For 70 years Professor John Crofton has been battling with one of the world’s biggest killers, TB, and the fight’s not over he tells Nick Thorpe.

Less than a decade after the carnage of the Second World War, Professor John Crofton found himself fighting a rather more specialised battle in his 400-bed Edinburgh hospital ward.

It was the 1950s and the first new drugs were producing patchy results against an ancient enemy called tuberculosis. While some patients recovered, others relapsed and died in the familiar way – the chest pains, the coughing of blood, the body’s slow ‘consumption’. Then one day the doctor and his team hit upon a simple but revolutionary idea.

“Failure was always due to drug resistance,” recalls the Dublin-born trailblazer, now 95, speaking at his home on the outskirts of Scotland’s capital. “So we decided to try with three drugs at the same time to be on the safe side – and to our astonishment we found we were curing everybody.”

Half a century later the ‘Edinburgh Method’ – the world’s first 100% cure for tuberculosis – has saved millions of lives globally, and its originator has been knighted for his contribution. But with a new and almost untreatable strain currently gaining strength on the Soviet fringes of Europe and across the developing world, Sir John Crofton can see no reason to rest on his laurels just yet.

“We should be worried,” says the veteran campaigner, a man not given to alarmism, who was invited to mark Global TB Day 2007 with a speech to the European Parliament in Brussels. “There are a number of new drugs approaching clinical trial at the moment, so there is hope – but I think we’ll have a period where we will lose a lot of patients, particularly in the developing world.”

The problem is essentially the same as it was in the 1950s: the ability of Mycobacterium tuberculosis to mutate and become immune to existing remedies, particularly where courses of medication are incorrectly administered or left unfinished. “People feel better in three or four weeks, and say ‘I’m cured and I don’t need to go on taking this stuff’,” sighs Crofton. “I understand: they have other priorities, especially poor people – like where the next meal is coming from.”

Yet this simple lapse in treatment is what first created the resistance to his powerful drug combination – streptomycin, PAS (p-Amino salicylic acid) and isoniazid – requiring the development of ever more complex and expensive cocktails to treat the new multi-drug resistant strains (MDR-TB). If they are treatable at all, that is. In the past year health workers and headline writers alike have been urgently flagging the spread of a new super-strain of extreme drug-resistant TB (XDR-TB). In KwaZulu-Natal it has ripped through dozens of hospitals bringing a mortality rate as high as 98%. “

In truth, TB has never decreased in the developing world,” says Sir John, who blames piecemeal or inadequate treatment, and the complicating influence of HIV and AIDS. “HIV makes you extraordinarily susceptible, attacking the most important cell in your body for protecting you against TB. I’ve heard cases where a TB patient has just been wheeled down a corridor where HIV patients have been waiting and they’ve developed TB.”

With TB already the leading cause of death in Africa for those with HIV, health ministers from 46 countries declared a continent-wide emergency in August 2005. But it’s not just the developing world that is under threat: recent confirmations from Canada, Japan and Norway bring the number of countries reporting XDR-TB cases to 27. In ‘hot zones’ like Latvia, Lithuania and Estonia,multi-drug resistant TB infection rates are as high as 10% – right on the borders of the EU. As the new slogan of the Stop TB Partnership puts it: TB anywhere is TB everywhere.

Even without the new strains, the arithmetic of TB is dizzying. Humanity’s most persistent plague, ingrained in modern slums as it was in the bones of Egyptian mummies, it kills 5000 people every day. According to the World Health Organisation nearly 2 billion people – one third of the world’s population – carry the bacterium in their bodies, of which 8 million will contract the disease and almost 2 million die annually. An untreated carrier is likely to infect 15 others in a year, by sneezing, speaking or simply breathing.

The young John Crofton first studied its effects on patients in a tented hospital by the Suez Canal in the Second World War. Not long out of Cambridge University, the young graduate learned from a charismatic chest specialist who later recruited him to some of the first clinical trials of the antibiotic streptomycin in London after the war. Until then, the best available treatment was ‘good food and bed rest’ – a prescription which saved barely half of those infected.

Some of history’s most famous names succumbed – among them John Keats, DH Lawrence, Frederic Chopin, Emily Brontë and George Orwell. “No self-respecting artist or poet dreamed of dying of anything else,” smiles Crofton grimly. “In my generation we practically all got infected by the time we grew up.”

