'Yes, we can end TB': Nick's message on World TB Day
World TB Day gives us the opportunity to remind politicians, the media and the public across the globe of the continuing importance of tackling this deadly disease. Tuberculosis should have been beaten with the discovery of antibiotics nearly a century ago, but with the arrival of the terrible HIV/AIDS pandemic in the 1980s, TB, one of the world’s oldest threats, became a new one as rates of the disease soared. The TB bug strikes when our immune systems are compromised, and it is the biggest killer of people with HIV/AIDS, as well as a risk to people with diabetes or who suffer very poor nutrition.
10.8 million people a year fall sick with TB, exacting an economic and social cost on the countries most affected, and 1.25 million people die of it every year, making it the world’s deadliest infectious disease. This is nothing less than a tragedy when TB is easily and relatively cheaply curable.
What’s more, drug resistant TB is a growing concern, and as a highly infectious, respiratory disease that knows no borders, it is a risk to us all. The State of Kansas has just seen one of the largest outbreaks of TB in the history of the United States. TB anywhere is TB everywhere.
So tackling TB should be a global health priority, and indeed one of the Sustainable Development Goals is to end TB, along with AIDS and malaria, by 2030. It’s a fine ambition, but the world is way off this target. At the current rate of progress, TB won’t be beaten for a century, and that means millions more lives lost needlessly and a continuing economic burden on countries that can least afford it.
If this all sounds pretty gloomy, there is in fact growing cause for optimism that the fight against TB can be won. Huge strides have been made in recent years. More people were officially diagnosed and treated last year than any before. New medicines mean shorter and safer treatments. Where antibiotics used to be taken over a period of months, the regimens can now be just weeks. We now have much better diagnostics: where we used to send sputum samples off to laboratories, with results taking days to come back, new and increasingly more mobile technologies allow instant diagnosis. And after far too long a wait, a vaccine to combat TB is at last in sight. Most people don’t realise that there is no effective adult vaccine against TB, and securing one would be a real breakthrough, because no epidemic in human history has been beaten without a vaccine.
At last, TB is also receiving the political attention it deserves. There have been two High Level Meetings on TB at the UN in the last six years, passing strong declarations and global commitments to get the fight against the disease back on track. The challenge is to secure the resources needed to deliver them.
There’s a very strong case to be made for committing this funding. Not just a humanitarian one, but a hard-headed political and economic case, too. The next global pandemic is likely to be another airborne respiratory bug, and the things governments need to do to be prepared for it, with effective surveillance, rapid diagnostics and an effective health infrastructure, are the things they need to do to beat TB. The public will be far less forgiving if governments aren’t ready next time. And sceptical finance ministries can be shown that TB investments are some of the most cost-effective that can be made, improving health and therefore productivity at relatively low cost.
In the overall scheme of global government spending, the funding required is by no means impossible – around US $22 billion a year. But only about a quarter of this is being found at present, and COVID both diverted resources away from TB and severely impacted the economies of wealthier countries who donate to important programmes to tackle TB such as the Global Fund. The recent decision of the US to withdraw funding from the WHO and to dismantle and drastically reduce funding for USAID, which was a major funder of TB programmes, is a severe blow.
And yet there are encouraging signs that other countries are stepping up. Nigeria has approved US$450 million of additional funding, while Ghana has committed $150 million to fight HIV, TB, and malaria. Others are planning similar increases, and it’s striking that important countries such as India, Indonesia and South Africa, which between them carry the highest burden of TB, now have the political leadership and major TB programmes that will make a real difference to the fight.
There are still significant challenges ahead. The number of cases of TB and deaths from the disease are still not falling fast enough. Far too many people with drug resistant TB are still not getting treated. We don't yet have the kind of short and simple TB treatment that would encourage governments to get behind mass latent TB diagnosis and treatment which we will need if we really want to end TB, although that may be on the way.
But there’s still hope that we can beat TB. This isn’t the 19th century when, with no cure available, the ‘white death’ or Consumption was one of the most likely ways in which our ancestors would die. Today, TB is preventable and curable, and with each new scientific and technological advance the prospect of ending the disease sooner comes closer. Advocacy for action on TB is becoming more vocal. The organisation I chair, the Global TB Caucus, is just one example of how the campaign is stepping up. We didn’t exist ten years ago, but now we number some 2,500 parliamentarians in over 100 countries, with more than 50 national TB caucuses in parliaments, making the case for action to our governments. Together with vibrant civil society organisations across the globe we are determined to win this fight. In the words of our movement’s slogan: Yes, we can end TB.