How to fight TB, malaria and AMR to meet the SDGs by 2030

Francis  Okoye, CNS Correspondent, Nigeria
[First published in Nigeria politics magazine]
The current plans to fight and put an end to TB, Malaria and AMR By 2030, thereby meeting the SDG goals, seem to be in doubt, and may not become a reality. Health experts gathered together in a webinar organized by Citizen News Service recently to discuss the issue of ‘Are TB, malaria and anti microbial resistance (AMR) declining fast enough to meet SDGS by 2030?’

Experts who contributed to the discussion included Dr. Lucica Ditiu Executive Director, Stop TB Partnership, Dr Tim France, Team Leader for External Communication, Asia Pacific Leaders’ Malaria Alliance (APLMA) and Managing Director Inis Communications, Dr. Anna Nakanwagi Mukwaya, Country Director-Uganda  for International Union against Tuberculosis and Lung Disease (The Union). The moderatos included Ashok Ramsarup-former Senior Programme Producer at South African Broadcasting corporation (SABC )and Shobka Shukla, Managing Editor, Citizen New Service. Although AMR is posing a serious threat to health security globally and is risking losing gains made in fighting many diseases, it is not even mentioned once in SDGs. But there is no way SDGs can be met unless we eliminate AMR.

It is business as usual

The End TB strategy aims to end the global TB epidemic, with targets to reduce TB deaths by 95% and to cut new cases by 90% between 2015 and 2035. It sets interim milestones for 2020, 2025, and 2030. However, it seems very difficult to realize these objectives as it is still business as usual. Current efforts, the experts said, will not end TB by 2035 but by 2182. For the fight against TB to be successful, we need to have integrated health systems; increased investments for improving socio-economic conditions of people; and patient-driven approaches.

The need to eliminate malaria

Malaria has been a health burden for over 50 years. It is proving to be a huge drain on economy, it keeps children out of school and causes serious health concerns as well as deaths. Added to this is the new risk of drug resistant malaria which has already raised its ugly head. Eliminating malaria should be a priority for governments. There is need for political leadership to implement specific programmes to stop malaria by 2030. The good news is that by 2025 some 50% of the regions that are prone to malaria  will be  malaria free.

No meaningful reductions in TB, malaria and AMR

Dr Anna Mukwaya, said that her country, Uganda, is a high burden country for TB and malaria and that HIV is driving TB epidemic in Africa. According to her, in many poor countries, one cannot expect any meaningful reductions in TB and malaria as very often medicine are not available, and health systems are ill equipped to deal with infectious diseases. There is attention on individual diseases but not on strengthening health systems. To reduce incidence of TB, it is important to reduce new HIV infections and provide anti retroviral drugs to all people living with HIV. Rural areas, urban slums and other hard to reach areas, need innovative interventions. Dr Mukwaya said that we need to find men and treat them, as most surveys show that men are often missed by many TB programmes and there is a huge gap between men who come to clinics and those who have the disease.

Multi drug resistant TB (MDR-TB)

According to Dr. Caminero, MDR-TB can be avoided, and cured. In 2014, 9.6 million new cases of all forms of TB were recorded with 1.1 million deaths; while 1.2 million HIV associated TB cases recorded 390,000 deaths. There were 480,000 MDR-TB cases and 190,000 deaths. MDR TB accounts for 3% of all new TB cases. In 2013, 50% of new MDR-TB had never been treated for TB highlighting the importance of transmission and the lack of appropriate infection control measures, particularly at community level. So poor management of drug susceptible TB is the main cause of MDR-TB. It can be avoided by strengthening  national TB programmes with good management of susceptible TB cases. Diagnosing and treating each case of TB and MDR-TB is key to prevent further transmission. Use of the new shortened treatment regimens and incorporating of new drugs can go a long way in dealing with MDR-TB and improve success rates. SDGs are not a new ideology. Countries need to deal with disease control, by being more accountable. They should address market driven mindsets as hardly any concrete efforts from them can be seen as 2017 approaches. There is need for some significant policy changes, including universal health coverage, to get success in the reduction of these diseases worldwide.

Francis  Okoye, Citizen News Service - CNS
September 14, 2016