In 2014, TB was contracted by 9.6 million people and ended the lives of 1.5 million.
In the WHO Southeast Asia Region, which accounts for a disproportionately high number of cases, the disease killed around 460,000 people and spread to some 340,000 children. Though progress in combating TB has been steady, it remains inadequate: at present rates people in Southeast Asia will continue to fall ill, suffer from, and be killed by TB well into the future.
Beginning this year, an intensified battle has been launched against the disease. The “End TB Strategy” aims to reduce the death toll by 95 per cent and cut new cases by 90 per cent by 2035, creating a region free of TB with zero death, disease and suffering. The goal is ambitious. It is also entirely achievable. The strategy rests on three pillars:
The importance of integrated, patient-centred care and prevention.
The need for bold policies and supportive systems.
And the value of intensified research and innovation.
But the strategy depends on governments creating and implementing policies that address the social, economic and behavioural factors that affect TB care and control, and tailor these policies for society’s most vulnerable. In other words, it means better governance.
Governments must strive to ensure early diagnosis and treatment for those suffering from TB while managing associated illnesses. They must also provide adequate funding for TB-related programmes and back them with unswerving political will. They must pursue research in order to gauge the effectiveness of the initiatives they are taking, thereby ensuring that public funds are used effectively and for the best possible outcomes. Importantly, governments must also alleviate the catastrophic expenses the disease inflicts on affected families – expenses that greatly diminish the incentive to seek care and stay the course of treatment. Poverty reduction, improved nutrition, and better living and working conditions will all make a significant difference in mitigating the burden TB poses. And they all require a society-wide change for the better.
Still, the single most effective tool for countries in Southeast Asia to meet the strategy’s targets and end the TB epidemic remains increasing health coverage. TB disproportionately affects marginalised populations, and is associated with poor living and working conditions. Inadequate access to healthcare services results in cases going undiagnosed, while weak, overstretched and inadequate health systems result in patients being unable to gain the care required to beat the disease. Countries in the region need to prioritise strengthening of health systems. By enhancing access to healthcare services and delivering the highest attainable standard of care, governments will increase their ability to prevent, treat and eradicate TB, as well as associated illnesses such as HIV/Aids. This will not only have positive health-related outcomes, but also contribute to future economic growth. The benefits are many.
Civil society and community groups have a critical role to play in engaging with government to ensure that access to healthcare is increased and universal health coverage becomes a reality. Claiming the rights accorded to ourselves, our families and our friends under the International Covenant on Social, Economic and Cultural Rights is a duty that must be taken seriously.
Beyond acknowledging the importance of increasing health coverage, ending the TB epidemic in Southeast Asia – particularly its drug resistant strains – also demands greater cross-border cooperation. A number of the globe’s highest TB-burden countries are in the Southeast Asia Region, which is also host to significant cross-border migrations. Enhancing TB prevention, care and control for people in all countries of the region means working in unison to develop frameworks that guide cross-border management of the disease and strengthen access to care and treatment for the vulnerable. To achieve this, visionary leadership is needed, as is a collective realisation that TB does not recognise national borders, nor does it care for citizenship categories.
On World TB Day, and at the start of WHO’s intensified push to “End TB”, we have the opportunity to renew our collective resolve to end the disease once and for all. This opportunity must not be missed.
Dr Poonam Khetrapal Singh is Southeast Asia regional director for the World Health Organisation.