Tuberculosis (TB) has killed far too many people around the world for many decades, and to this day continues to take millions of lives. The global response to this tragic disease has been disappointing and not very coherent, so far, but the upcoming UN meeting on TB to be held on the 26th of September 2018 in New York is seen by the BRICS countries as an opportunity for heads of state and other leaders to rise to the occasion and take bold action against TB. With strong leadership from the BRICS, these countries have, in principle at least, what it takes to lead the charge against a disease that is taking precious lives and weakening economies. The question is: will they do so, especially in this all-important year for the battle against TB?
As many in the TB community have already said, 2018 is a “Now or Never” moment for the fight against TB. If global leaders fail to do something substantial about this tragic disease after the UN HL meeting on TB, chances are that it will keep getting worse.
It breaks my heart to see so many people all over the world suffering from TB. Personally, I did not think that the disease was such a huge problem until 2009, when someone close to me told me that she had been diagnosed with TB. It was a difficult moment, and I have since gained an interest in the fight against the disease, because like many other diseases, it can lead to poverty as well as place a host of economic and social burdens on patients and their families.
The BRICS countries (Brazil, Russia, India, China, and South Africa) face a huge TB burden themselves: together they account for 46% of all incident cases of TB and 40% of all TB-related mortality. India alone has about 27 percent of the estimated global cases of TB, as well as a quarter of drug-resistant TB patients. Many of these TB patients or victims are young adults in their most productive years. With all that in mind, and as a South African citizen myself, I am really counting on the BRICS countries to take decisive action that stops the disease in its stride.
On the 23rd of May 2018, I attended a BRICS health ministers panel discussion at the WHA in Geneva. At the event, BRICS countries came together to reflect on the upcoming UN high level meeting on TB. The health minister of South Africa, Dr Aaron Motsoaledi, chaired the meeting, with other key participants being Mao Qunan, DG of Disease Prevention and Control Bureau, China; Gilberto Occhi, Minister of Health Brazil; Veronika Skvortsova, Minister of Health, the Russian Federation; J.P Nadda, Minister of Health, India; and of course Dr Tedros, a rather well-known gentleman by now I presume.
Dr Motsoaledi presided over the meeting, as the current president of BRICS. He stressed that the problem of TB is now beyond the ministers of health as there are many political, economic and social determinants of the disease. Hence, it is important for heads of state to attend the UN high level meeting on TB in person, he emphasized. He believes that with issues requiring a higher authority, involving heads of state could be a more efficient way of finding solutions and reflecting on the decisions that the UN high level meeting needs to make. This, I believe, is the kind of action that the BRICS countries could advocate as a global community to high level policy-makers, however, it remains unclear how they are going to mobilize heads of state to attend this meeting. The fact that the TB and NCD High-Level meetings follow each other closely in September, in New York, could be both an asset and a disadvantage. I can only hope they succeed, because as we all know, poor health in one part of the world has the risk of affecting us all, especially in this age of globalization.
Dr Motsoaledi also highlighted the need for countries to commit to spending 0.1% of their gross domestic product on TB research and development (i.e. one the five asks for heads of state, see below), and argued that current methods of approaching things must change if one is to hope for better outcomes.
Finally, he presented “the five asks” (see Project Syndicate for similar “TB asks” by Ditiu (Stop TB) & Sidibé (UNAIDS)) agreed upon by the BRICS, which heads of state should work towards:
- Reach all people by closing the gaps on TB diagnosis, treatment and prevention
- Transform the TB response to be equitable, rights-based and people-centered
- Accelerate development of essential new tools to end TB
- Invest the funds necessary to end TB
- Commit to decisive and accountable global leadership, including regular UN reporting and review
Dr Tedros, adding to this, emphasised the need for everyone to work together. Indeed, he stated that joint productive effort could lead to significant change, particularly in developing countries. Dr Tedros also insisted that the BRICS countries should be role models in the fight against TB, and highlighted the importance of working with the private sector to advance R&D.
China has committed to providing medical assistance and emergency medical aid to Belt and Road partners, in addition to providing support with regards to the management of major infectious diseases, including HIV, tuberculosis, and malaria. So there might be many TB related synergies too with the Belt & Road Initiative in the years to come.
India is certainly a key actor now in the global TB battle. The country is advocating for TB treatment to be seen as right. In March, during the 2018 Delhi End TB Summit, PM Modi set the bar high, as he called for all partners, public and private and the civil society, to work together towards ending TB in the world. The belief is that if India can be successful in ending TB, then globally the chances of eradicating the disease will also improve. As you probably recall, Modi committed to ending TB in India by 2025, 5 years ahead of (SDG) schedule. Let’s hope India can pull it off. Modi’s pledge certainly has injected new momentum in the global fight against TB.
I could tell from this side event that the BRICS countries are doing their best to assist each other, and also help other countries, and this makes me believe the world at large should not lose hope or give up the fight against TB. It is expected that at the UN high level meeting, the new and innovative strategies for combatting TB will be produced, and with the BRICS countries receiving technical input from other countries with better TB prevention & treatment results, they can really become inspirations for other countries within their continents which also have high burdens of the disease. One of the main challenges remains the identification of people who have been infected with the disease, particularly among populations who do not use conventional health services, for a variety of reasons.
With the 10th BRICS meeting scheduled for July, in Johannesburg (SA), maybe we could even see a breakthrough in agreeing on a BRICS action plan, before the UN high level meeting kicks off in September. In a previous (2017) BRICS meeting, the BRICS Leaders Xiamen Declaration specifically mentioned the need to improve the surveillance of TB and also agreed to set up a TB research network. If these action plans are indeed implemented, plus some others, BRICS countries could indeed take the lead on TB in the years to come.
As already mentioned above, it’s certainly now or never. But even if the UN HL meeting outcome were a bit disappointing, or not the breakthrough hoped for by the TB community, not all hope is lost.
You never know; if per chance some nasty multi-resistant form of TB were to hit Mr Trump, that might also be a “game changer” in the global battle against TB ! : )