Hyper Mega Bummer Boy

Kyoko, Souvenir of L'île d'Yeu, 2017

The deadliest infectious disease in human history is cured by the same packet of chewable tabs individually packed in foil. It comes in beef flavor so your dog won't resist taking its meds as much. It's like a hundred bucks for 30 tablets on pretty much any pet pharmacy.

For low and middle income countries who are buying their TB drugs in bulk, rifampicin works out to something like 3 cents per tablet. A few years back the WHO worked out that the cost of TB treatment averaged at $1 per person. That's for the whole 6 months of treatment.

HIV drugs in contrast cost anywhere from below 50 cents to nearly $2 per patient per day.

I need to add here, that TB has l-o-n-g latency times. On average a person who gets infected will not start to get sick and show signs of disease for 3-6 months at the short end, to 40-50+ years at the long end. Many people who get infected never progress to active disease. So you've got plenty of time to find folks who were exposed and give them preventive treatment, which is just 2 drugs for 3 months.

Despite all this, before the pandemic, every year, TB killed more people than any other infectious disease. Every. Single. Year. TB routinely kills more people than HIV and malaria combined.

In 2020 covid took the 'single biggest infectious disease killer' "crown" but as of 2024 TB has taken it back.

So, yeah. People dying of TB is not a problem with the drugs (well, not mostly; multi-drug resistant TB is a growing problem but this post is long enough already), and giving rifampicin to your dog is not taking it away from desperate people on the other side of the world. But yeah, why would companies sell it at 3c per tablet when they can sell it to pet owners in USA for a huge mark-up?

But also in terms of costs to governments or aid charities, you should be able to get a lot of bang for your buck in tackling TB - but it doesn't work out that way because it's the systemic issues, the infrastructure issues, that also need fixing in order for TB treatments to succeed. Daily meds for 6 months is a big commitment, requiring regular visits for blood work and check-ups and stuff. So instead people die from TB because of political choices, and poor social infrastructure, and systemic disenfranchisement, and overcrowded prisons, and displacement due to wars... I could go on.

TLDR - TB is a disease of poverty and malnutrition and overcrowding and lack of access to basic services. It is a disease that takes advantage of stigma and disenfranchisement and social isolation.