We Can Eliminate Tuberculosis

World Tuberculosis (TB) Day is commemorated on March 24 every year. The World Health Organisation’s (WHO) theme for World TB Day 2023 is 'Yes! We can end TB!'. It aims to inspire hope and encourage high-level leadership, increased investments, faster uptake of new guidelines, adoption of innovations and accelerated action to combat the TB epidemic. This year is critical, with opportunities to raise visibility and political commitment at the 2023 UN High-Level Meeting on TB. In 1882, Dr. Robert Koch discovered the bacterium (Mycobacterium tuberculosis) that causes TB, which opened the way towards diagnosing and finding cure for this disease. The world began to mark TB Day in memory of this medical breakthrough.

 TB is still one of the leading infectious killers in the world. Globally, an estimated 10.6million people fell ill and 1.6 million deaths occurred due to TB in the year 2021. In the SAARC region, an estimated 4 million cases accounted for 38 per cent of the global burden of TB with 0.6 million deaths reported in 2021. 

There were 2.8 million total notified cases and 2.6 million new and relapse cases. Among the 30 high TB/DR TB burden countries, India, Pakistan and Bangladesh in the SAARC member states accounts for high TB and India, Pakistan, Bangladesh and Nepal are DR-TB high burden countries. 

Reasons 

Major reasons behind high burden of TB in the SAARC region is due to the fact that this region represents many of the drivers of the modern TB epidemic  such as  rapid urbanisation, high-density populations, malnutrition, HIV, air pollution, rising incidences of diabetes and unregulated private sector. Additionally, social determinants of health such as education, income and social support also contribute to increase in incidences of TB in the region. Furthermore, the TB bacteria is becoming resistant to drugs, longer treatment durations, less effective and with more side effects, low compliance on the part of patents to treatments and failure of management of TB in the programme settings.

 In 1993, the WHO declared TB a public health emergency and called upon all governments to scale up TB control activities. Since then, the WHO, the United Nations, national governments and non-governmental organisations (NGOS) increased their commitments. Global efforts have resulted in an estimated 74 million lives saved since 2020.  On September 26, 2018, the United Nations General Assembly held the first-ever high level meeting (UN HLM) on ending TB globally. All SAARC countries also have pledged to end TB in their respective countries by 2030.

The spotlight of World TB Day will be on urging countries to ramp up progress in the lead-up to the 2023 UN High-Level Meeting on TB.  The commitments needed this year are:  

High-level leadership and action to end TB and the suffering of TB patients, and universal care for those affected. Increase collective responsibility by more investment of resources, support and sustaining the TB services to combat TB and lead to Universal Health Coverage.

Urgent investment of resources, support, care and information that is vital to ensure universal access to TB care for research. More investments in introduction of newer guidelines and research are vital to fast-track efforts to meet the targets. Health authorities should redouble efforts at all levels to support essential TB services, including during emergencies such as pandemics and disasters.

It is necessary to tackle health inequities to ensure health for all. The COVID-19 pandemic has drawn attention to the deep disparities between and within countries. People with TB are among the most marginalised and vulnerable in accessing care. A global action to address health inequities for people with TB and other diseases is needed.

Ending TB requires concerted action by all sectors. To provide TB services, support and safe environment in the right places, everyone including individuals, communities and governments have a role to play. The END TB targets cannot be achieved by the health system alone. It requires firm political commitment at the highest level with an effective accountability system.

On this day, SAARC member states inform the public in their countries about the impact of National TB Programmes and rededicate themselves to achieve the END TB Goals.  We at SAARC TB and HIV/AIDS Centre would like to share the successes of various member states in TB prevention and control activities through publication of the “SAARC Epidemiological Report on TB” and highlight the challenges in the region toward the elimination of TB.

 As per the high level commitments made by some SAARC member states during United Nations General Assembly High-Level Meeting (UNHLM) in 2018, anti-TB activities are being effectively  implemented by intensifying advocacy, social mobilisation, partnership, research and inter-sectorial efforts to achieve the target of ending the TB epidemic by 2030. Investments are needed for increasing access to rapid molecular diagnostics, effective shorter TB and DR TB treatment regimen, TB preventive treatment options and tests for TB infection.Promotion of research, development and innovations and access to digital tools to improve health outcomes also require investments. 

Decline in TB cases

In the context of Nepal, the National Strategic Plan of NTP ( 2021/22 to 2025/26 was developed with a budget plan of $192 million for strengthening NTP to achieve a decrease  in incidence rate of TB from 238 in 2020/21 to 81 patients per100,000 population by 2025/26; decrease in mortality rate from 58 in 2020/21 to 23 per100,000 by 20225/26; End TB by 2035; prevent TB by 2050; and reduce the catastrophic cost to zero on the lines of END TB Strategy of WHO.TB Free Palika (local level) Initiative is one of these innovative activities. The government plans to make the local governments responsible for tuberculosis control activities to achieve the END TB targets. 

A high-level END TB committee with political leadership will provide a unique opportunity to raise the profile of NTP and receive more secure high level commitments to enhance NTP through revived TB control activities to achieve goal of end the TB epidemic in Nepal by 2035 and eliminate it by 2050.  We cannot falter till we reach the goal and save every person, family and community impacted by this deadly disease. Let us join forces on this World TB Day, and call for an end to excuses and delays in prioritising investments and action to end one of the world's top infectious killers. Yes! Together we can end TB!”

(Dr.Myneedu is the Officer In-charge of SAARC TB and HIV/AIDS Centre, Thimi Bhaktapur. Dr. Pyakurel is a research officer at the Centre.)