Tuesday, October 4, 2016
Cambodia - TB kills three people every minute – the world must wake up to this pandemic
Dr Jess Potter and Dr Chhim examine a TB patient’s x-ray at Kampong Cham hospital, Cambodia. Photograph: Tom Maguire
The leading cause of death from infectious disease worldwide, tuberculosis (TB), is associated with immigration in the UK. There, I’ve said it. Now let’s move on because no Donald Trump-esque wall or Brexiteer is going to keep TB out. Perhaps we should ban all migration? Quite frankly that is a ridiculous notion; one that someone with even the most isolationist of stances would struggle to justify.
Some might argue that we could extend our current TB screening policy (people wishing to move here from countries where TB is common are checked pre-entry) to incorporate testing and treatment for the silent or latent form of the disease, but this would not cover the millions of people who come to the UK for up to six months on a tourist visa. Not to mention the ethical considerations. In any case, there is currently no effective way to treat the latent form of multi-drug resistant TB (MDR-TB). So, to my mind, there really is just one choice – we must tackle TB on a global scale and that means overseas investment.
For those of you that think TB was eradicated long ago, consigned to history with the likes of Edgar Allen Poe, think again. In 2014 an estimated 9.6 million people became unwell with TB [pdf] – that is equivalent to almost the entire population of Sweden. And the equivalent of almost everyone living in Stockholm – 1.5 million – died of the disease. TB kills three people every minute. If the moral imperative to save those lives is not enough, the global economic burden of TB is estimated at $12bn (£9bn) annually.
To avoid infecting his family Sam Moeum, 71, left the family home to complete his treatment and now lives alone in Momot district, Cambodia. Photograph: Tom Maguire
In 1993, after decades of decline, deaths from TB had to started to increase. The WHO declared TB a global emergency, we had taken our eye off the ball and cases of TB in parts of London became as common as in some areas of sub-Saharan Africa.
The global TB pandemic has been fuelled by disregard: political will is limited, investment in diagnostics, drugs and vaccines is poor, and the HIV epidemic played its role with sufferers around 27 times more likely to get TB. The disease, and particularly MDR-TB, thrives on fractured and underfunded health systems. TB generates global losses of $12bn annually and we need $6.4bn to end this epidemic. I am no economist but where we should spend our money seems clear to me.
In 2002 the Global Fund to fight TB, HIV and Malaria was established. Its strategy of providing funding at a country level and promoting a partnership approach between private, public and civil society will have saved an estimated 22 million lives by the end of this year. The millennium development goals to turn the tide on these epidemics by 2015 have been achieved: new HIV infections have fallen 38%, deaths from TB fell 45%, and the number of new cases of malaria has fallen by 37%.
For TB, the Global Fund provides over 75% of all international finance. Without it, there would not be an international response to the world’s leading infectious killer. To give you a sense of the role of the Global Fund in the fight against TB in particular, let me use Cambodia as a case study.
Dr Jess Potter speaks with TB patient Pann Sarin, first diagnosed with the illness after experiencing a fever and rapid weight loss, two main symptoms. Photograph: Tom Maguire
Emerging from the devastation of Pol Pot’s genocide and decades of civil war, Cambodia’s health system lay in tatters by the early 1990s. Cambodia is among the WHO high-burden TB countries. A prevalence survey in 2002 indicated that 1.5% of the population had the disease. My recent visit clearly showed that since then, with the support of international funding, an engaged ministry of health and a well-designed National TB Programme, Cambodia has reduced TB prevalence by approximately 50%.
Dr Mao Tan Eang, director of the national TB programme (NTP), told me that the key to ending TB has been to close the resource gap. In 2015, just 12% of the TB programme was funded domestically, 47% was funded by foreign donors (half of which came from the Global Fund), and the remainder was unfunded.
The UN sustainable development goal number three requires ensuring healthy lives with the ambitious target of ending the epidemics of Aids, tuberculosis and malaria by 2030. If we are to achieve these goals we must bridge the funding gap.
This month, Canada will host the 5th Global Fund replenishment conference. Canada has increased its donation by 20%, France has already pledged US$1.08bn, but the UK and Germany are yet to donate. There is a moral imperative and a strong economic case for doing so, and yet any chance of success is threatened by insufficient funding, public ambivalence and nationalist politics.
Last century we lost control. Let’s not do so again. The progress we have made since has given us a platform from which we can dare to dream of ridding the world of these devastating diseases, but only if we work together. For now, we wait with bated breath to discover whether the UK government will live up to its responsibilities. Lives are hanging in the balance.
Jessica Potter is a doctor and MRC research fellow at the Centre for Primary Care and Public Health, Blizard Institute, Queen Mary University of London. Follow @DrJessPotter on Twitter.