Decades of global neglect have resulted in tuberculosis (TB) becoming the leading cause of adult deaths — it kills nearly two million people a year. This is shocking given that TB is curable and preventable.
But there are signs of change as the spotlight shines on TB, including the United Nations Declaration of September 2018 titled “United to End Tuberculosis: An Urgent Global Response to a Global Epidemic”, where heads of state and government have “reaffirmed their commitment to end the global TB epidemic by 2030”.
What is Tuberculosis ?
Tuberculosis is an infectious disease that usually affects the lungs. Compared with other diseases caused by a single infectious agent, tuberculosis is the second biggest killer, globally. Doctors make a distinction between two kinds of tuberculosis infection: latent and active.
Latent TB – the bacteria remain in the body in an inactive state. They cause no symptoms and are not contagious, but they can become active.
Active TB – the bacteria do cause symptoms and can be transmitted to others.
Intrusive technologies :-
An emergent and disturbing arsenal of surveillance technologies has caught the attention of international and domestic policy makers and threatens to detract from an effective response to TB that is anchored in human rights and has a human touch. For example :-
- A plan in India is to implant microchips in people in order to track them and ensure they complete TB treatment.
- There are also seemingly endless technological tweaks to the Directly Observed Treatment, short course (DOTS) strategy, which requires patients to report every day to a health authority, who watches them swallow their tablets.
An obsession with new gadgets in disease management — in the context of a disease that could be eliminated in a relatively inexpensive way through human-rights based interventions.
Some interventions :-
December 10 was World Human Rights Day, which is a reminder also that we can only beat TB using an approach anchored in human rights. Such an approach focusses on creating health systems that foster trust, partnership and dignity.
- Use of Bedaquiline & Delamanid :-
In contrast to the dozens of whirring and chirping surveillance gizmos are bedaquiline and delamanid, the only new TB drugs. These drugs are far more effective against drug-resistant TB than prevailing treatments.
New guidelines by the World Health Organization (WHO) recommend the use of bedaquiline and delamanid against drug-resistant TB. But to date, only about 30,000 people have received the new drugs, compare this to the over 500,000 people who get sick with drug-resistant TB every year.
In other words, we mount an arsenal of cutting-edge technology to corral people into taking torturous, ineffective drugs even while we fail to use available drugs that work far better.
What needs to be done ?
International institutions, donors and countries need to focus and collaborate on the urgent production and distribution of affordable generics of bedaquiline and delamanid.
Meanwhile, we must escalate from all levels pressure on companies such as Johnson and Johnson and Otsuka to drop their prices to a dollar a day for each medication so that their exorbitant prices no longer exclude the vast majority of people from accessing the drugs.
- Human touch :-
Employ and deploy community health-care workers. Many domestic TB policies envision community health-care workers as the backbone of the response, yet, in practice, these front-line workers remain shockingly underused. In sufficient numbers equipped with proper training and dignified conditions of employment they would lead the response by bringing care to those furthest from the reach of traditional health-care systems. WHO should focus on recommendations around this cadre of workers and donors should focus funding to programmes that make the most of them.
- Accountability :-
The TB response can only be as good as the health-care systems through which it is implemented, and health-care systems are only as good as the structures that hold them to account.
Community-based structures such as “clinic committees” ensure accountability while also fostering partnership and trust between communities and their health-care systems. Grassroots civil society and community-based organisations also ensure accountability.
Such organisations are indispensable and would thrive on comparatively small amounts of funding. Accountability is a necessary condition for success. We must recognise that it is owed to communities, not donors or international institutions, and fund their efforts to ensure it.
Conclusion :- People with TB are saying they want what anyone wants — including health and dignity. The shiny allure of surveillance technology threatens to distract us from the real work of the TB response, work that involves partnering with communities to employ human-rights based strategies to beat TB.