Microbes at the Gates

Odds are good that on a plane or boat or bus somewhere in the world sits a refugee headed for the United States carrying the seeds of a weapon of mass destruction. The agent he unwittingly carries is insidious and lethal but slow acting, so the deaths it causes can come months or even years after it is disseminated in the population. It has the potential to overwhelm, to kill thousands, and there may be no vaccine, antidote or cure.

What is this ominous threat? An ingenious new biological weapon? No, it is a very old nemesis of humankind--tuberculosis, an infectious disease that kills more than 2 million people every year. Because the majority of them are poor and outside our borders, we don't hear much about them, but that may soon change. Tuberculosis is making a comeback and is conquering the treatments that have kept this killer at bay in the developed world. Multidrug-resistant tuberculosis--a death sentence in most developing countries--is becoming more common and is incurable in about half the cases, even in the United States.

Two numbers in the President's budget proposal stand in stark contrast to each other: $6 billion to fight bioterrorism versus $200 million to the Global Fund to Fight AIDS, Tuberculosis and Malaria. That works out to a little more than $1 billion per US anthrax death last year, as compared with $33 per global victim of the more common infectious scourges in 2001.

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