World TB Day: involving world leaders and local communities

29 Mar 2011

Paul Chinnock

Source: TropIKA.net

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Preparing sputum samples for testing with the recently developed Xpert test for tuberculosis. [Credit: FIND.]

Every year there are over nine million new cases of tuberculosis and the disease kills around 1.7 million people – most of them in the world’s poorest countries. World TB Day, which falls on 24th March each year, is designed to build awareness about the global epidemic of TB and the efforts being made to eliminate the disease.

The weeks preceding World TB Day 2011 saw a number of important developments in the fight against TB, many of which have been reported here on TropIKA.net. Much of the recent focus has been on improving the diagnosis of the disease. This is itself encouraging, as diagnostics tends to be a neglected area in research, policy and practice.

There was considerable excitement following a favourable evaluation of the Xpert molecular test for TB, which was subsequently endorsed by WHO, which wants to see a rapid roll out of this new technology. But already in widespread use, and responsible for many misdiagnosed cases, are rapid serological tests for TB; WHO has issued a recommendation that these tests should not be used. Other new approaches to TB diagnosis are also in the pipeline (including the ALS test under development in Bangladesh) but reports of these advances have highlighted a significant gap in TB research – the development of tests for the diagnosis of TB in children.

Many organizations involved in the fight against TB choose to launch new initiatives and reports on, or close to, World TB Day. This year, Médecins Sans Frontières (MSF) and the International Union against Tuberculosis & Lung Disease released a report that provides a detailed overview of the market for drug-resistant tuberculosis treatment. Another report, from the International Federation of Red Cross and Red Crescent Societies and the Stop TB Partnership, offers a window on the human side of the global TB pandemic, focusing on the trauma, stigma and other issues faced by TB patients.

UNITAID – the international facility for the purchase of drugs against HIV/AIDS, malaria and TB – chose World TB Day to urge research institutes and pharmaceutical companies to accelerate the development of new, faster-acting treatment regimens, and for multilateral agencies and developing countries to help create market space for these.

One initiative by Canadian researchers, described in an article published just before the Day, is a World Atlas of BCG policies and practices. (BCG is still the only vaccine in use against TB, though at least six others are now in development.) In the US, an international advocacy campaign, I am TB, was launched aimed at reducing stigma among patients with TB and those at risk for the disease.

Meanwhile, the Day also saw the unveiling of Africa’s first Xpert TB diagnosis machine. The equipment is in Durban in South Africa, a country that bears the world’s third largest TB burden. In neighbouring Swaziland, the Prime Minister declared TB to be “a national emergency”.

In Paris, at a meeting organized by the TuBerculosis Vaccine Initiative (TBVI) global health leaders discussed new approaches to TB vaccine funding.

Many of the announcements made on World TB Day were aimed at decision makers at the very highest level. WHO, the Global Fund to Fight AIDS, Tuberculosis & Malaria and the Stop TB Partnership called upon world leaders to step up their commitment and contributions to meet the goal of diagnosing and treating one million people with multidrug-resistant tuberculosis (MDR-TB) between 2011 and 2015.

UN Secretary General Ban Ki-moon said that without more funds, millions faced death from TB. In a statement he said:

“There is cause for optimism. The recent adoption of a fast and powerful new diagnostic tool promises to accelerate international gains against the disease. At the same time, our hope must be tempered by the sobering fact that multi-drug-resistant forms of tuberculosis (MDR-TB) remain an ever-present threat that, if allowed to spread unchecked, could set back the steady progress made during the past two decades”.

Other events, held at local and national level and including concerts and sponsored walks, were focused on involving the public at large. Making ordinary people aware of the scale of the TB pandemic and of what can be done to fight it will be essential in order to increase the rate of progress against the disease. In most countries this year, media coverage of World TB Day was, however, disappointing.

Noting that there is at present an “incredible energy in the TB community”, Dr Lucica Ditiu, Executive Secretary of the Stop TB Partnership said:

“Today we should reflect on this question: How can the world stand by and let all the deaths from TB continue, when they could be prevented? How can we allow people to die of a disease that can be readily cured through a treatment that costs less than a pair of blue jeans? This thought should provoke our outrage, and drive us to work harder and more closely in partnership against TB and do our best to move towards eliminating TB. I truly believe TB will be eliminated, maybe not in my lifetime, but for sure in my eight-year-old son’s.”