When asking people “what infectious disease is the biggest killer in the world today?” the answers vary hugely. But the answer, tuberculosis (TB), is not one that many people choose, despite killing more people than Ebola, HIV/Aids and malaria combined. TB is a disease that has existed since the Egyptian mummies yet still killed 1.7 million people in 2016: that’s one person every 18 seconds. This is despite TB being preventable, treatable and curable.
If you are from a developed country, you almost certainly didn’t answer the opening question with TB as it’s regarded as a disease of the past. But it has never gone away: today TB is a disease of poverty and long neglected as a result. This is exemplified by the fact that about 40% of people with TB are never properly diagnosed, drug-resistant strains of the disease are proliferating wildly, and funding falls woefully short of the need.
If you’ve been following TB closely, you’ll know that Heads of State and Government committed to end TB by 2030 when they signed up to the Global Goals. Unfortunately, we have historically seen big gaps between the ambition of the Global Goals target and the reality of lacklustre political engagement, leadership, and action. Without a rapid change in pace the end of TB will not be achieved for another 100 years – at least.
Thankfully, this political inertia is lifting. In 2017, commitments were made at the G20 and BRICS Summits to make TB a research priority. And then, in November, WHO convened a Ministerial Conference on TB in Moscow where 100 countries committed to scaling up their response to the TB epidemic. President Putin opened the conference, recognising TB as a major global health threat and the need for collective global action.
The Ministerial Conference paved the way to this year’s first ever UN High Level Meeting on TB, to be held in New York on 26 September. This is the first time in the centuries-old history of the disease that TB will be discussed, globally, at the Heads of State and Government level.
Last week, Prime Minister Modi demonstrated the political leadership needed leading up to the UN High-Level Meeting. I had the privilege of hearing him launch India’s National Strategic Plan for TB Elimination, setting out a vision of a ‘TB free India by 2025’. This is five years earlier than the Global Goal even though the country has the world’s highest TB burden. This means that nearly 2.8 million people get TB each year, of which 147,000 are drug-resistant, and an estimated 435,000 are killed by the disease. Such bold commitments are exactly what India needs to turn this epidemic around, and we need similarly ambitious commitments from world leaders everywhere in 2018.
Crucially, it is not just the responsibility of high-burden countries, such as India and Russia, to scale up the response to TB. Donor countries have never responded to TB with a vigour commensurate to the scale of the need. It is a global responsibility to invest in the research and development needed to create new drugs, diagnostics, and vaccines. Leaders from all countries must engage with the High-Level meeting with equal enthusiasm and responsibility, make meaningful, bold commitments, and be willing to be held accountable for delivering them.
A successful High-Level meeting also depends on the inclusion and empowerment of civil society and affected communities at every stage. The voices of people with first-hand experience of the disease are often too far from the centre of discussions.
During my visit to Delhi last week, I met the people at the forefront of the TB response in a neighbourhood clinic, and was reminded that TB treatment is as much social as it is medical. We were first greeted by a street magician whose wife had contracted drug-resistant TB. Because he didn’t want anyone else to have to go through what his wife did, he began raising his voice, through the medium of his street magic shows, to grab an audience, teach them about TB, and do the vital work of removing the stigma associated with the disease. It’s people like this man who understand, better than anyone, the realities of what it will take to end TB.
We look forward to seeing people and leaders from around the world gather later this year in New York, and we expect them to not miss this opportunity to turn the tide against TB. One of my favourite sayings is that “History is written by those who turn up.” We will see who is ready to make TB history this September, and we hope the room is very, very full.
If you live in the UK you can take action here by asking your local MP to push for our Head of State to make the UN High-Level Meeting a priority.