Manmade barriers blocking access to TB care

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Manmade barriers blocking access to TB care

Monday, 18 March 2024 | Shobha Shukla and Bobby Ramakant

We must walk the talk on the promise to end TB and deliver on sustainable development 'where no one is left behind'. There is no  excuse for inaction as clock is ticking fast It is not natural disasters (like hurricanes or storms) which block access to TB care services most times, but manmade barriers that fuel injustices, inequities, greed, and risk factors that put people at risk of TB disease and death.

Since these are manmade barriers, it is we who have to unmake them if we are to walk the talk on the promise to end TB and deliver on sustainable development 'where no one is left behind'. There is no other choice because it is a human rights imperative to end TB and deliver on #HealthForAll and #SDGs. And there is no excuse for inaction as clock is ticking: Only 21 months left to end TB in India, and 81 months left to end TB globally (by 2030).

But if justice and equality can become centre-stage in our world - from the point-of-view of the least served, least represented and least visible communities - and if they are served first with respect and equity, then perhaps we can avert a social uprising to get a just access to health and development for everyone. But then this is a big 'but'!

"We have allowed inequities to mar the TB response," said Dr Lucica Ditiu, Executive Director of Stop TB Partnership. Old TB guidelines of the past years will show how drug-resistant TB, or TB in children were on the blindspot in the Global South. But richer nations of the Global North were diagnosing and treating them back then. "We cannot have double standards," rightly said Dr Lucica Ditiu, who was speaking at the 2024 World Social Forum (WSF 2024) in Nepal.

Listen to the ones we serve

But are we finding TB, treating TB and preventing TB everywhere with the best of tools science has gifted us? Why is 140+ years old microscopy still being used in high TB burden nations to screen and diagnose TB? Why are older, longer, less effective, more toxic treatment regimens still being used? Why is TB prevention on the backseat?

Preventing people with latent TB from progressing to active TB disease is possible with the best of available treatments. along with addressing TB risk factors, like malnutrition, tobacco, alcohol, HIV, diabetes, among others. Are governments not committed to deliver on addressing them as well?

"We must secure the same equitable access to TB care services for everybody. We cannot do this equitably and justly unless we create the processes and systems to embrace everybody by listening to the ones we serve," said Dr Lucica Ditiu at WSF 2024.

Why is A missing in development?

Is it not high time to set (A)ccountability if even one TB death is a death too many? Despite having highly accurate molecular tests to diagnose TB early, shorter and more effective treatments (1 month regimen for latent TB, 4 months for drug-sensitive TB, and 6 months for drug-resistant TB), and scientific evidence-backed know-how to prevent TB, who is responsible for at least 10.6 million people who suffered from TB disease globally in 2022, out of which 1.3 million died?

Science has gifted us tools to test, treat and prevent TB but are we using them? "Science has never been at fault, but implementation has been lacking," said Professor (Dr) Rajendra Prasad, Dr BC Roy National Awardee.

Richer nations, like Australia for example, were able to deploy age-old tools in 1960s-1970s to screen everyone and find all TB, treat all TB and prevent all TB. The rate of TB in some of the richer nations is already at the much sought after elimination levels. Then why was it not replicated to fight TB in the rest of the world?

Sumit Mitra, President of Molbio Diagnostics wondered that when less than a quarter of the world's population lives in the Global North (richer nations) then why do those in the Global North have decision-making powers when it comes to global health - especially when health challenges are way more profound in the Global South?

What works really well in the Global North may not work well in the South. Health technologies conceived, designed, and manufactured in the Global North, and funded mostly by the Global North, are being rolled out in the Global South in a way those sitting in the North decide, said Mitra.

"I have every right to demand the best possible diagnosis and treatment. Just because someone is born in the Global North, her/ his/ their right to a healthy life is not in any way higher than mine," added Mitra.

The deadly divide in 2024

WHO's highest level initiative Find.Treat.All (first launched in 2018) calls upon all countries to replace microscopy (which underperforms in diagnosing TB) 100% with WHO recommended highly accurate molecular tests by 2027. But only 47% of those with TB disease got a molecular test diagnosis in 2022 as per the WHO Global TB Report 2023.

If we use a bad test that underperforms in diagnosing TB (like microscopy) we will miss TB even among those who take that test. These people who are not accurately and timely diagnosed suffer unnecessarily due to TB, as well as the infection keeps spreading from one person to another. Making upfront molecular test diagnosis to all those who take a TB test is essential entry gate to TB care pathway.

At least one-third of the estimated people with TB globally are not notified to TB programmes. Let us take the best of existing TB services equitably to the communities (and closer to the people) in high TB burden settings with dignity and respect. Linking all those diagnosed with effective and best of WHO recommended treatments is vital.

(Shobha Shukla and Bobby Ramakant co-lead the editorial of CNS (Citizen News Service) and are on the governing board of Global Antimicrobial Resistance Media Alliance (GAMA))

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