The world is finally committed to a comprehensive plan to beat TB
With Africa making up nearly half of the high-risk numbers, ministers at the UN came together and agreed on concrete steps to put an end to the disease, writes
IRECENTLY returned from the first World Health Organisation (WHO) ministerial conference on TB. Given that TB remains one of the biggest contributors to mortality and morbidity in our country, I think it’s imperative that I report back on this conference, how it came about and what decisions were taken.
During the 2016 UN General Assembly meeting in New York I argued that heads of state had, over the past few years, increased political commitment on several health issues, including HIV, non-communicable diseases and antimicrobial resistance.
However, tuberculosis, which is currently the leading infectious disease globally – with more than 10 million people infected annually and more than 5 000 killed each day – had yet to be accorded the same degree of global political concern.
Health ministers from a number of countries joined the call for TB to be discussed by heads of state at the UN and, to our delight, the assembly agreed to focus on TB in 2018. This is a major victory as it signals that at long last the fight against this disease will receive political commitment at the highest level.
The Russian Federation approached the WHO to host a global ministerial conference on TB this year. The proposal was embraced by ministers of health as it provided an ideal platform to prepare for the high-level assembly meeting.
South Africa was invited to participate in the steering committee to advise on preparation for this meeting, along with countries with large numbers of people with TB, the so-called “high burden” countries. In deciding on the theme of the meeting, it was clear to the organisers that TB could not be defeated by the health sector working in isolation.
Thus the title, “Ending Tuberculosis in the Sustainable Development Era: A Multisectoral Response”, located the conference squarely within the sustainable development goals and called for multisectoral action to end TB as a public health threat by 2030.
Having just returned from participating in this historic conference, it is important that I share my experience of it as well as its outcomes with the South African community.
The conference was attended by more than 1 000 delegates from 114 countries with 75 ministers participating. It was opened by President Vladimir Putin – highlighting the commitment of the Russian Federation’s head of state to tackling the high levels of TB.
Putin emphasised the need for co-ordinated action by all stakeholders and the importance of investment in research and development – to develop new diagnostics, vaccines and medicines.
I attended not only as South Africa’s minister of health but also as the chairman of the Global Stop TB Partnership Board and of the Southern African Development Community (SADC) health ministers, as well as represented AU health ministers.
The SADC health ministers asked me to inform the conference of the significant burden TB presents to the people of the region. Nine SADC countries are on the WHO’s list of top 30 high-burden countries: Angola, the Democratic Republic of Congo, Lesotho, Mozambique, Namibia, South Africa, Tanzania, Zambia and Zimbabwe.
Outside the SADC, the countries in Africa that contribute to the top 30 include: the Central African Republic, Congo, Liberia, and Sierra Leone. This means 13 countries in Africa – almost half.
With the significant burden of TB in South Africa, the SADC region and in West Africa, it was critical that we participated in the conference to ensure its outcomes also met our objectives.
Many of my counterparts from Africa participated, including in an AU/Nepadorganised breakfast meeting at which we discussed the AU position on TB, calling for greater political commitment, investment in TB research and development and focus on social determinants.
Given the high expectations that we had for the conference, what did we achieve? The outcomes and key issues that we will table at a high-level assembly meeting next year are reflected in the Moscow Declaration to End TB. I will summarise these: • TB elimination must receive the highest level of political commitment, including prioritising the provision of the necessary resources, from heads of state and leaders at all levels of society.
• There was a commitment to achieving goals by implementing universal health coverage and ensuring no one would be left behind because they were poor or marginalised in society.
• It was agreed our responses to the epidemic had to be multisectoral and we had to deal with the social determinants that fuelled TB: poverty and marginalisation, a lack of nutrition, tobacco and alcohol use.
• Countries’ programmes had to ensure we found the estimated almost 5million people with TB that were not diagnosed and on treatment. And we had to put at least 90% of people with TB on treatment and ensure at least 90% of those were treated successfully.
• It was agreed we needed to invest more in research and development. The current TB vaccine is 90 years old. There are few new TB medicines and it takes too long (six months to two years) to treat a case of TB. We lack point-of-care diagnostics – which means patients wait for weeks to get their diagnosis and often do not return for treatment.
• Because TB accounts for about a third of resistance to antibiotics, how we deal with antimicrobial resistance had to take priority.
People must be at the centre of our responses to the TB epidemic.
Closing the conference, the WHO’s director-general, Dr Tedros Adhanom Ghebreyesus, said: “Today marks a critical landmark in the fight to end TB. It signals a long overdue global commitment to stop the death and suffering caused by this ancient killer. This will come to pass only if every member state of the UN plays its part.”
On the sidelines of the conference and in my capacity of chairing the Stop TB Partnership Board, I met UN Deputy Secretary-General Amina Mohammed. She agreed that in addition to technical discussions of TB, we must ensure heads of state, including ministers of finance and development, and of justice and education are engaged if we are to mount a truly multisectoral response that is needed to eliminate TB as a public health threat.
I made it clear that unless our leaders fully understood the social and economic burden that TB represented and acted on this understanding, we would not end TB.
The Stop TB Partnership Board therefore plans to host dialogues with finance ministers as well as the private sector during our next board meeting in preparation for the high-level meeting in New York next year.
Closer to home, what do the Moscow Declaration and forthcoming high-level meeting mean for South Africa?
As I noted above, South Africa is regrettably one of the 30 high-burden TB countries.
There are many reasons for this, including our apartheid past, linked to mining, the migrant labour system, poverty and inadequate housing as well as the HIV epidemic, which has fuelled the TB epidemic since the early 1990s.
However, it is not enough to list the reasons for our heavy burden – we must take bold actions to eliminate TB as a public health threat by 2030 or earlier.
The good news is that we have already started to act boldly. We have expanded the use of the latest diagnostic technology (GeneXpert) to diagnose people with TB and drug-resistant TB.
We have expanded the use of a prophylactic drug (isoniazid) which prevents HIV-positive patients from contracting TB.
We have introduced two new drugs to treat drug-resistant TB (bedaquiline and delamanid).
These actions, as well as the successes of our HIV treatment programme, have resulted in a large decrease in the number of people dying from TB (as reported by StatsSA).
What is clear is that to reach our targets much more needs to be done. We will implement the commitments in the Moscow Declaration and endeavour to reach our targets before the 2030 deadline set by the WHO.
We also need to ensure that we support the political declaration and commitments that are to be made during the high-level meeting in September next year, including the development and implementation of a multisectoral accountability framework.
To do this, we need every South African, every civil society organisation, every employer and every government department, at all levels of government, to work together.
Working together we can and will beat TB. Dr Aaron Motsoaledi is the minister of health and chairs the Stop TB Partnership Board