End TB agenda: Have we done enough?

Alice Tembe, CNS Special Correspondent, Swaziland
As the world was commemorating the World AIDS Day on the 1st of December 2015, it came to fore that tremendous progress has been made in the past three decades-- from ‘no name for the wasting disease, no antiretroviral treatment (ART) for adults or children, no special trained doctors/nurses/laboratory specialists, no diagnostic equipment’, to ‘patient friendly treatment for both adults and children, state of the art equipment for diagnosis and continued care, elimination of mother to child transmission of HIV, specialized health care professionals and significant improvement of the quality of life for persons living with HIV’.

These thoughts were reiterated by the UN Special Envoy on TB, Dr Eric Goosby at the 46th Union World Conference on Lung Health, being held in Cape Town. It is a clear indication that with political will, commitment of resources, involvement of the beneficiaries, collaborative partnerships and prioritized research, humanity can reach great heights to self-preserve.

Switching gears, there is every need to talk on the progress of an equally life threatening disease (TB), that has been around from early 2400 BC, according to the Jewish Science Journals, and that costs more lives today than HIV/AID. The ordinary drug susceptible TB has managed to transpose itself to multi drug resistant TB (MDR-TB), and also has an over 70% co-infection rate with HIV.

Dr Katherine Floyd, coordinator of the WHO Global TB Programme,commenting on the 2014 WHO and UNAIDS comparison of TB and HIV ranking as leading causes of death worldwide, noted that they rank the same. She explained that in the year 2014 alone, 1.5 million deaths related to TB were recorded--890,000 were men, 480,000 women and 140,000 children. There are approximately 480,000 new cases of MDR-TB recorded annually and yet there is a 3.6 million TB detection gap when comparing the 9.6 million incidence and the 6 million notifications.

The TB drugs that were introduced many decades ago are still on the market for TB treatment today, diagnosis equipment still bases mainly on the traditional chest X-Ray and microscopic examination of sputum, especially in the high burden countries with limited resources. Millions of people, including children, are still dying from this curable disease, patients still have to take a concoction of a handful of bitter and toxic drugs for extended periods, and until a few months ago children were, and in most settings still are, being under/over dosed by crushing adult dosed tablets as per their body weight.

It is from this that I wonder if, as a generation, are we doing enough to combat and end TB. With the technological advancement and expertise around the globe coupled with learned experiences from HIV/AIDS, one wonders if there still is:
  • Consistent missing of priorities in the global research agenda for TB
  • Limitation of resources for accelerated research and implementation of TB interventions
  • Lack of a massive movement to end TB
  • Not loud enough voices for policy makers, donors and stakeholders to set a faster pace for ending TB

All these are just but a scratch on the surface to the 101-no-brainers that justify the need for the world to stand up and end TB. On a lighter note, most certainly as Plato said ‘…slow progress is better that no progress at all...’. However, at the rate of reduction in TB incidence it will take an infinitely long time to save humanity and there will just be history. A word of encouragement goes out to all stakeholders state and non-state actors alike to join forces in collaborative partnerships to push for (i) patient-friendly, less toxic, and shorter drug regimens for adults and children; (ii) deeper funding envelopes for implementing the End TB Strategy; (iii) prioritization of TB research agenda. 

Let the generations to come, not raise fingers at us for not having done would we have done enough for ending this epidemic.

Alice Tembe, CNS Special Correspondent, Swaziland
4 December 2015 
(Alice Tembe is providing thematic coverage from 46th Union World Conference on Lung Health in Cape Town, South Africa, with kind support from Lilly MDR TB Partnership. Follow her on Twitter: @Tembe3)