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The Director’s Corner

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Global Ministerial Conference in Moscow must deliver multisectoral solutions to fight TB

A message from José Luis Castro, Executive Director, The Union 

The release, last month, of the World Health Organization’s (WHO) Global Tuberculosis (TB) Report 2017, gave everyone working in the TB community a very clear message. There is no acceleration in the global response to TB – on the contrary. Progress is stagnating and the world is not on target to eliminate TB by 2030, or even close.

The report confirmed that TB remains the top infectious disease killer in the world. The figures indicate that, globally, 1.7 million people died from TB in 2016 (including almost 400,000 people with HIV-associated TB) and 10.4 million people fell ill from TB. Staggeringly, 4,700 people lose their lives to TB every single day.

For the WHO Global Ministerial Conference on TB*, in Moscow from 16 November, the stakes have never been higher. As well as being a critical marker on the road to the United Nations’ General Assembly (UNGA) first-ever high-level meeting (HLM) on TB in 2018, the Moscow meeting must deliver on building the momentum necessary for getting TB on the agendas of every individual country worldwide, mobilising every president and prime minister to act. TB has, for too many years, slipped under the radar of global public consciousness and political commitment has wavered in the face of other, more topical, demands. The result has meant a delegation of the problem of TB - and its prevention - to the public health and medical communities, with limited investment and responsibility from politicians and other key stakeholders. This cannot continue if we are to beat this epidemic. A multisectoral approach is the only approach to this problem. The Moscow meeting can deliver this – but time is running out.

So how do we make the Moscow ministerial meeting count? The Union will be advocating for firmer commitments from every sector working to address TB – that is world leaders, governments, interested institutions, stakeholders and civil society – between now and the HLM in 2018. In real terms, this means high burden countries must provide the financial means and diagnostic support for finding missing TB cases and making sure treatment is accessible to all; it means TB research and development (R&D) has to be a priority in the domestic budgets of individual countries; and it means all countries have to adopt and implement the WHO revised standards for MDR-TB treatment regimens, because a shorter treatment schedule – nine months instead of up to 24 – means less burden on healthcare systems, communities and local economies alike. These commitments must be accountable and come with firm deadlines and performance indicators that ensure the schedule cannot – must not – slip.

We will also be advocating for a change in approach to R&D for TB medicines. TB treatment requires a cocktail of multiple antibiotics. It isn’t practical or desirable to test one medicine at a time. We must test whole new regimens of multiple medicines simultaneously.

When in Moscow I will advocate for these changes and share initiatives that are offering examples of what needs to be done. Initiatives like the STREAM clinical trial - the world’s first multi-country randomised clinical trial to test the efficacy, safety and economic impact of shortened multidrug-resistant tuberculosis (MDR-TB) treatment regimens. STREAM has just released preliminary results showing that the nine-month regimen is very close to the effectiveness of the 20-24 month regimen recommended in the 2011 WHO guidelines, when both regimens are given under trial conditions. The STREAM trial demonstrates the huge importance of evaluating treatment regimens in clinical trials to fully understand their potential. And is just one step that needs to be taken to beat TB.

And I will also be sharing the innovative approach to R&D being developed by The Life Prize, that incentivises the research community so that collaboration is at the centre of R&D, the aim being to progress toward new, effective treatments to cure TB – in one month or even less.

One of the planned outcomes for the Moscow meeting will be the signing of a Ministerial Declaration by countries to accelerate action to eliminate TB. Let us all collaborate to ensure that the commitments made in Moscow will inform the UNGA HLM on TB next year and are bold enough to enable us to consign TB to the history books.

*The WHO Global Ministerial Conference on Ending TB in the Sustainable Development Era – A Multisectoral Response, 16-17 November, Moscow. Read more

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