World TB Day: It`s time....
Today (24th March) is World Tuberculosis (TB) Day - the first since last year’s historic United Nations High-Level Meeting (UN HLM) on TB, when Heads of State from across the globe came together and made strong commitments to end TB. The aim of the day is to raise public awareness about the devastating health, social and economic effects of TB - the world’s most deadly infectious killer. Each day around the world, nearly 4500 people lose their lives and close to 30,000 people fall ill with this preventable and curable disease.
24th March signifies the date when in 1882, Dr Robert Koch announced that he had discovered through his research, the bacterium that causes TB. The theme for this year is ‘IT`S TIME’ and aims to bring the global TB community together to ensure that the world`s governments are reminded of the commitments made at the UN HLM and to keep TB high on the global and national agenda.
IT`S TIME...
- ...to keep the promises made at the UN HLM on TB
- ...for a world without TB
- ...to treat 40 million people affected by TB by 2022
- ...to know your TB status
- ...to scale up access to prevention and treatment
- ...to ensure sufficient and sustainable financing for research
- ...to build accountability
- ...to end to stigma and discrimination
The World Health Organization (WHO) has launched a joint initiative “Find. Treat. All. #EndTB” with the Global Fund and Stop TB Partnership. The aim is for all sections of society from governments to civil society to ensure no one is left behind – part of WHO’s message and overall drive towards Universal Health Coverage (UHC).
IT`S TIME for action! IT`S TIME to End TB.
Developments around the world since the UN HLM
Improving Treatment
Current treatment for Tuberculosis can be long and arduous, coupled with potential toxicity for the patient, but hope may be on the horizon with the TB Drug Accelerator partnership (TBDA).
Launched in 2012 and sponsored by the Bill & Melinda Gates Foundation, the TBDA consists of eight pharmaceutical firms including GSK, Merck and Evotec, working together with research institutions to share early-stage work in the hunt for new, more efficient and safer treatments for TB.
Researchers hope to develop a course of treatment that comprises a fully oral combination regimen taken over a four-month period. Currently TB sufferers are given several different medicines for up to nine months – drugs that are often poorly tolerated and have unpleasant side effects.
“We’re focused on the discovery of novel medicines that can be effectively combined into a single tablet as a once-daily dose,” says Dr David Barros-Aguirre, who leads GSK’s Tuberculosis Unit in Spain. "That would be a transformational change from current TB therapy. And that requires us to share research and data as never before. If we get there, it will have been a heroic effort.”
Early treatment trials will begin this year in South Africa, with further trials during the next couple of years to assess the potential of novel combinations to become the gold standard for future TB treatment. “These combinations will be composed of drugs with new modes of action reducing the likelihood of resistance,” says Dr Barros-Aguirre.” Partners hope that this new treatment approach might be available within the next five to ten years.
A more effective TB treatment could potentially halve the number of people with active TB.
http://partnerships.ifpma.org/partnership/tb-drug-accelerator-program
https://www.telegraph.co.uk/education/stem-awards/healthcare/tuberculosis-vaccine/
Vaccine Research
The development of a new and more versatile Tuberculosis vaccine is much needed in the world, since the only licensed TB vaccine, Bacillus Calmette-Guerin (BCG), is nearly a hundred years old and has shown variable efficacy. New vaccine research from Professor Jordi Torrelles and his team at the Texas Biomedical Research Institute has shown enough potential to merit further investigation by modifying the BCG formulation.
"What we found is that our formulation of a vaccine protected better than the current vaccine and did not cause any lung tissue damage," Torrelles said. "If further research proves safety and effectiveness, the vaccine can be delivered directly into the lungs."
"If it works, the drug delivery system for humans would be a spray delivered through a device similar to an asthma inhaler," Torrelles explained. The current BCG vaccine is administered by injection into the upper arm.
Studies show BCG is 70 to 80 percent effective in protecting against the most severe forms of TB in children. However, BCG is less effective in preventing respiratory disease, which is the most common form of TB in adults, especially important for the elderly who are at greater risk of developing TB, through reactivation.
While immune-compromised patients like people with HIV/AIDS cannot take the BCG vaccine and have a ten-fold risk of developing TB if they have latent TB.
Torrelles predicts the modified BCG vaccine may offer immunity at any age and has therefore the potential to save millions of lives. His next step is to secure funding to continue and expand his team’s research, with the aim to have human clinical trials conducted in the next few years.
https://www.eurekalert.org/pub_releases/2019-03/tbri-tbs030419.php
On Political Level
In the UK in October 2018, the All Parliamentary Party Group (APPG) on TB met with Hon Dr Christopher Kalila MP, a former medical doctor and Chair of the Health Select Committee of the Zambian National Assembly. He now also chairs the National TB Caucus, the APPG's equivalent in Zambia, which launched in March 2018.
Dr Kalila spent two days in Westminster meeting with UK counterparts to discuss the recent UN HLM on TB and how countries like the UK and Zambia could work together to realise the ambitions of its political declaration.
Speaking of the TB situation in Zambia, Dr Kalila highlighted the impact of UK investments in both the Global Fund to fight AIDS, TB and Malaria and in TB research. He noted, however, that with some 40% of all people with TB still being missed by the health system in Zambia, much more work needed to be done.
