Tuberculosis, paradigm of an unequal disease

Tuberculosis, a disease that had become a myth, is still very much with us today, and has even re-emerged in the last thirty years as a result of the AIDS pandemic, which is facilitated by the lack of cellular immunity. The situation has worsened with the spread of strains resistant, in some cases, to all available anti-tuberculosis drugs. Tuberculosis is therefore currently one of the world's top public health priorities. However, among infectious diseases, it is one of those where inequity is most glaring. It is the poorest populations, those living in countries with the most disorganized medical systems, who pay the heaviest price: lack of surveillance and diagnosis, inadequate treatment in terms of quantity, quality and duration, leading to (multi)resistance. Our urban fourth world is not immune in these times of crisis, and certain environments, such as prisons, are breeding grounds for multi-resistant strains (100% in some Russian prisons). But there are other inequalities in the face of this disease. Some are medical, such as the extreme difficulty of diagnosis in young children, or the ineffectiveness of BCG in inter-tropical regions. Others are social and cultural, such as the stigmatization of women with tuberculosis, who are rejected by their communities in certain cultures. Managing tuberculosis on a global scale is a major challenge.