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Patients waiting to be tested for TB in Monrovia, Liberia.
Patients wait to be tested for TB in Monrovia, Liberia. Research has found programmes to tackle poverty could be just as effective in the fight against TB as medicines and vaccines. Photograph: Getty Images
Patients wait to be tested for TB in Monrovia, Liberia. Research has found programmes to tackle poverty could be just as effective in the fight against TB as medicines and vaccines. Photograph: Getty Images

Fighting the world's deadliest infectious disease: how to tackle TB

This article is more than 5 years old

Experts say global action to combat TB, which causes almost two million deaths a year, is inadequate. What must change?

It is the world’s deadliest infectious disease, killing almost 2 million people a year – more than HIV and malaria combined – but the fight against tuberculosis (TB) is still severely underfunded and neglected by politicians and decision-makers, experts warn.

TB is both preventable and curable, but remains a significant public health risk and caused more than 10 million people to fall ill in 2016. This month, the United Nations general assembly will hold the first high-level meeting on the TB crisis, putting a spotlight on the disease 25 years after it was declared a global emergency. Ahead of the event, the Guardian held a roundtable discussion with experts in the field, chaired by health editor Sarah Boseley and supported by the Stop TB Partnership, to discuss the barriers to fighting the disease.

It is inextricably linked with poverty, with more than 95% of deaths from TB taking place in low- and middle-income countries, which is why action has so far been “inadequate”, said Peter Sands, executive director of the Global Fund to fight Aids, TB and Malaria.

“Most people in places with money and power don’t think about TB at all,” he said. “People think TB was something sorted out a long time ago. Because they don’t have much resourcing for it, very few politicians are making courageous decisions.”

“There’s a lack of political will, and it’s exacerbated by the fact that TB is a disease of the poor,” said Nick Herbert, MP for Arundel and South Downs and co-chair of the all party parliamentary group on global TB and the Global TB Caucus.

Research has found programmes to tackle poverty could be just as effective in the fight against TB as medicines and vaccines. Bill Lynn, a clinician for London North West University NHS healthcare trust, and Ruth Sherratt, senior international programme officer at TB Alert, both noted the complex social and economic factors driving the problem. “It is a disease linked with poverty, and populations that are physically, socially and culturally hard to reach,” said Sherratt. “We need to make sure the funding addresses those issues as well.”

Reaching those with the disease is even a significant barrier in the UK. Lynn Altass, national TB strategy programme manager for NHS England, pointed out that much of the population with TB in England are migrants and even though they may have been here for years, they still don’t know how to access the healthcare system. Hostile environment policies also discourage people from coming forward.

An important way to raise awareness among the public and politicians is to show the widespread impact on society. “TB impacts economies of countries, it affects men at the most active age, it impacts the money part of the economy, the families,” said Lucica Ditiu, executive director of Stop TB Partnership.

Although financing for care and prevention has increased over the last decade, there remains a funding gap – $2.3bn (£1.74bn) in 2017. The biggest donor, the Global Fund to fight Aids, TB and Malaria, allocates just 18% of its resources to the disease.

“Underlying it is, frankly, a lack of resources,” said Sands. “We need to expand the funding envelope and get countries to take TB seriously in terms of domestic priorities … but we’ll get more money as a result of success and political visibility.”

The funding gaps affect progress in developing technologies to tackle TB. Francis Drobniewski, professor of global health and tuberculosis at Imperial College London, said there was a lack of sufficient cheap and effective point of care diagnostics.

Guests at the table discuss the barriers to fighting TB. Photograph: James Drew Turner/The Guardian

Els Torreele, executive director of Médecins Sans Frontières’ access campaign, added there has been a dearth of research and development (R&D) over many years for adequate tools for diagnosis and treatment.

In the last few years, bedaquiline (a bacterial drug belonging to a new class of antibiotics) has been released to treat patients with drug-resistant TB. “Before bedaquiline, the last drug we developed was before we put a man on the moon,” said Aaron Oxley, executive director of Results UK. “Unfortunately in TB – or fortunately now – things are about to get more expensive because we’re getting tools that actually work.”

But Torreele disagreed that there is always a correlation between expense and things that work. “It goes back to how we are financing R&D, and who gets to benefit,” she said, calling for more accountability of pharmaceutical companies and for non-governmental organisations and campaigners work together to press for cheaper tools.

Governments should also be held to account, and the upcoming UN high-level meeting is “the start of a process that should lock governments into concerted action”, Sands said.

Herbert hopes to continue holding governments to account at the next Global TB Caucus, which brings together global parliamentarians. He noted the attendance from European heads of government, including the UK, has been disappointing.

Nevertheless, 2018 has already seen a significant shift in the fight against TB. Prime minister Narendra Modi launched a campaign to eliminate TB in India by 2025 – five years before the target set in the sustainable development goals. The plan focuses on a patient-centred approach, reaching undiagnosed TB in at-risk populations, and TB patients seeking care from private providers.

There are other positive projects taking place worldwide. Aamir Khan, executive director of IRD Global, led a zero TB city initiative in Pakistan, making a vital people-centric approach to tackling the disease. “The key element is to think of TB approach in terms of a social movement,” he said, as a large problem is stigma and people not coming forward with symptoms. In one programme, IRD Global engaged 40,000 schoolgirls in how to look for TB, encouraging them to look for signs in 10 houses neighbouring theirs. In one month, these girls referred 50,000 individuals to testing sites, he said.

Phumeza Tisile, a TB survivor from South Africa who was diagnosed when a student in 2010, said the public and decision makers are not hearing from the right voices, and that the media, in particular, doesn’t “publish the stories celebrating if someone got cured”.

She added: “All you see is death in the stories. That doesn’t encourage people to speak about it.”

At the table

Sarah Boseley (chair) health editor, the Guardian

Lynn Altass, national TB strategy programme manager, NHS England/Public Health England

Lucica Ditiu, executive director, Stop TB Partnership

Francis Drobniewski, Professor of Global Health and Tuberculosis, Imperial College, London

Nick Herbert, MP for Arundel and South Downs and co-chair of the all party parliamentary group on global TB and the Global TB Caucus

Aamir Khan, executive director, IRD Global

Bill Lynn, clinician, London NW University NHS healthcare trust

Aaron Oxley, executive director, Results UK

Peter Sands, executive director, the Global Fund to Fight Aids, Tuberculosis and Malaria

Ruth Sherratt, senior international programme officer, TB Alert

Phumeza Tisile, South African TB ambassador

Els Torreele, executive director, Médecins Sans Frontières’ access campaign

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