EMELDA MWITWA, Lusaka
WHEN the Sustainable Development Goals were unveiled in 2015, world leaders pledged to end tuberculosis by 2030.
However, as the clock ticks towards the set time, the world response is moving at a seemingly slow pace, raising fear that the target may not be met.
TB is the world’s largest infectious killer disease, claiming 16 million lives last year and infecting 10 million people in 2017 alone.
It often affects the poor, most vulnerable and marginalised members of society. Often, this includes women, children, older persons, refugees and migrants.
Despite the commitment of world leaders to end TB, the fight against the disease is greatly under-funded with at least US$13 billion needed annually by 2022.
“Our progress on tuberculosis has simply not been good enough. Tuberculosis is preventable, treatable and curable. And yet this disease claimed 1.6 million lives last year, including 300,000 people who lived with HIV. Multi-drug resistant TB remains a public health crisis. This is unacceptable,” President of the 73rd United Nations General Assembly (UNGA) Maria Espinosa said at the high-level meeting on the Fight against TB on September 26.
The economic losses due to TB are enormous as the disease could cost the global economy over US$1 trillion by 2030.
Ms Espinosa said improved health infrastructure and enhanced coordination across ministries and between governments, civil society and the UN, could help improve community health. She urged individual countries to strengthen health care systems as they tackle TB.
The UNGA President said there is need to scale up funding and research for TB, noting that this year there is a gap of about US$5 billion for action and research.
The world needs to treat 40 million people affected by TB and provide 30 million people with preventive treatment to meet the SDG targets for 2030.
“We must mobilise US$13 billion annually by 2022 for implementation and US$2 billion for research,” Ms Espinosa told heads of state at the UNGA.
In response, world leaders who attended the UNGA 73 committed themselves to ensuring that 40 million people with tuberculosis receive the care they need by end of 2022.
After the high-level meeting, the 193 member states that attended the General Assembly agreed to provide 30 million people with preventive treatment to protect them from developing TB.
Heads of state and government who attended this first-ever UN high-level meeting on TB agreed to mobilise US$13 billion a year by 2022 to implement TB prevention and care, and US$2 billion for research.
World Health Organisation (WHO) Director Genetal Tedros Ghebreyesus, said the leaders also committed themselves to taking firm action against drug-resistant forms of TB, build accountability and prioritise human rights issues such as stigma that still prevails around TB in many parts of the world.
He said the leaders acknowledged that the current rate of progress towards eliminating TB was endangering prospects of meeting global targets.
The political declaration on TB comes after the recent leadership commitments at global and regional level – including the 2017 Moscow Declaration to end TB – to drive universal access, sufficient and sustainable financing, intensified research and innovation, and accountability across all sectors.
While progress towards combating TB has been slow in other countries, Zambia is among the countries that have reported improvement in reducing the TB incidence.
“Madam President, Zambia has made steady progress in tackling the TB epidemic. We have reduced the TB incidence rate by 50 percent between 2000 and 2016. In addition, the proportion of TB patients successfully treated has been over 85 percent in the last decade, reaching 88 percent in 2017,” President Lungu told the high-level meeting on the fight against TB.
He said despite this progress, Zambia still remains one of the 30 high TB and TB/HIV burden countries with a TB incidence rate of 376 per 100,000 population.
This places Zambia’s TB incidence rate at two times higher than the average incidence of the African region and three times higher than the global average.
As a result, every year, an estimated 62,000 people are infected with TB out of which 42 percent remain undetected due to limited access to highly sensitive TB diagnostic tools.
“As a result, approximately 46 people die every day in the country to a cause attributable to TB,” President Lungu said.
He said efforts at country level have been reinforced towards the elimination of TB by 2030 and that the Global End TB Strategy targets have been mainstreamed in the National Development Plan for the period 2017 to 2021.
Apart from that, the National Health Strategic Plan, along with other national policy documents, has helped to ensure that the TB response is comprehensive and targets all key populations, with a focus on persons living with HIV, children, prisoners, miners as well as ex-miners.
In addition, the country is concentrating efforts on innovative, high impact community interventions across the country, in order to achieve universal health coverage.
“As a demonstration of our commitment, we have increased domestic funding towards TB programmes from 9 percent in 2017 to 28 percent in 2018 of the total annual budget for TB,” Mr Lungu told the 73rd UNGA President.
Furthermore, in order to attain sustainable financing in the health sector, and in an effort to mobilise domestic resources towards universal health coverage, Parliament enacted the National Health Insurance Act in April this year.
However, the President said there still remains a wide gap in the acceleration of Zambia’s TB elimination agenda.
“In this regard, enhanced international support is needed to increase the network of sensitive TB diagnostic tools, medicines and research to generate local evidence,” he said.
He said Government would like to secure sufficient and sustainable financing, both domestically and internationally, to close the current funding gaps for the implementation of TB treatment and care.
At a regional level, TB continues to be a significant cause of sickness and death in Southern African Development Community (SADC).
In a speech delivered to the UNGA by Namibia, the current Chair of SADC, the TB situation in the region is fuelled by parallel issues of HIV epidemic, malaria, poverty, disparities, stigma, discrimination and unfavourable living and working conditions.
With a population of 2.5 million people, Namibia ranks as ninth highest per capita of TB burden in the world. It is one of the top three causes of hospitalisation in Namibia, with some cases ending in death. This high HIV prevalence contributes significantly to the TB burden.
UN Secretary General Antonio Guterres said the world needs better health and social welfare systems to end the epidemic and stop the global public health crisis of drug- resistant TB.
“With roughly half a million drug-resistant cases of TB each year, we need scientific advances to find better tools to fight TB and overcome the increasing threat of anti-microbial resistance,” Mr Guterres said.
He said the fight against the world’s most infectious killer disease should also encompass fighting poverty, inequality, migration and conflict as they all fuel TB.
“TB helps fuel other epidemics, poverty and distress. It exists in a vicious cycle that will require an all-systems approach that accounts for the social drivers that perpetuate its spread.
The International Federation of the Red Cross and Red Crescent Societies has urged that TB care and treatment efforts should also focus on inmates, migrants and people affected in natural disasters, conflicts and other humanitarian emergencies.
“TB was declared a public health emergency in 1993, but over 10 million people still contract the disease every year. It is the world’s biggest infectious killer disease, and our actions to fight this deadly epidemic have been woefully insufficient,” Richard Blewitt said on behalf of the organisation.
EMELDA MWITWA, Lusaka