The United Nations will bring together 192 countries for the fourth high-level meeting on tuberculosis in 2018. (Reuters)

United Nations' first high-level meeting on TB could usher in a new world order

Yogan Pillay (author)
The global body heeds calls by SA health minister Aaron Motsoaledi for high-level meeting on age-old killer.

COMMENT

The United Nations is set to make history. In 2018, the global body will bring together 192 countries for what will be the UN's fourth high-level meeting on a health issue in its more than 70-year history. The subject: tuberculosis (TB).

Heads of state attend high-level meetings like these and resolutions adopted there typically commit countries to strengthening responses to diseases by increasing awareness – and resources for research into new diagnostics and medicines.

The UN's first high-level meeting on a health issue was in 2001 when leaders convened to discuss HIV's devastating impacts. The meeting resulted in ambitious targets to curb new HIV infections and increase funding and investments in research. These objectives would become a forerunner to the Millennium Development Goals. In 2002, the international financing mechanism Global Fund to Fight Aids, TB and Malaria was created.

The UN's high-level meeting on HIV was followed by similar gatherings on non-communicable diseases (2011), Ebola (2014) and antimicrobial resistance (2016).

As can be seen from the impact of the United Nations on HIV, these meetings have the potential to provide political leadership, significantly increase global, regional and national awareness and mobilise much-needed resources for a heightened response During the September 2016 high-level meeting on antimicrobial resistance, Motsoaledi called for a similar meeting to be held on TB, given that resistance to TB drugs accounts for 30% of the world's burden of antimicrobial drug resistance, according to the Stop TB Partnership.

In 2015, South Africa diagnosed 10 000 cases of drug-resistant TB, according to the WHO's 2016 global TB report. South Africa's latest drug-resistant TB survey found that about 3% of TB case are resistant to at least two of the most commonly used anti-TB drugs.

Globally, WHO data shows TB continues to be one of the 10 top causes of death. Not surprising when the WHO estimates that only about 60% of people who develop TB globally are ever treated.

The world's latest round of international development targets, the Sustainable Development Goals (SDGs) now calls for a stop to these deaths. The SDGs targets call for a 90% reduction in TB deaths and a similar 80% reduction in new TB infections by 2030. Under the targets, the world has committed to ensuring that within the next 14 years no family, anywhere in the world, affected by TB faces catastrophic costs due to TB.

Unless we find people with TB as soon as possible after infection, initiate them on treatment and ensure that they are successfully treated, we will struggle to achieve the Sustainable Development Goals.

South Africa must play its part in decreasing the TB burden, both for our sake as a nation as well as our contribution to the global TB burden. South Africa is among six countries in the world alongside India, Indonesia, China, Nigeria and Pakistan that the WHO says account for 60% of the global TB burden.

Given that our health minister has urged the global community to take TB seriously, we must start at home. The good news is that we have.

Under Motsoaledi's leadership, we became the first country in the world to roll out the latest TB diagnostic tool, the GeneXpert, en masse. The coffee-maker sized machine can diagnose TB and drug-resistant TB within two hours. This is in sharp contrast to traditional, laboratory-based methods that can take weeks or months.

We have identified areas with large TB burdens, like mining areas, and increased TB screening. Today, South Africa also boasts the largest number of patients in the world on the new TB treatment, bedaquiline.

In 2017, we will do more. We will ensure people know enough to prevent the spread of TB through simple methods such as frequent hand washing, coughing into one's elbow or sleeve and keeping windows open in closed spaces, including taxis and buses.

We will screen more people and treat more people. We will also do more to support people to ensure that they not only start treatment but also stay on treatment.

Of course, we know that TB is a disease of poverty and the increasing inequity and unemployment levels must also be addressed with a sense of urgency.

As 2017 begins, doing our part to eliminate TB as a public health threat should be everyone's New Year resolution.

Yogan Pillay is the health department's deputy director general for HIV, TB and maternal, child and women's health.

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Tuberculosis (TB)