Traversing TB’s undulating journey of ambitious targets and facile strategies in achieving SDGs

Roger Paul Kamugasha, CNS Correspondent, Uganda
TB is one of the oldest human infectious diseases, but it was only in 1882 that the German Nobel Laureate Dr Robert Koch discovered the cause of it—Mycobacterium tuberculosis. 135 years down the line of this discovery the disease still remains a silent killer. TB cases are still far from declining at the intended rate to meet the Sustainable Development Goal (SDG) of ending TB by 2030.

With SDG 3.3 talking of ending TB by 2030, and WHO’s End TB Strategy targeting to reduce TB deaths by 95% and to cut new TB cases by 90% between 2015 and 2035, we are far behind, in terms of a strategy shift to come anywhere nearer to achieving these targets. We are allergic to innovations in the TB fight and a broad section of players are still stressing on the medical aspects of the disease, while turning a blind eye to its human face and to behaviour change investments.

Facing decades of relegation, TB long remained non-enumerated and treated just like another disease. Even though the Global Fund to fight AIDS, TB and Malaria (GFATM) was formed in January 2002, TB, until a few years ago, remained in its sub-disease category. This could happen through persistent advocacy by none other than TB affected and infected advocates who became change agents by strongly advocating for TB representation at the country coordinating mechanisms— a move that took advantage of the Global Fund transition from the round-based model to the new funding model that required meaningful engagement of key affected populations. This became a cross-cutting milestone across the low and middle income countries (LMIC).

The lack of prioritizing investments for advocacy has contributed to increasing the TB burden, and hiking cases of Multi Drug Resistant TB (MDR -TB) and Extensively Drug Resistant TB (XDR- TB). It is well known that one of the major causes of resistant strains is poor treatment adherence as well as poor infection control.

Ensuring healthy lives and promoting the well-being for all at all ages is essential to sustainable development. Some significant strides in advocacy have been made in the efforts to end TB, with remarkable milestones like the recently held G20 meeting that has put TB on the agenda, the forthcoming WHO Global Ministerial Conference “Ending TB in the Sustainable Development Era: A Multi sectoral Response” in Moscow in November 2017, and the first ever UN High Level Meeting on TB scheduled for 2018. All these are pieces to form a strong global platform towards ending TB by 2030.

However, there seems to be a mismatch between ambitious targets and the facile strategies to achieve them. While the G20 meet reinforced the nations’ commitment to improve the global TB response by ensuring a methodical approach to tackle TB and antimicrobial resistance (AMR) that would trigger access to affordable medicines, diagnostics and vaccines, there is an urgent need to revisit the existing strategies that have failed to deliver and replace them with quick- wins in an innovative way that would visibly strike a balance between human rights and public health perspectives.

We cannot achieve the TB targets, especially in the LMICs where some countries are coming up with punitive laws for people with TB and HIV. Ugandan law criminalizes HIV/AIDS Transmission, and requires pregnant women to undergo mandatory HIV testing without their consent. Likewise, the Kenyan government defends jailing of TB patients who are not treatment-compliant (in 2010 two TB patients were imprisoned for 8 months after originally failing to stick to their drug regimen). However the High Court has declared this move as unconstitutional. Then again, there are countries where homosexuality is treated as an offence, forcing many to remain underground and escape treatment.

There is need for advocacy to repeal these punitive laws that have increased the stigma and discrimination around HIV and TB and discouraged more people from being tested and treated. With such momentum we can envisage attaining SDGs.

For countries to address the HIV /TB epidemics effectively, focus on advocacy for meaningful engagement of key vulnerable populations at all levels of planning and decision making from global to regional, national and sub-national is fundamental. Criminalizing them would only exacerbate the pandemic.

There is need to fix the system in advance to allow the flow of affordable life-saving generic medicines to the world’s poorest, before millions of lives, mostly from Africa, are lost. The reason why nearly 3 million Africans are now on anti retroviral (ARV) therapy is that the cost of drugs has come down drastically from $10,000 when the patented treatments were first developed, to as little as $80 per patient per year now. This drop was caused by aggressive competition from the Indian generic manufacturers who were free to replicate the drugs under Indian law.

Intellectual property rights are an area of law that have not traditionally been examined in tandem with human rights laws. On a fundamental level, the issue of access to medicines and treatment is linked to the right to health and hence to the conventional concept of human rights.

This calls for governments to harmonize the intellectual property regime with key stakeholders in the supply chain edifice, that includes the  private sector and civil society at the forefront. Putting all these into consideration will increase the pace of achieving SDGs and reverse this undulating journey of ambitious targets and facile strategies.

Roger Paul Kamugasha, Citizen News Service (CNS)
 August 8, 2017

(The author of the story is also the Editor in Chief of The Health Times, Africa)   

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