During their meeting, they discussed the importance of holding governments accountable for delivering on the UN HLM political declaration, both domestically and through intergovernmental platforms such as the Commonwealth and G20. They also agreed to an informal 'pairing' with the APPG to facilitate knowledge sharing and joint planning.
Also, in October 2018 and Health Ministers of the world's 20 largest economies met in Argentina, to reaffirm their commitment to global health and sustainable development. This included UK representation by Parliamentary Under Secretary of State for Public Health and Primary Care, Steve Brine MP, and the Chief Medical Officer, Dame Sally Davies.
The meeting re-affirmed that the UN HLM declaration should recognise the importance of funding research and development for new antimicrobials, diagnostic technologies, vaccines and other preventative measures, while promoting affordable and equitable access to all individuals in need, as well as the need for the strengthening of public health care systems.
In November 2018, members of the House of Lords pressed the government to step up its efforts in the global fight against TB to ensure that the world reached the targets of the UN HLM TB.
Lord Collins of Highbury, Lord Alton, Baroness Sheehan and Lord Black of Brentwood asked the UK Government to take further action to ensure the integration of HIV and TB programmes, as recommended by the WHO, and to ensure funding is made available for vaccine research. Lord Berkeley spoke openly about how his own life was saved thanks to the TB treatment provided by the NHS and emphasised the role of poverty exasperating the disease.
The final supplementary question was asked by the Lord Bishop of St Albans who noted that while the UK's substantial contribution to the fight against TB ought to be praised, the persistence of a sizeable funding gap was of grave concern and asked what plans the Government had to draw together international partners to give TB a much higher priority, to ensure TB treatment was widely available.
Lord Bates, answering on behalf of the Government, noted the UK's leading contribution to the Global Fund to fight AIDS, Tuberculosis and Malaria. He explained the role the UK could play in leading by example but recognised that in order for the UN HLM target of finding and treating 40 million people by 2022 to be reached, much more funding needed to be mobilised and called for other countries to step up their efforts.
In February 2019, the Stop TB Partnership Board had their first meeting since the UN HLM and made a number of critical decisions to support bold and immediate actions towards reaching the commitments and targets set forth in the UN Political Declaration on TB.
These included:
- The urgent need for significant increase in funding for TB response - for implementation and research.
- Modernise changes to TB care to secure access to diagnosis and treatment for all those affected by TB.
- To focus on the empowerment of women and girls and gender equality to tackle serious challenges at the community level as a priority factor in the fight against TB.
- To reduce stigma and discrimination caused by TB within global communities.
- To ensure undiagnosed TB infected persons are found, which if left undetected could lead to an infectious and lethal pool that will undermine all efforts in eradicating the world of TB.
- To constantly hold to account Heads of State about their responsibility for the success of the TB response in their countries.
This was best summed up by Aaron Oxley, Board Member and Executive Director of RESULTS UK, who stated. "Accountability was one of the success stories of the UN HLM, but it should on all levels, from the political top to grassroots activism to make sure things actually do happen,"
This month, I received correspondence from the Department of Health & Social Care, stating the UK Government`s commitment to TB control. The letter said that the UK Government is aware that rates of TB in England, especially in London, are high compared with other western European countries, so improving TB control is therefore a priority.
To address the high rates of TB in England, Public Health England and NHS England jointly published the document Collaborative Tuberculosis Strategy for England 2015-2020. The strategy aims to achieve a year-on-year decrease in cases of TB, a reduction in health inequalities and the elimination of TB as a public health problem in England. The strategy is successfully delivering a decline in TB cases in England but the Government knows there is still work to do.
Raising awareness, reducing TB-related stigma and improving healthcare access are important intervention areas recommended by the strategy. Other important areas include improving contact tracing, addressing drug resistance and establishing dedicated services for hard-to-reach and vulnerable groups.
As part of the strategy, NHS England has provided funding for clinical commissioning groups that have high TB incidence and high TB burden, to offer latent TB testing and treatment to new entrants to the UK (within the past five years) who have come from countries with a TB incidence of 150 per 100,000 people or from sub-Saharan Africa.
The Government’s efforts to combat TB are not limited to activities within the UK. Abroad, the UK is a global leader in tackling the TB epidemic through:
- funding for increased access to care through the Global Fund
- work to strengthen health systems in low and middle-income countries
- funding for research into new products to combat TB
- work on shaping the costs of new products.
The UK Government actively contributed to the development of the political declaration at the UN HLM and they were pleased to be working with other countries and partners to gain support for these commitments.
In summary, it seems from this snapshot on World TB Day, the momentum from the UN HLM on TB is being maintained. Long may this continue in the fight to end TB
IT`S TIME to “Find. Treat. All. #EndTB”
Mark Pointer
WHO Tuberculosis In Numbers
- TB is one of the top 10 causes of death worldwide?
- 1 million cases of childhood TB occur each year
- Every year, TB is responsible for 250,000 child deaths
- Between 2000 and 2017, around 54 million lives were saved through TB diagnosis and treatment
- TB incidence is falling by about 2 per cent each year
- 95 per cent of all TB cases occur in low- and middle-income countries
In 2017, eight countries accounted for two-thirds of new TB cases:
- India
- China
- Indonesia
- The Philippines
- Pakistan
- Nigeria
- Bangladesh
- South Africa