Sulphonamides, only antibiotics that had just become available were not working. Scientists discovered two drugs in 1944. First, Streptomycin (SM) by Selman Waksman and second, Para-amino-salicylic acid (PAS) by Jorgen Lehmann. We started using these two drugs in combination to treat TB.

More discoveries led to evolution in Drug therapy for TB. Isoniazid (INH) was discovered in 1952, and treatment duration with three drug combination (INH+SM+PAS) was 24 months. Rifampicin and Ethambutol were introduced in 1960s, and TB was now treatable in 9 months. Pyrazinamide was added to the regimen in 1980s, and since then we use four drug regimen (consisting of Rifampicin, INH, Ethambutol and Pyrazinamide) for 6-months. More effective drugs could help reduce this duration further.

Road to elimination remains treacherous

In late 1980s, while world seemed to be closer to elimination of TB, two worries rattled the globe. First was emergence of HIV-AIDS, which weakened human immunity, making them more susceptible to TB. Second was evolution of TB-bacilli, which now had multi-drug resistant (MDR-TB) strains.

As effective anti-TB medicines were introduced, most countries had moved from TB-association based programs to government funded national TB-control programs. Fundraising through postage stamps had now stopped.

In 1995, National TB programs, especially in high burden countries adopted directly observed treatment short-course (DOTS) regimens. Seven years later, in 2002 a global fund to fight three diseases – AIDS, TB and malaria was launched. Today, this global fund provides 76% of all international funds to fight TB.

Overall, global burden of TB has tremendously declined. However, it remains high in South Asia, Africa, and Eastern Europe. Our struggle to eliminate TB continues. We observe 24th March, the day of discovery of TB bacillus as “World TB day” – to renew our commitment to continue with crusade for TB-elimination.