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Discourse: Universal health coverage urgent to end TB
Tuberculosis (TB) remains among the 10 leading causes of death worldwide and Indonesia has the world’s second-highest incidence of TB
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em>Tuberculosis (TB) remains among the 10 leading causes of death worldwide and Indonesia has the world’s second-highest incidence of TB. For World TB Day, which fell on March 24, Eric Goosby, the United Nations special envoy on tuberculosis, talked to The Jakarta Post’s Rita Widiadana. Goosby is also professor of medicine and director of global health delivery and diplomacy at the University of California, San Francisco. The following are excerpts from the e-mail interview.
Question: What are the most challenging factors in eliminating TB?
Answer: TB remains the leading infectious disease killer on the planet, killing 1.6 million people in 2017 alone. Moreover, an estimated 10 million people became ill with TB in 2017. Eight countries in Southeast Asia and Africa, including Indonesia, accounted for two-thirds of all new cases worldwide.
The mortality rate is declining, by approximately 3 percent per year since 2000, or 43 percent overall between 2000 and 2017. This decline resulted from substantial progress in the number of patients being diagnosed and treated.
The most challenging factors that hinder efforts to eliminate TB are obtaining the resources needed to invest in the acceleration of new tools and diagnostics; the inability to complete diagnosis and treat when necessary; and the lack of political will.
Although treatable and curable, why is TB still a daunting global public health problem?
TB preys on people living in poverty — many don’t have access to diagnosis, let alone receive treatment. Moreover, because TB is so easy to transmit — a simple cough can do it — people living or working with a person who has TB are susceptible.
People in poverty also don’t have political clout. They are essentially voiceless when it comes to advocating for change.
Another challenge is that efforts to tackle TB have historically been underfunded. Consequently, we have a TB vaccine that is 100 years old. Better diagnostic tools are sorely needed.
What is the significance of the recently released report by the Lancet Commission on global efforts to eliminate TB?
At the first ever UN high-level meeting on tuberculosis, heads of state and other officials resolved to take major steps toward building a TB-free world. They outlined ambitious goals to successfully treat 40 million people
with TB and prevent at least 30 million people from becoming ill between 2018 and 2022, by scaling up preventive treatment efforts.
The purpose of the Lancet Report is to help provide a road map for the 10 countries with the highest TB incidences.
In Indonesia, no one anticipates that the goals will be reached by 2022. However, it is absolutely imperative that Indonesia increases its commitment to fighting this deadly disease. Countries like Indonesia can increase their annual TB expenditure more than five-fold over the next five years through increased revenue generation and allocation of greater budgetary resources to health.
The dividend of this investment can be significant. The countries that have achieved great progress against TB have shown broad economic and health benefits.
Of the 10 million people who become ill with TB annually, almost half of them, mostly in poor countries, do not get the care they need. How should the world address this issue?
In the Lancet Report, the commission identified the following steps to help countries tackle TB: Implement and expand on proven, evidence-based strategies; increase investment to accelerate the development of new tools; increase domestic financing and improve accountability.
Experts say that to eradicate TB requires not only comprehensive medical treatment, but also social, economic, political and other related factors. What is your opinion?
No doubt various factors impact the ability to fight TB. Which factor play the dominant role depends on the country. Lack of political ranks high and results in underfunding. Socially, in many high-burden countries there is a real need to knock down the serious barriers to care that exist, such as stigma and discrimination.
Economically, not treating TB can result in astronomical costs. In India unavoidable TB deaths will cost the economy at least US$32 billion each year over the next 30 years.
Most of all what is needed is universal health coverage. We will not successfully end TB without universal healthcare.
After India, Indonesia has the highest incidence of TB. Is Indonesia on track to eliminate TB by 2030?
Given Indonesia’s high number of cases of TB [over 1 million cases according to the Health Ministry], it is impossible to imagine that it will meet the global goal of ending TB by 2030.
It is critical that Indonesia commits to fully funding its anti-TB efforts. Currently, Indonesia is only covering 51 percent of what is needed.
Last September, the first UN high-level meeting on TB produced a political declaration on TB. Do you see any actual progress among governments in scaling up TB prevention and elimination programs?
It’s too early to measure progress, but what we are seeing is growing momentum — and that’s extremely important because political will plays such a critical role in defeating TB.
The purpose of the Lancet Report is to build upon the UN high-level meeting and provide high burden countries with a road map to ending TB. We hope countries take seriously its recommendations to help them build a TB-free world.
