Paediatric TB: 2015 and beyond

Owen Nyaka, CNS Correspondent, Malawi 
Photo credit: CNS:
The countdown is on. The clock is ticking and we are running out of time yet. Once the Millennium Development Goals (MDGs) expire this year we will be addressing lung health in the perspective of post 2015 Sustainable Development Framework. Upon realising that public demand and political commitment remains inadequate on lung health and that TB is a significant cause of illness and death among children, Citizen News Services (CNS) organised a webinar for media on lung health beyond 2015.

Speaking in the webinar, Joanna Breitstein, Senior Director, Communications at TB Alliance (Global Alliance for TB Drug Development) said that to make zero childhood TB deaths a reality requires sustained advocacy, greater commitment, mobilization of increased resources and a joint effort by all stakeholders involved in providing health care for children and in TB control.

World Health Organization (WHO) estimates show that 550,000 children acquired TB in 2013, and also that 80,000 children die from TB each year and children account for over half a million new cases annually.

Joanna said that although the childhood TB Roadmap which is aimed at increasing visibility and advocacy on pediatric TB was published in 2013; and that child survival is improving from pneumonia and diseases that come with HIV infection, but those gains have not been realised for children with TB.

“Where we are today, pediatric treatment is too long and too difficult. Children take six months to two years or even longer. When World Health Organization (WHO) revised guidelines for treatment in 2010 that was a big moment because children were not taking much tablets,” Breitstein said, adding “Today, we still have big pills, wrong doses with bad taste which result in drug resistance".

Since the revision of WHO guidelines, Breitstein says there are no simple, friendly appropriate doses as first line TB drugs for children. Globally, children are provided treatment in a complicated process, such as putting medicines in food or doses being dissolved in water. There is a gap of 7-years or more projected between launch of adult treatments and availability of child formulations.

“This year, we are moving forward to introduce new simple, child friendly formulations of first-line TB treatment. These are fixed dose combination. The correct WHO recommended doses will soon be available. This would improve treatment outcomes. In 2016, we urge the media, stakeholders, NTP programmes, and donors to advocate and raise awareness for adoption of simple, correct first line pediatric formulations,” said Breitsein.

She also said that in the coming years, we absolutely need to develop child-friendly forms of second line treatments, which is likely to be more difficult than the first line treatment because the market for this is too small, and for the potential profit manufacturer to make profit is too minimal. However, this is an urgent global health issue, which needs donors’ support in order to become a reality.

The Communication expert insisted upon the need for accelerating research for simpler and faster-acting treatments for children. Neglect on Child TB got us to where we are today. Childhood roadmap estimates that between 2011 to 2015 US$200 million is needed for paediatric TB research and development. In 2013, just US$ 25.3 million was spent on paediatric TB research and development  that was nearly double than previous year.

“We must increase advocacy now to change the funding landscape for a better tomorrow. At country level there is need for people working around advocacy, as well as journalists, to understand the setting of national WHO guidelines that recommend a new updated dosage treatment and draw attention to the problem; this is a best first step for the media and advocates,” said Breitsein.

Children get TB the same way adolescents and adults get it. TB accounts for one-quarter of deaths in people living with HIV worldwide and is one of the most common causes of morbidity in people living with HIV. The dual epidemics of TB and HIV are particularly pervasive in Africa, where HIV has been the most important contributing factor in the increasing incidence of TB over the last 10 years.

In the coming months, several global health organizations will be hosting international meetings pertaining to lung health and, more broadly, the world’s post-2015 development plans. As the United Nations Millennium Development Goals reach their deadline, it is imperative that the global health community takes stock of what has been achieved—and, more importantly, what has not.

By the time 46th Union World Conference on Lung Health is held in Cape Town this December, the global health community will be referring to the Sustainable Development Goals as official drivers of the post-2015 global development agenda, after the UN General Assembly adopts them in September. As we move into 2015 and beyond, we will face an unfinished agenda on key health issues—like TB-HIV co-infection—as well as newer challenges that will require innovative approaches, like TB-diabetes, not to forget TB in children.

Owen Nyaka, Citizen News Service - CNS
August 12, 2015