Putting Political Will into Action to End TB

This week, for the first time in its history, the United Nations hosted a high-level meeting on TB, where world leaders agreed on a global plan to step up the fight against TB. Although the final political declaration has won approval, it is now up to countries to take action.

Leading up to the high-level meeting, MSH and PATH co-hosted a side event, Putting Political Will into Action: Public-Private Partnership to End TB. This candid conversation with a diverse panel of experts and activists emphasized the urgent need to forge deeper government, community, and private sector engagement to make meaningful progress toward ending TB, the world’s largest infectious killer.

The panel included voices representing civil society, multilateral perspectives, and patient advocates who are dedicated to fighting the disease.  

In her opening remarks, MSH’s President and CEO, Marian W. Wentworth, set the stage for the conversation, reminding the crowd of what’s at stake this week. “By the end of today, according to WHO, about 4,000 people will have died from tuberculosis.” The toll of this terrible disease, which mainly affects young adults in their most productive years, is too high to remain unchecked. “On average, people living with TB lose more than 50% of their income due to reduced productivity,” said Wentworth, noting that the social and economic losses make it much more difficult for countries to expand their economies and invest in other important areas of society. “While early diagnosis is key to preventing the spread of TB,” added Wentworth, “the necessary capacity to detect and treat the disease is lacking in many countries.” Antimicrobial resistance is a dangerous and growing threat, she warned.

Keynote speaker and moderator of the discussion, Dr. Vanessa Kerry, CEO and founder of Seed Global Health, offered a broad perspective: People are the heart of the health system. When an entire health system’s workforce is appropriately trained and equipped, they can both care for their community and become educators and advocates themselves. “Entrenched problems are solvable if we are smart and honest and think about what we haven’t fully tackled before we can go forward.”

The real issue at hand, said Dr. Joanne Carter, Executive Director of RESULTS and Vice Chair of the Stop TB Partnership Coordinating Board, is not whether we can reach everyone with TB, but whether we choose to make TB a political priority: “TB has climbed to the top as the leading infectious disease killer because it has been stuck at the bottom of the list of political priorities.” Carter reminded the audience that health systems are failing to reach nearly 40% of the people who get TB every year, according to WHO’s 2018 Global Tuberculosis Report. “It doesn’t take an epidemiologist to tell us that if we’re not getting treatment of some quality to almost 40% of the people who are getting sick, we’re not going to make progress against this infectious killer…For a disease that we can prevent, treat, and cure—this is really unconscionable.” As a result of the high-level meeting, Carter added, we must require high-level commitments and ways to track progress at the head-of-state level and at regional and global forums so that success and failure are owned by heads of states. “And we need to have implementation tools like scorecards and national and regional ranking so that the response to TB is something that is measured and tracked and owned by civil society and governments.”

Calling for greater inclusion of, and investment in, the private sector, Dr. Lal Sadasivan, TB Technical Director, HIV/TB Global Program at PATH, shared how competition for resources and poor coordination between public and private health service providers in India and elsewhere is a major bottleneck in delivering quality care for those with TB. “We know that about 70–80% of the people who have TB seek care from the private sector,” said Sadasivan. “Usually they don’t follow any standard TB guidelines and as a result offer suboptimal care, which leads to complications—delayed diagnosis, the wrong treatment, resulting in drug resistance, etc.” To address the high burden of disease and find the missing cases of TB, argues Sadasivan, we must see investment in the growing private sector as an opportunity for effective partnerships, not a threat.

Dr. Pedro Suarez, Senior Director, Infectious Disease Cluster at MSH, spoke about the need for increased public–private partnerships to harness the potential for digital health technologies. “We have digital technology to detect TB, but this tech is very expensive,” said Suarez, noting that each digital X-ray machine costs between $100,000 and $150,000. But these investments in health technology—from data capture systems to new diagnostics, such as point-of-use testing for TB—are essential to controlling the epidemic. Suarez also contrasted the successes of the HIV community “who speak with one voice” with those of the TB community, which has been less able to engender the support needed to combat the disease.

Dr. Khuat Thi Hai Oanh, Executive Director, Center for Supporting Community Development Initiatives in Vietnam and Mr. Alberto Colorado, Patient Advocate and Coordinator for the Americas TB Coalition from Peru, brought an activist and community perspective to the discussion. “We’ve realized we’re not going to end TB—no matter how many billions of dollars we spend—without civil society and community engagement,” says Oanh. “In Vietnam, people die of TB. We have to ask why people are dying when services are available?” The same 40% of people with TB who are not identified, noted Oanh, “are the same 40% who are the hardest to reach: They are more likely to be marginalized, criminalized, hidden, ignored, voiceless…they don’t speak the same language the politicians and the doctors speak.” Openness to creating dialogue and understanding between decision makers and those affected is badly needed: “People living with TB have knowledge and know-how of their own that the politicians and the doctors may not understand.”

Colorado ‏reflected on the structures of power that oppress communities that continue to grapple with TB. “The problem of TB is that we’re lacking honesty. We are missing love and compassion for the people.” Having worked in Latin America, Colorado pointed out the political stigma around TB. Health authorities are slow to acknowledge that TB is a big problem in prisons and indigenous communities. “People come to the UN, talk about countries, then go home, while people who are suffering have to stay with the disease… It’s not until parliamentarians meet patients, meet providers, that they are affected and say ‘we’re going to do something.’ But for many, it’s too late.” Both Colorado and Oanh emphasized that we cannot end the TB epidemic without civil society engagement. “When the system is not at the human level, there will be a big barrier. Civil society is not the enemy,” said Colorado.

As deliberations among world leaders and civil society and private sector representatives continued to unfold at the UN General Assembly, MSH was proud to join partner organizations in endorsing the 2018 Roadmap Towards Ending TB in Children and Adolescents, which aims for zero TB deaths among children worldwide. This effort will require sustained commitment by all stakeholders involved in providing health care for children and increased resources toward the development of child-friendly tests, treatments, and other interventions for TB control. Using a health systems strengthening approach, MSH is committed to fighting TB in the 42 countries where it works. Through international, national, and local partnerships, MSH will strengthen the capacity of health systems, national TB programs, and health managers to prevent the spread of TB and improve the lives of all who are affected by it.

Read the Blog: Public-Private-Partnerships Will Help End TB