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Jakarta Post

Let’s not forget tuberculosis while fighting COVID

  • Warren Entsch and Putih Sari

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Canberra/Jakarta   /   Fri, July 3, 2020   /   08:28 am
Let’s not forget tuberculosis while fighting COVID Tuberculosis (TB) remains among the 10 leading causes of death worldwide and Indonesia has the world’s second-highest incidence of TB. (Shutterstock/Kateryna Kon)

The news about Indonesian hospitals being able to admit more non-COVID-19 patients was a welcome update. The pandemic has had an unprecedented impact on the world as we know it and many of us are still uncovering so many of its unforeseen consequences.

As members of the Global TB Caucus, an international network of elected representatives who work on issues of tuberculosis (TB), our focus over these past months has been on our management of TB, the world's deadliest infectious disease.

Let us consider for a moment, the havoc COVID has done to TB health services. Drug resistant TB wards converted to COVID wards, health workers diverted to COVID response, rapidly falling identified TB case numbers; the list goes on.

According to a modelling analysis undertaken by the STOP TB partnership in association with Imperial College, Avenir Health, Johns Hopkins University and USAID, the impact of reduced availability and use of TB services is that 6.3 million more people will fall ill due to TB by 2025 and 1.4 million more will die if immediate action is not taken. This puts the world at infection levels last seen five to eight years ago - a setback we cannot afford.

What worries us parliamentarians is that these deaths will add to the 4,200 deaths already happening every day due to TB in the world and that lockdown is not yet over in many countries and that recovery may take several months.

If you put this into context for Indonesia, every year more than 98,000 Indonesians die due to TB, more people than HIV/AIDS, malaria and COVID-19. Indonesia is one of the highest TB burden countries in the world with an estimated 845,000 TB cases every year. Only 68 percent of cases are reported every year, which means 32 percent of cases are still not detected. The case notification is reduced even more significantly during this time of pandemic, which means that more people with TB are not detected, still infecting the community and potentially not accessing treatment.

With all eyes on COVID-19, we need to focus on TB too. In just the past months, the global community has mobilized more than US$15 trillion through over 1,000 initiatives addressing the health, social and economic impacts of COVID-19. TB funding, on the other hand, has been struggling to bridge the annual funding gap of $1.6 billion, which is less than 0.01 percent of the funding for COVID-19 to date.

This is historic, and should pave the way forward for countries to invest more in health and health research and development. The COVID-19 pandemic has highlighted that there can be no real growth or development without investment in health first.

This is important because for the first time, the world has taken coordinated action in a crisis based on science and health. For example, the national development agenda in Indonesia also shifted to focus on health security since the COVID-19 pandemic.

Before the first few cases were reported, President Joko “Jokowi” Widodo declared his full support to end TB by 2030. He granted the process of drafting a presidential decree on TB expected to be finalized within this year. He also reiterated his concern about the nations’ high TB burden when opening the National Development Agenda Meeting 2021 to high-level stakeholders in May.

Advancements in the country’s political agenda are hoped to enable national authorities to narrow the TB funding gap. In 2019, 57 percent of the US$ 366 million needed to finance the national TB effort was unfunded, while 30 percent was funded domestically. According to the National TB Strategic Plan 2020-2024, the national and subnational government budget for TB program funding in Indonesia is anticipated to increase substantially each year during the 2021-2023 period.

Domestic funds supporting the TB program in 2021-2023 are expected to include payments from the Health Care and Social Security Agency (BPJS Kesehatan) and finance needs in procurement, program management, human resources development, surveillance and community-based activities.

Indonesia and Australia’s strategic partnership has grown even stronger with the recently concluded trade agreement, known as the Indonesia-Australia Comprehensive Economic Partnership Agreement.

This agreement provides an opportunity for the two nations to create a deeper and stronger business and trade relationship, including in regard to infrastructure and health. This is also echoed in the recent Departments of Foreign Affairs and Trade’s Partnerships for Recovery plan prioritizing Indonesia among the tier one countries in the region.

Now is the opportunity to strengthen the Australia-Indonesia health security partnership and discuss opportunities for deeper engagement and investment in health security and infectious diseases, including TB.

Indonesia and Australia can therefore emerge as leaders in the region in prioritizing health priorities in respective regional forums. Together, the region needs to leverage TB program infrastructure in response to COVID-19, while maintaining core TB services, including the scale- up of molecular testing and appropriate triage of people affected by COVID-19 and TB, and involving communities and civil society as key partners in TB and COVID-19 response.

It is also important to increase efforts and investment in TB, with supplementary measures and resources to reduce the accumulated pool of undetected people with TB, such as ramped-up active case finding, intensive community engagement and contact tracing, using digital technology and other tools.

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Warren Entsch is a member of the Australian Federal Parliament and cochair of the Australian TB Caucus and the Asia Pacific TB Caucus. Putih Sari is an Indonesian legislator and former deputy chair of House of Representatives Commission IX overseeing health, employment and population.

Disclaimer: The opinions expressed in this article are those of the author and do not reflect the official stance of The Jakarta Post.