Bill & Melinda Gates Foundation

The Collective Effort to Turn the Tide on the War Against TB

March 23, 2015

Today is World TB Day – a day in which traditionally the TB community gets busy organizing events – both at a high level and at the community level – in trying to raise awareness in countries all over the world.

I feel that this year is different and that there is a wind of change within the TB community. We have collectively fought TB for many, many years and when you do something for that long, you expect to see some big gains. But TB is not a disease that can be easily defeated – it is a chronic disease, it can take time for symptoms to appear before it kills slowly and quietly. It is a disease that goes hand in hand with the development of countries’ health systems and with other determinants of health – nutrition, sanitation, housing – and progress is therefore slow as a measure of advancement in all these other areas.

So, it is of course frustrating to see that despite our best efforts, each day we still have 24,000 new cases and 4,000 deaths from the disease and that there is an unacceptable low rate of decline in incidence of 1.5% each year. At this trajectory, neither we nor our children or the children of our children will ever be able to see the end of the TB epidemic.

But this year, I feel different. I feel a wind of change. Last year the World Health Assembly approved the End TB Strategy, aiming to end the TB as an epidemic by 2035 and based on these targets, the Stop TB Partnership Task Force is developing a very ambitious Global Plan to Stop TB 2016-2020 to ensure that the first five years of this cycle is starting in force and that it is on the right path.

In December 2014, Ministers of Health from Brazil, Russia, India, China and South Africa made historic commitments to have TB high on their agenda. The Ministers approved the development of a cooperation plan, including a common approach to universal access to first line TB medicines for all people with TB in BRICS countries, as well as in low- and middle-income countries. BRICS Ministers agreed that intensified action in their countries was essential to ending TB and agreed to aspire towards a 90-90-90 TB target: 90% of vulnerable groups screened, 90% diagnosed and started on treatment, and 90% treatment success. Ministers also agreed to cooperate on scientific research and innovations on diagnostics and treatment, including drug resistance and service delivery of TB. With almost 50% of all TB cases and almost 60% of MDR-TB cases in BRICS countries, this strong statement and signal from the BRICS leadership is crucial in moving toward the world ending the TB epidemic.

At the end of March, we will have the first-ever Eastern Partnership Ministerial Conference on TB under the EU Presidency of Latvia. Member States will come together to pledge action and agree to endorse the Riga Declaration on TB which will provide a political roadmap for action and domestic investments. The drug-resistant situation we are all facing is not going unnoticed and we hope that the global AMR movement will use drug resistant TB as its first area of intervention.

After many years, we now have two new drugs, bedaquiline and delamanid that are available to be used by countries’ programmes to save the lives of people. The United States Agency for International Development (USAID) and the Johnson & Johnson affiliate, Janssen Therapeutics, signed an agreement to provide bedaquiline free to patients from more than 100 low- and middle-income countries suffering from strains of TB that are resistant to two or more antibiotics.

Thanks to funding from the United States, the United Kingdom, the Bill & Melinda Gates Foundation and hopefully others, a new TB drug regimen PaMZ, if successful, will have the potential of eliminating the need for injectable drugs as well as reducing the cost of drug-resistant therapy by more than 90%. It also promises to be compatible with commonly used HIV drugs, helping the millions of people co-infected with TB/HIV.

There is definitely change in the air. The Stop TB Partnership’s Global Drug Facility has been instrumental this year in contributing massively to price reduction of MDR-TB regimens which will in turn result in a significant decrease in the overall cost of treatment. The savings achieved from the lower cost of high-quality medicines will allow us to use the savings to increase the number of patients treated.

And of course we feel the change. The TB REACH team is working with our grantees and partners in bringing to light the most innovative efforts needed to detect and enrol on treatment and cure the most vulnerable groups by using mHealth and eHealth solutions as well as bold service delivery solutions. TB REACH, generously funded by the government of Canada, is an incubator for local innovations in TB care delivery that is not funded anywhere.

Change is not always easy, but with strong partners we will succeed. The largest external donor to TB, the Global Fund to Fight AIDS, Tuberculosis and Malaria, is ensuring that through the funding model which is in place, more efficient investments are made in countries, for a bigger impact towards sustainable solutions.

But more than anything, we need people to enable change and I feel a much stronger voice from the TB affected community and people suffering because of TB in all the processes. Through the different networks of TB activists, including the Global Coalition of TB Activists, TB Europe Coalition, African Coalition for TB and many others, I feel strongly that change is possible.

I am an impatient optimist forced to wait for the change to become reality – and I know that this will happen soon. 

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