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The Director's Corner

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The health sector can’t end the TB epidemic alone. Time for politicians to make their influence count.

A message from José Luis Castro, Executive Director, The Union – August 2018 

At AIDS 2018 in Amsterdam last month, I was struck by a comment from a nurse who was speaking in a plenary session focusing on the current challenges in tuberculosis (TB) care and in TB and HIV integration. She pointed out that there was a vital issue that was being side-stepped at best and often ignored; that of supporting and protecting healthcare workers as an integral part of the TB response.

She said, and I quote, “As a primary care giver and a nurse to my core, I can think of no other calling that I would rather answer – and no other calling that falls on repeated deaf ears when we appeal for duty of care and other provisions – such as decent equipment, new tools, access to research and up-to-date training - that are fundamental to most professions but are sadly lacking in the field of TB.”

Undoubtedly, healthcare workers are employed in complex, stressful, and often hazardous environments. Without their willingness to venture into these situations, often at risk to their personal health and safety, our healthcare systems would crumble. Healthcare providers are fundamental to the provision of good quality, affordable healthcare, core to Goal 3 - ‘Good health and well-being’ - of the United Nations (UN) sustainable development agenda for 2030. This principle should determine that everyone receives the care they need, when they need it – and at a good quality standard. But healthcare workers are too often having to deliver TB prevention and treatment services in the context of changing priorities, new legislation and new treatment regimens and without, as my nursing colleague expresses so articulately, the most basic tools and equipment to help them.

The Union works in some of the world’s poorest communities where issues of chaotic infrastructure, unstable economies and uneven healthcare services are commonplace and all impact negatively on TB treatment and care. In Uganda, for example, our staff and collaborators are developing some innovative approaches to tackling unheard of levels of TB in both adults and children, initiatives that rely on using mobile phone technology to track patients and that are making a real difference in terms of patient adherence to TB treatment regimens. Yet the same centres pioneering this work are also dealing with daily struggles around the basics of sanitation, clean water supplies, inconsistent electricity and out-of-date equipment that is beyond repair.

The health sector can’t end the TB epidemic alone, especially in scenarios like these. It is time to take the pressure off our overburdened healthcare providers and place it squarely where it belongs – on our most senior political leaders whose help we need to galvanise action from social and economic sectors. This is why the resulting political declaration from the UN High-Level Meeting (HLM) on TB on 26 September is the best opportunity we’ve had for world leaders to make a stand against TB. The TB community has asked governments and heads of state to act on five key priorities that reflect the necessary multi-sectoral approach and that we believe are the most critical to ending this global epidemic:

  • We must reach everyone, everywhere who needs TB care. This means closing the gaping holes in TB diagnosis, treatment and prevention by diagnosing and treating a cumulative 40 million people by 2022.
  • We must transform how we respond to TB by placing human rights at the core of our response. This is about making people, irrespective of their circumstances, the centre of everything we do.
  • New tools to end TB are needed right now. We’re seeing new breakthroughs in the medical field every day, yet innovation in TB lags behind. In the past 50 years only two new TB medicines have come to market, when we need a pipeline of at least 18, according to estimates from the World Health Organization.
  • Invest the necessary funds to end TB. We have not seen nearly the resources invested in TB research that the challenge demands or that have gone to other epidemics, like HIV/AIDS. We want to see $2 billion invested worldwide every year in TB research and development. This is $1.3 billion more than we’re seeing right now.
  • All the above must be subject to decisive, accountable, global leadership.

You can read the key priorities in full here. It may strike you that many of those requests, if implemented, would go some way to addressing the issues faced by healthcare workers worldwide. I hope that the nurse who spoke at AIDS 2018, The Union’s staff and colleagues in Uganda, and thousands like them, will, this time next year, have grounds for optimism that the fight to eliminate TB has been made more equitable and that the end TB goal is an aim that we can meet.

Add your voice to ours with The Union’s UN HLM on TB Digital Toolkit.