editorial-3-the-road-to-ending-tuberculosisgs-mains-paper-3-health

  • The world got a wake­up call in 1993 about tuberculosis (TB) when the World Health Organization declared it a global health emergency.
  • The 1993 World Development Report labelled TB treatment for adults as the best buy among all developmental interventions.
  • The response in the 30 years since has been short on urgency and long on processes.
  • The current goal is to end TB by 2030, but clarity on definitions of ‘end’ and the means of verification are not fully in place.

 

 

 

The Global Fund

  • Following on the call first made in 2001 at the G7 in Okinawa, Japan, by Kofi Annan, and formalised at the next summit in Genoa, Italy, The Global Fund to Fight AIDS, TB and Malaria began disbursing the first round of money directed towards the global TB epidemic in 2003.
  • The story of how this new war chest against diseases of poverty did not remain confined to financing HIV programmes alone is for historians of public health to tease out.
  • Twenty years on, the Global Fund has become the single largest channel of additional money for global TB control.
  • But it remains hostage to the zero­ sum games imposed on it from its donor constituents and between the champions of the three diseases the Fund was set up to provide additional financing for.
  • Mandated with the task of mobilising and marshaling a disparate set of actors towards the goal of ending TB, the Stop TB Partnership got a formal presence on the board of the Global Fund close to seven years after it was constituted.
  • The Stop TB board meets in Varanasi, India, this week, and will coincide with World TB Day (March 24).
  • Using social safety programmes to address the poverty drivers of the TB epidemic and leveraging the “mobile and computational data revolution” to improve treatment outcomes have also begun shaping the trajectory of global efforts to end TB.
  • India’s leadership of the G20 and the focus on health could be catalytic, in the same manner that the Japanese G7 presidency in 2001 was for the creation of the Global Fund.

 

  • Providing historical symmetry, Japan leads the G7 in 2023, providing leaders of both nations and groupings to act synergistically towards ending TB.
  • The first area — and the one likely to take the longest to mature despite exciting developments — is in the development and wide use of an adult TB vaccine.
    • The current one, delivered at birth and useful particularly for children, is 100 years old.
  • The second area — one that can move much faster than the vaccine — is that of getting newer therapeutic agents for TB.
    • After a development drought of nearly five decades, a few new anti­ TB drugs are today available for widespread use, if only costs and production capacities weren’t constraints.

 

  • Diagnostics: The third and most immediate area of action is within the space of diagnostics.
  • There are exciting developments for use of AI­ assisted handheld radiology with 90­ second reporting and 95% plus accuracy for diagnosing TB.
  • Confirmatory diagnosis using nucleic acid amplification is ripe for disruption. India convened the InDx diagnostics coalition in Bengaluru for COVID­19.
  • This, and other biotech startups, should be incentivised to break the complexity of molecular testing and price barriers with affordable high ­quality innovations.
  • India’s G20 presidency this year, the Varanasi Stop TB board meeting this week, and the United Nations High ­Level Meeting on TB in September this year provide the perfect platform for India’s actions to speak loudly.

TB related Initiatives:

Global Efforts:

  • The WHO (World Health Organisation) has launched a joint initiative “Find. Treat. All. #EndTB” with the Global Fund and Stop TB Partnership.
  • WHO also releases the Global Tuberculosis Report.

India’s Efforts:

  • National Strategic Plan (NSP) for Tuberculosis Elimination (2017-2025), The Nikshay Ecosystem (National TB information system), Nikshay Poshan Yojana (NPY- financial support), TB Harega Desh Jeetega Campaign.
  • Currently, two vaccines VPM (Vaccine Projekt Management) 1002 and MIP (Mycobacterium Indicus Pranii) have been developed and identified for TB, and are under Phase-3 clinical trial.