India holds the key to ending TB emergency
José Luis Castro, 22 October 2019
A week is a long time in politics, and in global health!
A week ago, we welcomed the success of the Global Fund replenishment, where concerted advocacy secured a record total of over US$ 14 billion. While this is a great testament to the commitment of governments to tackle AIDS, TB and malaria, we know it will not in itself be enough to change the trajectory of the epidemic.
Last week, the scale of the challenge was thrown into sharp relief by the publication of the Global Tuberculosis Report 2019 by the World Health Organization (WHO). The good news is continued steady reduction in mortality: 1.5 million people died from TB in 2018, down from 1.6 million in 2017. We have also seen progress in detection and diagnosis: 7 million people worldwide were diagnosed and treated for TB – up from 6.4 million in 2017.
However, around 10 million people became ill with TB in 2018, including 1.1 million children, and progress is well short of what we need to reach the 2030 targets. These goals will remain a well-meaning fantasy unless there is a dramatic shift in the way we do business.
In particular, we have barely made a start on prevention. If we are to have a realistic chance of eliminating TB then we need to begin preventing the disease wherever we are treating it. In 2018, just over one in four children at risk of TB infection had access to preventive therapy, and among HIV-negative adults, preventive therapy coverage actually decreased 30% since 2017.
We urgently need new tools and affordable, accessible drugs to scale up the response. We also need to tackle underlying factors including smoking, diabetes and HIV, and longer-term, to address social and environmental factors, nutrition, housing and air quality.
Next week, we are looking forward to the 50th Union World Conference on Lung Health in Hyderabad. It is fitting that we are coming to India, which has the highest TB burden in the world with one in four of all global cases, but is also at the forefront of efforts to end the epidemic.
The Indian government led by Prime Minister Modi has made the fight against TB a central priority and boldly pledged to end TB by 2025, five years before the globally agreed target. They have backed this pledge with financial commitments and a comprehensive national strategy, which is being pushed through at national and state levels.
At the conference next week, we will be joined by very high-level representatives of the Indian government and corporate sector, as well as the World Health Organization and many other global partners and members from around the world, to discuss innovative solutions across the board.
There will be significant announcements of advances in diagnostics, treatment and prevention, as well as policy interventions. We are expecting up to 4,000 delegates including political leaders and health officials, doctors, researchers, nurses, TB survivors and civil society organisations.
As well as the first conference in more than half a century to be held in India, it will also host the inaugural Survivors Summit, an active community programme, and many events and symposia relating to all aspects of TB and lung health.
We are looking forward to extraordinary science, people and partnerships, and at this critical juncture in the fight against TB, I believe we have the opportunity to make the change we need to end the emergency.