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The Director's Corner

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Systematic neglect of child TB amounts to human rights violation

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

23 May 2018

It is both timely and appropriate that, during the 71st World Health Assembly in Geneva, and just four months in advance of the first ever United Nations High-Level Meeting on Tuberculosis (UN HLM on TB), The Union is launching a white paper into one of the world’s most prevalent – yet largely unrecognised – epidemics. Child TB. 

As well as highlighting the very real issue of the causes and effects of TB in children, the report – The Silent Epidemic: A Call to Action Against Child Tuberculosis – also investigates why the disease has been effectively ignored for decades, resulting in millions of needless deaths, amounting to what is, fundamentally, a terrible infringement of the human rights of children everywhere.

Children are particularly vulnerable to TB. The data show an estimated one million children under the age of 15 become sick with TB each year. Of those, 239,000 - that’s nearly one in four - die. TB is preventable, treatable and curable. This is as true for children as for adults. Yet it is not being treated - on the contrary. Ninety percent of children sick with TB worldwide receive no treatment at all. This neglect translates to the unnecessary death of millions of children, creating huge trauma for their families.

Why is this occurring? The Union’s report points to a traditional health approach that prioritises stopping TB transmission. An approach that, in dealing with the world’s biggest infectious disease killer, might make logistical sense. But this policy has pushed children and their needs aside. The simple truth is that children are far less contagious than adults and the standard tools used to diagnose TB in kids are woefully inadequate. And those over-burdened and under-resourced TB programmes, working in scenarios where funding and trained staff is scarce or non-existent, have followed policies that are effectively treating children as being of lesser importance than adults, when it comes to addressing the overall burden of TB.

In the global health community, we are in agreement that the right to medical care and preventive therapies are basic human rights, that universal access to healthcare is a global aim that the world must work towards. It is the priority of the World Health Organization (WHO) and fundamental to the Sustainable Development Goals. In this context, the neglect of child TB is a human rights violation by any standard.

Ending this shocking cycle should not be beyond the world’s abilities, given adequate investment and resources, and the collective will to effect change. Last month, The Union hosted a media field trip to Kampala, Uganda, to demonstrate methods that are enabling the case-finding and treatment of at-risk children, including using mobile phone technology to keep real-time records and enable tracking of patients; and delivering hospital-based TB screening programmes for expectant mothers.

These interventions, part of The Union’s DETECT Child TB project, are demonstrating that medical professionals can be equipped with the knowledge and tools to diagnose and treat TB in children, with access to care provided at the community level. The Union is also screening those households where an adult has been diagnosed with TB to test if children have been exposed in the home – a routine that must become the standard that is implemented everywhere. Where The Union has piloted this approach in Uganda, 72 percent of at-risk children were able to receive preventive TB treatment, up from less than 5 percent previously.

To be a success, the UN HLM on TB on 26 September 2018 needs to generate concrete action, where governments are held accountable for achieving time-limited targets, for investing in new research and delivering the care to which all children with TB have a fundamental right.  Anything less is a dereliction of responsibility to the most vulnerable in our societies.

We must – and they must – change the script. Children have the same right as adults to benefit from proper TB diagnosis, treatment and care. Let’s act like we mean it. Because the elimination of TB is depending on it. 

The Silent Epidemic: A Call to Action Against Child Tuberculosis can be downloaded here

All roads lead to universal health coverage - Dr Tedros Adhanom Ghebreyesus, Director-General of WHO