Are we on the path of eradicating TB by 2030?

Josephine Chinele, CNS Correspondent, Malawi
Each year, leaders from around the world descend on New York City for the United Nations General Assembly. Last year marked the historic adoption of the Sustainable Development Goals (SDGs) 2030, which replaced the Millennium Development Goals. The SDGs marked a turning point in the way broad, global issues are addressed. However, it remains to be seen what impact they will have. The SDGs cover a number of important social and developmental areas, including climate change and resilience, global health, and economic empowerment.

In total, there are 17 goals and 169 targets. SDG Goal 3, with its 13 targets, focuses on global health. Even as all 17 goals are equally important, they cannot be achieved if the nationals of the member states are not healthy. According to the World Health Organization (WHO) almost all of the other 16 goals are directly related to health or will contribute to health indirectly. Malawi’s public health system is beset with many problems, including lack of quality health care due to poor patient doctor ratio; inadequate drugs and medical supplies, corruption, drug theft and lack of sophisticated treatment equipment among others. SDG 3.3 specifically commits to end the epidemics of AIDS, TB, malaria and neglected tropical diseases by 2030 and also to combat hepatitis, waterborne diseases and other communicable diseases. One important factor not mentioned in the SDGs is the need to address antimicrobial resistance (AMR)—the spread of strains of diseases like TB and malaria that are resistant to standard treatments. AMR has emerged as an urgent global health challenge that could prevent many countries from achieving the health-related SDGs.

Citizen News Alliance (CNS) brief for journalists indicates that to address the global challenge posed by AMR, the UN will host a high-level meeting on AMR on 21 September, during the General Assembly. This will be a key moment for mobilizing international action against MDR-TB. Although TB prevalence declined by 41% between 1990 and 2013, still an estimated 1.5 million people died of it in 2014. Executive Director for Uganda International Union against Tuberculosis and Lung Disease (The Union), Dr Anna Nakanwagi-Mukwaya notes that there is slow progress in the decline of TB to meet the SDGs by 2030. She explains that, in the last decade, much more funding was provided for TB control, but the decline in incidence was only 2% per year. “Surveys done in the last two years have shown much higher prevalence rates of TB compared to what was earlier estimated for many countries, more especially in sub-Saharan Africa, which is still driving the TB epidemic,”  says Mukwaya. She notes that the health systems in many countries are very poor and cannot support meaningful reduction of TB, malaria and anti-microbial resistance—“TB and malaria control cannot be achieved within poor health systems. Unfortunately a lot of attention and funding is focused on individual disease programmes and not health systems strengthening.”

She recommends that to rapidly reduce the TB incidence, there is need to reduce new HIV incidence and treat all people living with HIV with antiretroviral treatment. “Provide more support from national budgets and donors to strengthen health systems and therefore implement innovative interventions to increase access to TB services within slums and hard to reach populations,” Nakanwagi-Mukwaya suggests. Multi drug resistant TB (MDR-TB) is an emerging problem for Malawi too. According to Malawi’s National TB Control programme, the prevalence rate of MDR-TB is 5% as per a 2011 survey. The country reports around 28 cases of MDR-TB in a year. For TB, countries can take an important step toward addressing drug-resistance. In May 2015 the WHO endorsed a new shortened treatment regimen for MDR-TB. This new 9-12 month treatment is substantially shorter and easier to tolerate than the previous 24-months regimen. In order for the new regimen to reach patients in need, countries must now incorporate the new regimen into clinical guidelines, train health workers to deliver it, and ensure that adequate supplies of quality-assured medicines are available. The world needs greater emphasis on combating drug-resistance in order to reach its goal of eradicating TB, HIV, malaria and other diseases.

Josephine Chinele, Citizen News Service - CNS
September 21, 2016