I was privileged to attend the 46th Union World Conference on Lung Health from 2-6 December 2015. This is an annual conference that brings together researchers, policy makers, patients, activists, journalists, and representatives of non-governmental organizations (NGOs), funding agencies, and industry from all over the world. They come together to exchange knowledge, share experience, and expand networks. In 2015, the conference took place in beautiful Cape Town, South Africa and attracted over 4000 delegates from some 130 countries. As in previous years, the main discussions at the conference revolved around tuberculosis (TB), although some non-infectious diseases were also covered.Mr Matamela Cyril Ramaphosa, Deputy President, South Africa delivering the inaugural lecture entitled “Turning the tide against lung disease in South Africa” at the 46th Union World Conference on Lung Health
TB is an air-borne bacterial infection caused by Mycobacterium tuberculosis. It is a major cause of disease burden globally, especially in low- and middle income countries. The Global TB Report 2015 estimated that there were 9.6 million people contracted TB and 1.5 million died in 2014. An estimated 480,000 people developed multidrug-resistant TB (MDRTB – TB resistant to two antibiotics namely Isoniazid and Rifampicin) in the same year. Although it is encouraging that The Millennium Development Goal target of halting and reversing the TB epidemic by 2015 has been met globally, with the current rate of progress at 1.5% decline of TB incidence per year, it will take approximately 200 years from now to eliminate TB (defined as less than 1 TB case per million people per year) (Figure). This is unacceptable! With this in mind, the theme of the 2015 conference was “A New Agenda – Lung Health Beyond 2015”. The aim was to spark discussions on paradigm shifts in TB control guided by the Sustainable Development Goals, World Health Organization’s (WHO) the End TB strategy, the global plan of the Stop TB Partnership and UNAIDS strategies. Among the health targets of the newly adopted Sustainable Development Goals is to end TB epidemic by 2030 that entails reduction of TB deaths by 90%, TB incidence by 80% compared to 2015 figures and no TB affected families facing catastrophic costs.Figure – Current trend of global TB incidence and projected acceleration of the decline in global TB incidence rates with optimization of current tools combined with progress towards universal health coverage and social protection from 2015, and the additional impact of new tools by 2025
Source – Factsheet: Post-2015 Global TB Strategy and targets
TB today is a disease of poverty and exclusion. It is a disease that thrives in conditions of social inequality and injustice. The most vulnerable populations are mining communities, children, people living with HIV, injecting drug users, prisoners, homeless people, Indigenous populations and migrants among others. Social and cultural problems are the main drivers of the global TB epidemic. Therefore, TB control programs cannot work in a silo. They need to engage all sectors and integrate TB surveillance, diagnosis and treatment services with wider health and social care services such as antenatal care, diabetes, HIV services, prisons, refugee camps, and shelters for homeless people, etc in order to build healthy and sustainable societies – a paradigm shift!
The stigma and discriminations associated with TB means that many patients will not turn up to clinics and hospitals for treatment. The Global TB Report 2015 estimated that 37% of global TB cases are missed by the health system without being diagnosed, or without receiving treatments and care that they need. To overcome this, we need to adopt a proactive approach and find the cases and improve their access to treatment and care. TB REACH is a good example of such program. The aim of the TB REACH program is to promote intensive case finding and maintain the patients on treatment within the National TB program to ensure high cure rate. The program has supported 109 projects in 44 countries with a focus on the population who are poor and vulnerable with limited access to treatment and care. To achieve it, the health care worker needs to break down the barriers and stigma against the vulnerable populations.
There are 3 principles underpinning various HIV disease control interventions namely political commitment, science and social mobilization. The same principles are also applicable to TB control. However, the fact that 37% of global TB cases not being notified reveals a tremendous room for improvement in terms of social mobilization. Therefore, a new agenda is calling for a paradigm shift in activism for treatment access, social empowerment, and family support. During the conference, a number of patients who had MDRTB and extended drug resistant TB (XDRTB, defined as MDRTB with further resistance to fluoroquinolone and at least one second-line antibiotics) shared their heartbreaking experience of coping with HIV/TB co-infection, difficulties in accessing MDRTB treatment and how they managed to overcome the challenges. These patients’ stories are the strongest voice to engage the community and to motivate other TB patients to keep going. The IMBIZO program also innovatively provided a community space at the conference that, through artworks and performance, helped to raise awareness of TB related issues and what we, as a member of the public, can do to help. It was also to advocate the stake holders for patients’ better access to TB diagnostics and treatment.
This is just a snapshot of the main insights I received from the conference. There are, of course, a lot more highlights and experience yet to be shared. I am humbled by the scale of the conference and the interest of the global community in TB control and research. The 2016 conference theme is also very interesting – Confronting Resistance: from fundamentals to innovations. I am excited to follow what opportunities will be unlocked by these paradigm shifts.