The topic of the forthcoming UNHLM is right there. Will it, however, accelerate the fight against tuberculosis? One wonders how far governments have advanced research, financing, and innovation, as well as provided fair access to prevention, testing, treatment, and care.
Tuberculosis can be avoided. However, it was not the case for the 10.6 million people who become sick with tuberculosis in 2021. Tuberculosis is treatable. However, that was not the case for the approximately 1.6 million individuals who died of tuberculosis in the same year.
Science has given us new techniques for preventing tuberculosis, diagnosing it early and precisely, and treating it. But are we employing these new techniques appropriately, particularly in high-TB burden nations, to achieve zero new TB cases, quick and accurate diagnosis of 100% of people with TB, and successful treatment and cure?
Only 61% of persons with tuberculosis were recognized and treated in 2021. The World Health Organization (WHO) recommends utilizing molecular tests to diagnosis drug-sensitive tuberculosis (TB) and rifampicin resistance early on, yet only 38% of persons with TB were identified with molecular testing between 2018 and 2021. Instead, a stunning 62% of persons with tuberculosis were detected using the 140-year-old sputum smear microscopy, which performs poorly in TB diagnosis. Only 23% of persons in India, which has the greatest number of TB patients worldwide, received a genetic test in 2022. Truenat, the only point-of-care and decentralized molecular test authorized by the WHO and manufactured in India by Molbio Diagnostics, is the most widely used molecular test in India.
We will not be able to: 1) detect everyone with tuberculosis, 2) reduce unnecessary human suffering and fatalities, and 3) break the cycle of infection transmission until we totally and promptly replace traditional diagnostic methods, such as smear microscopy, with WHO-recommended molecular testing.
The same is true for therapy regimens intended to prevent and treat tuberculosis. The one-month therapy to prevent tuberculosis (TPT), four-month regimen to treat drug-sensitive tuberculosis, and six-month regimen to treat drug-resistant tuberculosis have yet to become a reality for the vast majority of TB patients worldwide.
Furthermore, nations fall far behind in tackling the top five TB risk factors: malnutrition, cigarette use, alcohol consumption, diabetes, and HIV, as well as in providing TB preventive medication to individuals with latent TB who are at high risk of advancing to active illness.
It’s past time to change the sails!
“The pessimist complains about the wind; the optimist expects it to change; and the realist adjusts the sails,” William Arthur Ward once observed. Optimism about ending tuberculosis by 2030 is insufficient unless accompanied by action.
Convert scientific discoveries into public health benefits.
Sriram Natarajan, co-founder and CEO of Molbio Diagnostics (which manufactures the Truenat molecular test), reminds us that while world leaders made important TB-related commitments at the first-ever UNHLM on TB in 2018, it did not end with a powerful enough political declaration.
“TB can be eliminated because there are already effective TB diagnostic tools, new treatment regimens, and evidence-based approaches that have been shown to work.” New TB-fighting technologies may also be available shortly. But it will not happen until we completely deploy the tools with an action plan on the ground. And that requires funds. “World leaders must follow through on their commitment to end tuberculosis with full funding,” Natarajan added.
First, close the financial gap for tuberculosis.
Every dollar invested on TB returns $46 in benefits. The battle against tuberculosis is still hampered by budgetary constraints in many high-TB burden countries.
“Every year, there is a US$ 20 million gap in Ghana’s national strategy plan.” This is a significant disparity. We need this money to conduct more molecular testing for tuberculosis, screen for tuberculosis using digital X-rays, and deploy improved technologies. If we acquire resources to close the financial gap in Ghana, we would invest 85% of them in diagnostics and 15% in programmatic interventions to boost the national TB response,” stated Dr Yaw Adusi-Poku, Programme Manager, National Tuberculosis Control, Ghana Health Services.
TB actions should mirror the urgency and purpose displayed by leaders during the COVID-19 epidemic. “I’d like to see world leaders from high-income countries pool their resources to eradicate this curable and preventable disease.” “I want world leaders from high-TB burden countries to optimize resource utilization through equity development and convincing domestic co-financing that is sustainable,” stated Dr. Nguyen Binh Hoa, Vice Manager of the Vietnam National TB Programme and Vice Director of the National Lung Hospital.
Dr. Louine Morel, Medical Registrar, Communicable Disease unit, Ministry of Health of Seychelles, concurs. Seychelles has the lowest TB rates in Africa. She, too, advocates for full support of the TB response.
Because tuberculosis is a social illness, a socially equitable solution is required.
It is past time to hold people accountable. “I would like world leaders to commit to and be held accountable for ending tuberculosis within our lifetime.” To do so, we must identify and treat undiagnosed tuberculosis patients. In addition, we must optimally adopt new therapies such as molecular diagnostics, safer, shorter, and more effective treatment regimens,” Dr. Hoa noted. “If a whole-of-government and-society approach worked for COVID-19, why is it absent from the TB response?” We must shift our focus from tuberculosis as a clinical disease to tuberculosis as a social disease. We must reduce the catastrophic costs that persons with tuberculosis experience.”
Dr. Imran Pambudi, Director of Communicable Disease Prevention and Control Unit, Ministry of Health, Indonesia, concurs, emphasizing the critical importance of fully funding the fight against tuberculosis, rock solid political commitment, and a whole-of-government and whole-of-society approach to ending tuberculosis within a given timeline.
