Regional director WHO Southeast Asia
The World Health Organization’s Global Tuberculosis Report, released on Oct. 17, outlines several positive trends in the battle against the world’s most deadly infectious disease.
First, efforts to expand TB treatment are yielding results. In 2018, 600 000 more people globally received TB treatment than the previous year. TB-related deaths dropped by more than 6 percent.
Second, TB prevention is picking up pace. Substantially more children below the age of five who are contacts of TB patients are accessing preventive treatment, with a 4 percent rise on 2017 levels. The coverage of people living with HIV (PLHIV) rose by an impressive 19 percent.
And third, we have made inroads in the fight against drug resistance. In 2018 more than 156 000 patients globally with rifampicin-resistant or multi-drug resistant TB initiated treatment, an increase of almost 12 percent on the previous year. Treatment success rates for both new and drug-resistant cases continue to improve.
But as the Report outlines, challenges persist.
Drug-resistant TB remains a serious global threat. Just one in three people afflicted are on treatment. Gaps in case notifications remain. An estimated three million patients globally are unaccounted for. Access to preventive treatment is insufficient. Just below half of people newly enrolled in HIV care are receiving preventive therapy. And funding shortfalls continue. In 2019 alone, committed global funding for TB diagnosis and care fell short by US$3.3 billion.
The Global Report is clear: The world will struggle to reach the 2020 milestones of WHO’s “End TB Strategy”. This is of concern given that by 2030 WHO and its member states and partners aim to end TB, as reflected in the Sustainable Development Goals and the United Nation’s high-level Political Declaration on the Fight against TB.
As the world’s most TB-affected region, the Southeast Asia region’s progress is significant.
As per the Report, between 2017 and 2018 Southeast Asia’s estimated case incidence fell from 226 per 100,000 people to 220 per 100,000. The notification of TB cases increased substantially, from 2.96 million to 3.36 million, with most cases coming from India and Indonesia – a credit to their resolve. Notably, the number of children under five who required preventive TB treatment and accessed it increased by12 percent. Myanmar was identified as one of a clutch of countries on track to reach the global End TB 2020 milestones.
Though the region’s progress has been strong, more is needed. The Global Report’s key takeaway is simple, and reflects WHO Southeast Asia’s flagship priority on the issue: Accelerate efforts to end TB by 2030.
To do that, active case-finding should be intensified. Efforts to engage communities should be stepped up and the private sector encouraged to act. In particular, community groups should be further empowered, including by engaging them in policy development. Information campaigns should be targeted at high-risk communities, and access to TB testing guaranteed.
Enhancing the coverage of preventive treatment is crucial. By fully implementing the WHO Southeast Asia’s recently adopted action plan on latent TB, member states can reduce the region’s annual burden of TB patients by an additional 12-15 percent annually. That equates to around 270,000 fewer patients each year. All household contacts of TB patients should be screened, in addition to people living with HIV and those at high risk of developing the disease. Preventive treatment should be provided where needed.
Social protection and support mechanisms for TB patients should be augmented. Undergoing treatment for TB often involves time off work, which can impede treatment adherence. Food supplements and vouchers, transport subsidies and financial incentives are all important in ensuring the best patient outcomes are achieved and catastrophic costs are avoided. This is especially important as the Region strives to achieve universal health coverage.
Finally, all national action plans should be aligned with the Political Declaration’s targets. As WHO Southeast Asia works to attain the investment target of at least $2 billion annually, all countries must stay on target. Of the 40 million people globally that require diagnosis and treatment by 2030, at least 18 million will come from the Southeast Asia region. Of the 30 million that require preventive treatment, the Region will cover at least 10.5 million.
Though our work is cut out, the foundations for progress are strong. We have high-level commitment. We have technical capacity. We have community buy-in and partner support. In other words, we have all the assets needed to act on the Report’s findings and ensure the End TB strategy’s milestones are met and the Political Declaration’s targets are reached. The WHO is committed to supporting member states achieve each of these outcomes, and to securing continued progress in Southeast Asia. Ending TB by 2030 is possible. We must dare to be bold.
World Health Organization’s regional director
Disclaimer: The opinions expressed in this article are those of the author and do not reflect the official stance of The Jakarta Post.