Time to End the Neglect
By Mandeep Dhaliwal, Director of HIV, Health and Development at the United Nations Development Programme
At last week’s TB Summit in New Delhi, India’s Prime Minister Narendra Modi announced the country’s plan to eradicate TB by 2025, five years ahead of the global target. Modi’s commitment was met with applause and enthusiasm by the global community and has the potential to prove a turning point against the disease in India — the country with the world’s highest TB burden.
Of course, defeating TB in India, or any other country, requires more than just words. Despite the fact that the disease is preventable and curable, it continues to claim the lives of 1.7 million people around the world each year — making it the world’s deadliest infectious disease.
Efforts to develop new medicines to combat TB are underway — an important step, but one that is insufficient on its own. We need more than medicines to stem the tide on this deadly disease. To end TB, countries must promote laws and policies that address the socioeconomic determinants of the disease and protect people’s human rights.
For years, we’ve known that the poorest and most marginalized people in society are the ones who bear the highest burden of TB. Poverty, a key marker of health inequity, has clear association with an increased risk of TB infection, and 95% of TB deaths occur in low- and middle-income countries. TB also disproportionately affects people who are already being left behind, including ethnic minority groups, refugees and those affected by social risk factors including homelessness, alcohol and drug misuse or imprisonment.
Addressing the socioeconomic determinants of TB requires taking action across sectors and ensuring that no one is left behind. This year’s theme for World TB Day — “Wanted: Leaders for a TB-free world” — highlights the need to engage leaders from all sectors and all walks of life in the fight against TB. Ending TB is not just an issue for the health sector.
We know from experience what types of policies are needed to turn the tide on TB. In the mid-1900s, the United Kingdom (UK) made progress in controlling the disease by introducing social and economic development policies and interventions to support TB control, including through addressing overcrowded housing conditions and establishing social protection programmes to improve people’s nutrition and economic wellbeing. The UK’s experience also shows why we can’t become complacent: the disease was never eliminated. Sustained TB control efforts are needed to eliminate TB for good.
Ending TB also requires removing punitive laws, policies and practices that perpetuate stigma and discrimination. The success of countries in driving down TB rates and illness depends on encouraging people with TB to seek the treatment they need, rather than penalizing or prosecuting them because they’re unable to access health services or adhere to treatment.
Partners are taking encouraging steps to identify and address laws that stand in the way of progress on TB. For example, the Kenya Legal and Ethical Issues Network on HIV and AIDS (KELIN) recently conducted the first legal environment assessment for TB, using a tool developed by the Stop TB Partnership and the United Nations Development Programme.
One of the report’s recommendations is to review provisions in the country’s Public Health Act that are used to incarcerate TB patients who don’t adhere to their treatment — a key step to protecting the rights of people living with the disease.
We know what works to end TB; now, it’s time to do something about it. Prime Minister Modi’s commitment to end TB in India by 2025 is an encouraging sign of political leadership on the issue, and the upcoming UN General Assembly High-Level Meeting on TB presents an opportunity to further accelerate progress toward ending this ancient disease.
We can’t afford to fail this time around. Without multisectoral action, TB will cost the world economy US$ 1 trillion by 2030 and the Sustainable Development Goals’ target of ending the TB epidemic by 2030 will be missed by 150 years — making the goal of achieving health for all a distant dream.
Let’s join forces to demonstrate the leadership needed to end TB. The time for neglecting TB is up.