People with tuberculosis should take the lead in creating demand.
“TB-affected communities must drive demand for WHO-recommended best-in-class TB diagnostics, treatment regimens, care and support, and prevention services to reach everyone in need, everywhere.” I’m encouraging TB survivors to act as demand generators. There must be a robust and increasing grassroots push for the government to support basic healthcare. We have a long way to go, but I see the key: you must persuade people of the importance of being healthy. “I may not be able to design structures anymore, but I can design healthier lives,” said Eloisa ‘Louie’ Zepeda-Teng, a former architect and Founder of TB People Philippines who survived TB of the brain but lost her vision to the disease.
Food is the most effective TB vaccination.
A recent research called RATIONS conducted in India found that distributing a box of food rations to the family of TB patients reduced TB incidence by 39-48%. “Governments must address malnutrition,” stated Dr. Arvind Mathur, WHO Representative in Timor-Leste. Nutritious eating is very vital in TB care and control.”
“I hope that the political declaration that member countries are considering as a result of the UNHLM on TB not only brings together science-based practical and actionable suggestions for member countries, but that countries also commit to increased domestic funding.” They should consider implementing WHO-recommended science-based TB prevention, detection, and treatment regimes. We anticipate a comprehensive, multi-sectoral reaction in action, both at the national and sub-national levels, as well as at the level of every individual who may have been afflicted by tuberculosis. “We are all responsible for bringing detection, treatment, and all support services to that individual in order to restore him or her to the normal health that he or she is entitled to,” Dr Mathur continued.
Healthcare professionals are present, but modern instruments are not.
“My message to the world leaders at the UNHLM on tuberculosis is to fully support technology and new tools for case detection and management of tuberculosis.” We have willing healthcare personnel, such as myself and my field team, who are eager to implement these new TB technologies efficiently. I do not want anyone to die from tuberculosis. Furthermore, many individuals do not seek treatment because of the stigma and because the most advanced diagnostic instruments are in such remote locations that they are out of reach for them. We can help stop tuberculosis by delivering point-of-care and decentralized molecular testing to their doorstep,” stated Dr Samantha Tinsay, Municipal Health Officer of Bantayan Municipality in Cebu, Philippines.
It is everyone’s right not to become infected with tuberculosis.
“I want us and our children to be free of tuberculosis.” It should be everyone’s right not to become infected with tuberculosis. More money should be spent on TB research. The most recent diagnoses and treatment regimens for active and latent tuberculosis must be made available to everybody. “All of us are unable to access the diagnostics and treatment regimens that are already available,” Ani Herna Sari, TB survivor and founder of the Rekat Peduli Indonesia Foundation, correctly said.
Is enough being done to reach the unreached?
In recent years, governments have attempted to fill gaps in TB response. “For example, the Stop TB Partnership and USAID’s introduction of the New Tools Project (iNTP) has aided in the rollout of a package of the most recent innovations in diagnostics, treatments, and digital health technologies to strengthen TB care in high-burden countries.” The application of these new technologies under iNTP, which includes the Truenat molecular test, has demonstrated the influence on public health. It is time for governments to scale up these effective approaches to help locate the missing millions of TB patients. Only through increasing the deployment of new instruments for TB diagnoses, treatment, and digital health technologies will we be able to reach the unreachable,” correctly stated Sumit Mitra, President of Global Sales and Marketing, Molbio diagnoses.
Stop the war.
Dr. Hiam Yaacoub, who has managed Lebanon’s National Tuberculosis Programme since 2012, believes that strife and war cannot be ignored in the fight against tuberculosis. They endanger not just social and economic security, but also health security, which includes TB response. “We must put an end to these wars,” she remarked. “Global peace is also essential to ending TB,” as well as all other SDGs.
“UNHLM on TB should put TB on the agenda, not only by signing declarations and commitments to support us in developing ambitious strategic plans, but also by securing funding for us to implement these plans and reach our goal of a TB-free world,” Dr Yaacoub says. I would request that they make all of the most recent TB tests, medicines, and preventative measures, including vaccinations (now under development), accessible and available to all people in all countries. Furthermore, I would request that they acquire resources to combat the socioeconomic determinants of TB, such as poverty and malnutrition, which are the true causes of TB.”
Evaline Kibuchi, Chief National Coordinator of Stop TB Partnership Kenya, agrees that when a safe and effective TB vaccine becomes available, it should be distributed fairly.
It’s time to make good on the #endTB pledge.
The clock is ticking as the finish line for tuberculosis approaches. With fewer than 88 months remaining to eradicate TB globally, Molbio Diagnostics co-founder and serial entrepreneur Sriram Natarajan is hoping for greater promises to energize the battle against TB at the next UNHLM. “When all is said and done, a lot of people are dying of TB unnecessarily.” “These lives could be saved if the right tools were introduced in a timely and effective manner,” he added.
The cost of inaction (in terms of completely translating scientific achievements into public health effect) is unacceptably high. Failure to use the WHO-recommended standard instruments for tuberculosis diagnoses and treatment leads in missing TB cases, unnecessary suffering, and premature deaths. Furthermore, failing to break the cycle of infection transmission threatens to undo the advances gained in the fight against tuberculosis.