Will the world leaders walk the talk to end TB at the upcoming UN High Level Meeting?
SHOBHA SHUKLA, BOBBY RAMAKANT - CNS
Leaders of all the UN member countries are expected to convene on 22nd September 2023 at the upcoming second United Nations General Assembly High Level Meeting (UNHLM) on TB (the first one was held in September 2018). The theme of this year's UNHLM is: "Advancing science, finance and innovation, and their benefits, to urgently end the global TB epidemic, in particular by ensuring equitable access to prevention, testing, treatment and care."
The theme of the upcoming UNHLM is on spot. But will it turbocharge the fight against TB? One wonders that so far, to what extent the governments have advanced science, finance, and innovation, and ensured equitable access to prevention, testing, treatment, and care?
TB is preventable. Yet it was not for over 10.6 million people who got infected with TB in 2021. TB is curable. But it was not for over 1.6 million people who died of TB in the same year.
In 2021, only 61% of people with TB were diagnosed and put on treatment. The UN health agency, the World Health Organization (WHO), recommends using molecular tests for diagnosing drug senstivie TB and rifampicin-resistance upfront, but only 38% of people with TB were diagnosed using molecular testing between 2018 and 2021. A whopping 62% of people with TB were instead diagnosed using the 140 years-old sputum smear microscopy which underperforms in TB diagnosis. In India, which is home to the highest number of people with TB globally, only 23% of people got a molecular test in 2022. The most used molecular test in India is Truenat, which is the only point-of-care and decentralised molecular test recommended by the WHO and is made in India by Molbio Diagnostics.
Unless we completely and quickly replace the old diagnostic tools, like smear microscopy, with WHO recommended molecular tests, we will not be able to: 1) diagnose everyone with TB, 2) prevent avoidable human suffering and avert untimely deaths, and 2) break the chain of infection transmission.
The same goes for treatment regimens being used to prevent and treat TB. The one-month long treatment to prevent TB (TPT), the four-month regimen to treat drug-sensitive TB, and the six-month regimen to treat drug-resistant TB are yet to become a reality for a majority of the people with TB worldwide.
In addition, countries are also lagging way behind in addressing the top-5 TB risk factors: malnutrition, tobacco use, alcohol consumption, diabetes, and HIV; as well as in rolling out TB preventive therapy to those with latent TB and at higher risk of progressing to active disease.
High time we adjust the sails!
"The pessimist complains about the wind; the optimist expects it to change; the realist adjusts the sails," had said William Arthur Ward. The optimism to end TB by 2030 alone is not enough unless it is matched with action.
Translate scientific achievements into public health impact
Sriram Natarajan, co-founder and Chief Executive Officer of Molbio Diagnostics (that makes Truenat molecular test) reminds us that while important TB-related commitments were made by the world leaders at the first-ever UNHLM on TB held in 2018, it did not end with a powerful-enough political declaration.
"TB can be eliminated because effective TB diagnostic tools, new treatment regimens, and evidence-based approaches that have shown to work, are already there. New tools to fight TB may come soon too. But unless we fully implement the tools with an action plan on the ground, it is not going to happen. And that needs money. World leaders need to follow upon their commitment to end TB with full financing," added Natarajan.
Eliminate the TB funding gap first
Every US$ 1 invested in TB yields benefits of US$ 46. Still financial crunch ails the fight against TB in many high TB burden nations.
"In Ghana's national strategy plan, we have a gap of US$ 20 million every year. This is a huge gap. We need this money to do more molecular testing for TB, TB screening by using digital X-rays, and implement better technologies. If we get resources to fill the funding gap in Ghana, then 85% of them will be invested in diagnostics and 15% in programmatic interventions to strengthen the national TB response," said Dr Yaw Adusi-Poku, Programme Manager, National TB Control, Ghana Health Services.
TB responses should match the urgency and purpose which leaders had demonstrated during the COVID-19 pandemic. "I would like to see world leaders from high income countries to share resources needed to eliminate this curable and preventable disease. I want world leaders from high TB burden countries to optimise utilisation of their resources through equity development and convincing domestic co-financing that is sustainable," said Dr Nguyen Binh Hoa, Vice Manager of Vietnam National TB Programme and Vice Director of National Lung Hospital.
Agrees Dr Louine Morel, Medical Registrar, Communicable Disease unit, Ministry of Health of Seychelles - which has the lowest TB rates in Africa. She too calls for fully funding the TB response.
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