Time to consign TB to the history books

Written by Ivan Solovic and Raquel Duarte on 23 March 2018 in Opinion Plus
Opinion Plus

TB is far from being consigned to the history books, but there is real hope for a TB-free world in the coming decades, write Ivan Solovic and Raquel Duarte.

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Tuberculosis has no shortage of high profile heroines. Consumption, as original audiences would have known it, fuelled the romantic narrative of operatic voices on the stage from Mimi in Puccini's La Bohème to Violetta in Giuseppe Verdi's La Traviata.

As for heroes, World Tuberculosis Day, marks Dr Robert Koch’s discovery on 24 March 1882 of mycobacterium tuberculosis as the cause of the disease.

This year to mark World TB day the World Health Organisation (WHO) is looking to find the future heroes – the leaders who will help to achieve a TB-free world.


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Given the passage of time from 1882 to 2018, many are happy to confine TB to the past. But while it may well be a disease with history, it is regretably not yet a disease of the past.

In 2016 an estimated 10.4 million people fell ill with TB, with 1.7 million deaths, including 400,000 million deaths among people co-infected with HIV. The disease kills more than 5000 children, women and men each day and leaves no country untouched.

It is one of the leading killers among people of working age people creating and reinforcing a cycle of ill-health and poverty, with potential catastrophic social and economic consequences for families, communities, and countries.

TB disproportionately afflicts the poorest and the most vulnerable populations. Tobacco smoking, harmful use of alcohol and other substance abuse, air pollution, exposure to silica dust, living with HIV/AIDS, diabetes and malnutrition all increase the risk of TB.

TB today is particularly worrying as it comes with a new drug-resistant face which is a major risk to global health security. There were 600,000 new cases with resistance to rifampicin (the most powerful first-line drug) in 2016, of which 82 per cent of cases were also resistant to other drugs.

In the European Union and European Economic Area (EU/EEA), TB continues to be a major public health challenge with 58,994 cases notified in 2016. Although several EU/EEA countries are progressing towards sustained low levels of TB incidence and some towards the pre-elimination phase (defined as less than 10 cases per million population), great diversity in TB disease burden remains within the sub-region.

Drug resistant TB, multidrug resistant TB (MDR-TB) and extensively drug resistant TB (XDR-TB) pose a specific public health threat in many countries. Furthermore, documenting the prevalence of HIV co-infection among TB cases is still compromised by sub-optimal reporting in several countries.

That being said, there is currently an unprecedented momentum in the fight against TB. Following the successful WHO Ministerial Conference in Moscow and the upcoming UN high-level meeting in September 2018, world leaders seem more committed than ever to tackle the TB epidemic.

If we are to meet the sustainable development goals to end TB by 2030, it is crucial that the European Union also plays its part in the battle.

Two years after the end of the EU action plan on TB, little has been done on the creation of the new integrated policy framework addressing HIV/AIDS, Tuberculosis and Hepatitis C.

The European Parliament resolution on the EU’s response to HIV/AIDS, Tuberculosis and Hepatitis C, adopted in July 2017 is a significant step but the NGO community is still waiting for a TB, HIV/AIDS and Hepatitis C policy framework adressing each disease’s specificities.

An integrated and comprehensive approach is urgently needed to meet the challenges posed by TB in terms of prevention, treatment and care and the allocation of adequate funding to research in the European Union and neighboring countries.

As clearly set by Article 168 of the Lisbon Treaty, the EU has the legal basis and the obligation to protect human health and combat the major cross-border health scourges, such as TB. The European Parliament must continue to press the European Commission to act – and not lose the momentum aforded by the UN process.

TB is far from being defeated but there is real hope for a TB-free world in the coming decades. But we need more heroes; leaders to push for strong political commitment to bring Dr Robert Koch’s work to its end act and to consign TB to the history books.

 

About the author

Ivan Solovic, National Institute for TB, Lung Diseases and Thoracic Surgery, Vysne Hagy, Catholic University Ruzomberok, Ruzomberok, Slovakia

Raquel Duarte, EPI Unit, Institute of Public Health, University of Porto, Porto, Portugal

On behalf of the European Respiratory Society (ERS) Ad hoc Working Group on TB Advocacy

 

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