How SA got the UN to talk about TB

Heads of state dis­cussed one of the world’s big­gest killers in New York this week — and it was our health min­is­ter who got them to­gether

Mail & Guardian - - Health - Aaron Mot­soaledi

For the first time in the his­tory of the United Na­tions (UN), the body hosted a high-level meet­ing of heads of states to talk about TB. Ma­jor epi­demic dis­eases are con­sid­ered global se­cu­rity threats. That is why govern­ment heads dis­cussed HIV at a high- level UN meet­ing in 2001, 2011 and 2016. Ebola was a topic in 2014 and an­timi­cro­bial re­sis­tance (when an­tibi­otics used for many decades are no longer ef­fec­tive) in 2016. Non­com­mu­ni­ca­ble dis­eases such as can­cer, di­a­betes, hy­per­ten­sion and car­dio­vas­cu­lar dis­eases were de­lib­er­ated on in 2011 and 2014 and were also fo­cused on again in the Gen­eral Assem­bly this week.

But one dis­ease — the in­fec­tious dis­ease that kills the most peo­ple — was ig­nored and hadn’t made a blip on the UN’s radar.

Un­til this week.

This dis­ease is TB — the con­di­tion we know so well in South Africa. You may won­der why I’m mak­ing a big is­sue about an ill­ness that has been around for cen­turies and has never been re­garded as a cri­sis.

To­day I’m in­form­ing you that TB has in­deed be­come a huge global health se­cu­rity threat.

Here are the facts: over the past 200 years TB has killed more peo­ple than malaria, cholera, yel­low fever, the bubonic plague, in­fluenza, po­lio, Ebola and HIV com­bined.

In 2017, 10-mil­lion peo­ple de­vel­oped ac­tive TB glob­ally, ac­cord­ing to the World Health Or­gan­i­sa­tion’s 2018 Global TB re­port. The dis­ease killed 1.6-mil­lion peo­ple glob­ally — more than 4 000 peo­ple each day.

Is it not sur­pris­ing that such a big killer was ig­nored by global pow­ers?

It’s not that world lead­ers didn’t know about TB. Four­teen years ago, South African world icon Nel­son Man­dela, whose le­gacy is be­ing cel­e­brated at this year’s Gen­eral Assem­bly, warned: “The world has made de­feat­ing Aids a top pri­or­ity. This is a bless­ing. But TB re­mains ig­nored.”

At the 2004 In­ter­na­tional Aids con­fer­ence in Bangkok he pleaded: “To­day we are call­ing on the world to recog­nise that we can’t fight Aids un­less we do much more to fight TB as well.”

Why have in­ter­na­tional lead­ers not taken Madiba’s warn­ing se­ri­ously?

In my opin­ion, it is be­cause other dis­eases kill peo­ple in much more dra­matic ways than TB. They bring trauma and panic.

TB, on the other hand, is not a drama queen. It kills silently and slowly. Nev­er­the­less it’s an ex­tremely ef­fec­tive killer.

Be­cause of its si­lence and slow­ness it doesn’t prod any­one into ac­tion — un­like HIV, Ebola, malaria and other in­fec­tious dis­eases.

This is what makes TB so ex­traor­di­nar­ily dan­ger­ous.

In 2001, the World Health Or­gan­i­sa­tion (WHO) es­tab­lished an or­gan­i­sa­tion called the Stop TB Part­ner­ship Board. Its role is to im­ple­ment pro­grammes to fight TB.

The Stop TB Part­ner­ship Board is hosted un­der the um­brella of the United Na­tions Of­fice for Project Ser­vices.

I’m the chair­per­son of the Stop TB Part­ner­ship Board.

In 2016 I was in­vited, in my ca­pac­ity as the chair­per­son, to par­tic­i­pate in a UN high-level meet­ing to dis­cuss an­timi­cro­bial re­sis­tance. I had in­for­ma­tion at my dis­posal that one third of an­timi­cro­bial re­sis­tance was due to TB (which is treated with an­tibi­otics). It was there­fore of great con­cern to me that the UN would dis­cuss an­timi­cro­bial re­sis­tance but ig­nore TB.

I pointed out that the world has al­ready lost one third of the war against an­timi­cro­bial re­sis­tance but noth­ing is done about TB. I ar­gued that TB should also be given the op­por­tu­nity to be de­bated by heads of states.

The South African Mis­sion at the UN, led by Am­bas­sador Jerry Matjila, then mo­bilised coun­tries in­clud­ing Nor­way, France, Thai­land, Sene­gal, In­done­sia and Brazil to sup­port this mis­sion. These na­tions, led by South Africa, spon­sored a mo­tion urg­ing the UN to host a high-level meet­ing on TB.

This meet­ing hap­pened on Wed­nes­day. It is a dream come true and South Africa ought to be very proud of this achieve­ment.

In prepa­ra­tion for the meet­ing, the WHO and the Rus­sian Fed­er­a­tion, to­gether with the Stop TB Part­ner­ship, or­gan­ised a min­is­te­rial meet­ing in Mos­cow in Novem­ber. The meet­ing was opened by the Pres­i­dent of the Rus­sian Fed­er­a­tion Vladimir Putin and ad­dressed by the deputy sec­re­tary gen­eral of the UN, Amina Mo­hamed, the di­rec­tor gen­eral of the WHO, Te­dros Ghe­breye­sus and Unaids’ ex­ec­u­tive di­rec­tor, Michel Sidibe. Eighty health min­is­ters and 2 000 del­e­gates at­tended.

At the min­is­te­rial meet­ing, it was agreed that five pri­or­i­ties, called the “five asks”, must fea­ture at the UN meet­ing. These range from find­ing re­sources to pre­vent, di­ag­nose and suc­cess­fully treat all those with TB and to sup­port fur­ther re­search and de­vel­op­ment.

We are hope­ful that this de­bate and the po­lit­i­cal dec­la­ra­tion that was signed will usher in a new era that will en­able coun­tries to erad­i­cate the world’s big­gest silent killer by 2030 or ear­lier.

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