All the more tantalizing, then, that Crofton’s breakthrough means the disease in its simplest form is now entirely treatable for as little as £10 per patient – if only patients can be induced to finish the treatment.With this in mind, governments last year signed up to the Global Plan to Stop TB, aiming to halve levels by 2015 with a combination of a steady nerve and hard cash.

The target sum of $56 billion will require a tripling of international aid over the next ten years. Announcing the new targets last year with UK Chancellor Gordon Brown and Nigerian President Olusegun Obasanjo, Microsoft tycoon Bill Gates was among the first to rise to the challenge, pledging $900,000 from his own foundation.

While there’s still a long way to go, Prof Crofton’s long experience with the disease has given him a quiet but determined optimism.When he moved north to become Professor of Respiratory Diseases and Tuberculosis at Edinburgh University in 1952, TB cases numbered around 50,000 in a depressed, post-war Britain.Yet with the right cocktail of drugs, the disease was wiped out completely in Edinburgh within six years, and by 1987 programmes of mass BCG vaccinations cut Britain’s toll to just 5,500.

For the vast majority of the population, the classic bloody handkerchief of TB was relegated to TV Dickens adaptations, while the Edinburgh Method was rolled out in 23 European countries and North America. Crofton subsequently co-authored Clinical Tuberculosis, a basic guide for nonspecialist health workers, now about to go into its third edition after printing 150,000 copies in 20 different languages.

Essential in the fight against the new strains is the DOTS (directly observed treatment short) course – effectively the offspring of Edinburgh Method – which allows quick access to more expensive reserve drugs on condition that patients are monitored through the full treatment.

“We originally wanted someone in a health centre to witness the patient swallowing every dose,” says Crofton, who advised the WHO in drawing up the rules more than a decade ago.“But the problem was that in practice somebody might have to walk ten kilometres to a health centre – so there have been a lot of experiments getting people to take them in front of their local shop keepers, for example.That’s proved successful in certain areas in South Africa.”

And if proof is needed that persistence eventually pays off, he points to another of his respiratory victories: the successful ban of smoking in public places in his adopted homeland of Scotland after decades of lobbying.

“The secret was keeping it in the public eye,” says his wife Eileen, who was awarded an MBE for her work as director of Scotland’s Action on Smoking and Health (ASH), founded by her husband. “It’s taken 30 years to see the ban implemented, but these things do take time.” More recently Tobacco, a campaigners’ handbook co-authored by Sir John has been selling well globally in languages from Bulgarian to Urdu, with a recent request for 15,000 copies in Hindi and Chinese. In a career stretching 70 years he has continued to criss-cross the globe – 50 countries at the last count – advising and inspiring experts less than half his age, from New York health tsars to Chinese party apparatchiks.

“He’s like an internal combustion engine!” laughs Eileen, seven years younger than her husband, who she met in 1945 at a VE day celebration in Northern Ireland, where they were stationed a different hospitals. “He’s the optimist, and I’m the pragmatist.” What’s most astonishing about this mild-mannered 95-year-old is his continuing energy. “Technically I retired in 1977, but it’s a very exciting time just now,” smiles Sir John, who was awarded the Union Medal last year and continues to brief experts half his age on how to keep up the pressure. “It puts off the Alzheimer’s,we hope.”

Lately husband and wife have been lending their support to a new campaign, lobbying governments and business to tackle Britain’s binge-drinking culture much as ASH tackled smoking. And on the day I visited, Sir John was perusing a response from International Development Secretary Hilary Benn to a letter he had written on the importance of keeping global water resources public.

“He’s such a sprightly individual – and with a mind like a razor,” says Edinburgh West MP John Barratt, who last year placed a parliamentary motion calling for greater recognition of Sir John’s achievements after hearing him give evidence to the Commons select committee on international development.“ He’s a real national treasure.”

But Sir John seems increasingly content to stay out of the limelight as his twilight years advance, enjoying his five children and eleven grandchildren, looking after Eileen – who is increasingly disabled – and writing up his memoirs. What he’ll never relinquish completely, one suspects, is the battle with his age-old foe. “The funny thing is I’m not actually all that bright,” he claims, self-deprecating to the last. “I think I’m just good at seeing things that fairly obviously need to be done - and getting on with doing them.”

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_{Photo: Marc Marnie}