TB is set to regain its position as the leading infectious killer worldwide. The World Health Organization’s (WHO’s) End-TB Strategy aims to end the global TB pandemic by 2035. Since its launch in 2015, the strategy has marshalled unprecedented political will, international collaboration, and funding to develop better diagnostic tests, new drugs, and a new vaccine. However, we have not even reached the halfway mark in our  TB elimination goals. In this presentation, I shall argue that the reason for this disappointing progress might be underinvestment in a therapy we already have: food.

Undernutrition blunts the function of the immune system and increases the risk for TB so much so that it is likened to HIV/AIDS and called “nutritionally acquired immunodeficiency syndrome” or N-AIDS. Undernourished patients with TB get sicker, have more extensive lung damage, and are more likely to die from TB. It would be unimaginable to leave HIV/AIDS untreated so why do we tolerate neglect of N-AIDS?

Based on modeling studies, feeding an undernourished individual and increasing their body mass index (BMI) from 16 to 20 would decrease their risk for TB disease by about 50 percent. This would be as beneficial as the new TB vaccine, which is generating great enthusiasm. Of course, feeding people has benefits beyond mitigating TB risk: prevention of complications from vitamin and mineral deficiencies, protection against other infectious diseases, increased economic productivity, and decreased human suffering due to hunger. Thus, reducing undernutrition on a population-level may represent a sustainable approach to eliminating TB and preserving human capital which draws on lessons Dr. Guerrant has taught us all. 

To meet the goals of the End-TB Strategy, we must take immediate and radical action. Continued investment in diagnostics, drugs, and vaccines is critical, but we must also invest in meals as we do in medicines. The only way to make rapid progress toward TB elimination is extend our work upstream and focus on prevention by addressing socioeconomic factors such as undernutrition.