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Tuberculosis – catch up and reclaim the advantages

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Millions of people have continued to access services that can test for and treat TB, and which can mitigate its socio-economic determinants, such as poverty and undernutrition. Heng Chivoan

Tuberculosis – catch up and reclaim the advantages

The World Health Organisation (WHO) Southeast Asia region is at a critical moment in its quest to end tuberculosis by 2030. Throughout the Covid-19 response, WHO and its member states in the region have made concerted and largely successful efforts to maintain essential health services, including for TB and other infectious diseases.

Millions of people have continued to access services that can test for and treat TB, and which can mitigate its socio-economic determinants, such as poverty and undernutrition.

Patients have nevertheless been missed and treatment delayed or disrupted. In November 2020, the Global Fund to Fight AIDS, Tuberculosis and Malaria reported that nearly 75 per cent of the TB programmes it supports globally had experienced disruptions, with 13 per cent reporting high or very high disruptions.

The latest WHO Global TB Report shows that several high-burden countries globally witnessed a decline of more than 50 per cent in the number of cases reported between January and June 2020 compared with the same period the previous year. WHO modelling suggests that these and other gaps could result in a level of global mortality last seen in 2012, leading to an additional 1.4 million TB deaths by 2025.

Our progress must not be undone. Since 2015 the region has increased treatment coverage by more than 30 per cent and raised case notification from 2.6 million to 3.6 million. Most countries have substantially scaled up TB funding. Some countries have tripled it.

All countries are committed to achieving the targets identified in the UN Political Declaration on the Fight against TB and continue to implement the global end TB strategy. The quick thinking and rapid action of programme staff from across the region has almost certainly averted worst-case modelling scenarios, with preliminary data suggesting an average decrease in TB case notification in the region in 2020 of around 20–25 per cent.

For the region to maintain its many advances, and to build on the steely resolve shown throughout the pandemic response, intensified action that is people-centered and which addresses all aspects of TB prevention, diagnosis and treatment is needed, with a focus on several priority areas of work.

First, creating or enabling multisectoral mechanisms that are empowered through high-level political buy-in. Such mechanisms will help all stakeholders identify gaps and plan coherent multisectoral action that drives rapid and sustained progress. They will also help key actors monitor progress and establish firm lines of accountability on our path towards the end TB targets. What is not measured nor owned will not be achieved.

Second, promoting meaningful community engagement through capacity building and partnering at all levels of programme planning and implementation. Community health workers, youth and civil society hold immense potential to help intensify case finding and facilitate the provision of people-centered prevention and care services. Every effort must be made to harness and apply that potential and to use innovative technologies such as electronic medication monitors to advance treatment adherence.

Third, addressing the social and economic determinants of TB. Opportunities to streamline cash transfer and nutrition support schemes, for example by removing bureaucratic hurdles, should be identified and grasped. Nutrition-sensitive social protection and community programmes should be expanded, both in funding and reach.

Poverty reduction strategies must continue to be rolled out as part of a wider commitment to implement “health-in-all” policies that outlast the Covid-19 response and recovery.

For countries to act on these and other priorities, additional resources are required. Member states have in recent years demonstrated remarkable commitment to adequately fund TB programmes, which must continue to be promoted. The front-loading of resources from international and global partners such as Global Fund could prove particularly valuable, allowing countries to catch up on pre-pandemic progress and prevent the possibility of a sustained lapse, which would prove especially harmful in what is the world’s most TB-affected region.

Innovative ways to cut costs and expand funding sources must continue to be explored. Most countries will need additional resources to cover lost ground for all diseases, not just TB. Integrated action across several disease programmes could amplify impact in resource-constrained settings.

Collaboration among member states could lead to substantial savings on the price of drugs, which several countries in the Region manufacture. Novel financing mechanisms could significantly expand the funds available to national TB programmes. The region’s annual TB funding gap of close to $1 billion must be filled with rapid effect.

We are at a critical juncture. The emergence and spread of Covid-19 globally and in the region has provided immense challenges for health systems and disease-specific programs, including for TB. It will do so for the immediate and near future.

WHO’s continued support to all countries in the region to not only hold the line against TB but to catch up and reclaim the advantage will be steadfast, as it must be. The clock is ticking on our 2030 goal. Not a second can be spared.

Poonam Khetrapal Singh is World Health Organisation’s Southeast Asia regional director



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