The resurgence of tuberculosis is behavioral, not medical. Nudges can fix it – Erez Yoeli, David Rand, and Jon Rathauser

Erez Yoeli, research scientist at MIT’s Sloan School of Management

David Rand, Associate Professor of Management Science and Brain and Cognitive Sciences, MIT Sloan School of Management

From STAT

Nancy had been coughing for months. When she started experiencing chest pain, this bubbly mother of three and very proud grandmother went to see a doctor at her local clinic in Thika, about 20 miles northeast of Nairobi. He delivered a crushing diagnosis: She had contracted a drug-resistant strain of tuberculosis. That was in June 2016.

For the next eight months, Nancy went to the clinic daily to receive an injection of a strong antibiotic and take a cocktail of 15 pills that were also antibiotics. She became so weakened by the disease and her medications that she couldn’t walk. Her children carried her to the clinic for her daily visits and provided constant support and encouragement, but she still felt she was alone — she wasn’t working, and her friends avoided her out of fear of being infected by the disease.

Nancy is one of roughly 10 million people worldwide who develop tuberculosis each year. Once on the decline, TB has again become the world’s deadliest infectious disease, killing nearly 2 million people a year, more than malaria and HIV combined.

The cause of TB’s resurgence is not medical; a highly effective though burdensome treatment has existed for the disease since the mid-1940s. Instead, the cause is mostly behavioral: Faced with the prospect of extended treatment and isolating stigma, many people are slow to seek treatment or quit partway through. This fuels the tuberculosis epidemic by giving the disease ample opportunities to spread and mutate into drug-resistant strains like the one that infected Nancy.

If the fuel is behavioral, then the solution should be as well.

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