Concerted action is needed to end TB by 2030

Urvashi Prasad, CNS Correspondent, India
There are 9.6 million new cases of TB and 1.5 million deaths due to it, annually. Also, an estimated 500,000 people develop multi-drug resistant TB (MDR-TB) every year. As highlighted by Paul Jensen, Director of Policy and Strategy, International Union Against Tuberculosis and Lung Disease (The Union), in a webinar organized by CNS, TB, despite being fully curable, kills more people than any other infectious disease in the world.

This underscores the need for more stakeholders to get involved with tackling TB at a global level. Concerted action is needed urgently because TB is a life altering illness which takes a serious physical, emotional, social and financial toll on patients and their families. The challenge is becoming more difficult because of the increasing emergence of drug resistant forms of TB. Ending the TB epidemic by 2030 as per the global commitment under the Sustainable Development Goals (SDGs), therefore, requires multi-sectoral action. During the webinar, WHO’s Global TB Programme Director, Mario C. Raviglione, emphasized that various SDGs, including 1, 2, 4, 7, 8, 10 and 11, contribute in different ways to addressing the TB epidemic. This is because a number of factors are associated with TB and contribute to the spread of the disease either directly or indirectly. These include poor living and working conditions, food insecurity and unhealthy behaviours.

For waging an effective battle against TB, an area that needs greater focus globally is research. Dr. Soumya Swaminathan, Director Indian Council of Medical Research (ICMR) and Secretary, Department of Health Research, Ministry of Health & Family Welfare, India, outlined some of the important priorities in TB research.  Firstly, TB diagnosis needs to be improved with the development of rapid point-of-care devices which are affordable, easy to use and can be deployed in different contexts. Secondly, biomarkers are needed for predicting disease progression. This will help to target preventive therapy to those who need it the most, instead of providing it to everyone, which is not only unnecessary for the individuals concerned but is also not cost effective. Thirdly, a universal regimen for TB could revolutionize treatment. This requires many more clinical studies to be conducted and new drug combinations to be tested. Fourthly, an effective vaccine is needed for preventing adult forms of TB. She also pointed out the importance of greater investment in operational research.

This is crucial because even when effective drugs and vaccines are available, they often do not reach those who need them the most. Therefore, innovations are critical for optimizing service delivery in diverse settings. For instance, a delivery model that works well in an urban slum might not be as successful in a remote village. Dr. Swaminathan highlighted an effort that is being made in India to bring together all major national and international stakeholders to develop new tools for TB through the creation of a consortium by the ICMR—the “India TB Research and Development Corporation”. Another area of vital importance in the fight against TB is addressing psychosocial issues, stigma and discrimination. Prabha Mahesh, a TB survivor and Programme Manager, Alert India, provided an example of a checklist that has been developed for pinpointing the reasons why patients who are on TB treatment might not complete the full course. The use of such a tool can help to target interventions more effectively in communities and minimize the treatment non compliance rates. The goal of ending the TB epidemic by 2030 is a very difficult one and will not be achieved unless all stakeholders come together. Investments in TB, in the form of human resources, finances and technology, must be made a priority.

Urvashi Prasad, Citizen News Service - CNS
March 30, 2017