Epilogue

Solomon R. Benatar

Department of Medicine, Medical School, University of Cape Town, Observatory 7925, Cape Town, South Africa

A quarter of a century ago there was hope that tuberculosis could be eradicated from the world, even though it was anticipated that this would take many decades to achieve. The causative organism was well known, and effective drugs were available. These drugs had been well tested in clinical trials, and rifampicin, a new and powerful drug that allowed treatment time to be reduced by two-thirds, was coming into widespread use. Today, the possibility of eradicating tuberculosis is not only more remote but also seems almost impossible to contemplate given the development of multidrug resistance and the profoundly adverse influence of HIV infection (Benatar 1995).

The lost opportunity to eradicate a disease responsible for vast human suffering can be attributed to the failure to appreciate the extent to which tuberculosis and other diseases cannot be addressed merely from a biomedical perspective. There is a desperate need also to address widening economic disparities associated with exploitative economic and military policies and wars that are killing more civilians than ever, displacing whole populations from their homes and countries, and rendering them vulnerable to old and new infectious diseases. Ecological degradation, due to both population growth in poor countries and unsustainable consumption patterns in wealthy countries, pose additional threats to the health of whole populations (McMichael 1993, Benatar 1997).

Scientific advances must continue to be made as these will lead to the development of more effective drugs and vaccines that could shorten the duration of treatment. However, this will not be sufficient, and scientists cannot complacently confine themselves to the comfort of their laboratories. They need to harness the credibility associated with their scientific knowledge to contribute to those social and political processes that could reduce exploitation, reduce wastage of resources on weapons of mass destruction and improve population health through investment in development. If they fail to do so they will be seen by future generations to have been blind, selfish or stupid!

Antituberculosis treatment is one of the most cost-effective treatments available in the world. Making such drugs available to all with the disease is not beyond the financial or organizational capacity of the world. The withdrawal of the USA and the UK from payments of their subscriptions to the IUATLD (International Union against Tuberculosis and Lung Diseases) is a sad reflection on the humanitarianism of some of the most privileged people in the world.

As we look back and recognize that it took 50 years for the antislavery campaign to render slavery illegal, we can appreciate that it is indeed possible to reverse profound social ills, although the process is difficult and slow. Endeavours to reduce the production, sale and use of weapons of mass destruction and efforts to divert resources towards more productive uses needs widespread support and could have a major impact on tuberculosis and other infectious diseases (Benatar 1997).

Can we afford to be silent and complacent? What kind of moral judgements will be made about us in the future if we neglect these obvious obligations? Will scientists be seen in the same light as South Africans who were blind to the effects of apartheid? We know the answers to these questions. It is time to take action that includes but goes beyond our justifiable commitment to sustaining scientific progress.

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