Daily Times

The silent pandemic of Tuberculosis continues its ravages against humankind, with 10 million persons contracted with the disease and killed an estimated 1.4 million persons in 2019, translating to around 4,000 deaths in each day. The situation in Pakistan, that stands fifth on the list of worst affected countries globally, is equally grim where around 580,000 people estimated to have contracted the disease, out of which only 360,000 were identified in 2019 and put on treatment. The remaining 220,000 persons were missed to notification and got added to the prevalent pool of patients that go undetected and further spread the disease. We just cannot look at these facts as mere statistics and move on. That is simply not an option – neither today on World TB Day nor on any other day of the year!

We need to know that Tuberculosis is a deadly and contagious disease which mostly affects lungs but can affect almost any part of the body, and occurs mostly in low-income people. While our TB control programme initiated in the fiscal year 2000-2001 succeeded to a large extent in expanding TB care facilities across the country during its first decade, the case detection seems to have more or less stagnated during the second decade while actually being on the decline over the past two years.

The United Nations convened a first ever high-level ministerial meeting for elimination of Tuberculosis in September 2018. The world leaders made the commitment for ending the tuberculosis epidemic globally by 2030 in line with the Sustainable Development Goals and pledged to provide leadership to work together to address the social and economic determinants of the epidemic and protect and fulfil the human rights and dignity of all people. An important signatory to the declaration was Pakistan’s Foreign Minister H. E. Mr. Shah Mahmood Qureshi who stressed the importance of fighting the TB epidemic that places a heavy burden on the world’s most poor and vulnerable.

World Tuberculosis Day is Being Observed Globally today

The Stop TB Partnership moved swiftly to delineate country level targets and actions required by each government particularly in high-burden countries. Twelve days before World TB Day last year, however, the global community was struck by another massive challenge – COVID-19 was declared a pandemic by the World Health Organization jolting the routine activities of the Health Sector. The COVID-19 pandemic has a significant impact on the provision of care for people with tuberculosis. Access to diagnostic testing has declined with TB notifications dropping by 17% for all forms of TB in 2020 in Pakistan with a significant drop of 40% in quarter 2 (April – June) of that year, partly because of partial lockdowns and limited human and material resources, but also because of the social stigma of having a cough or being unwell. With the pandemic having drastically reduced the TB case notification rate, urgent actions are required. Policymakers have to rise to the challenge and ensure that TB care is not affected and its preventive, diagnostic and treatment infrastructure is not disrupted due to the COVID-19 response.

‘The Clock is Ticking’ – the theme for World TB Day 2021 highlights the urgency for intensifying the efforts for ending TB by an inclusive approach involving the political leadership, parliamentarians, community leaders, TB survivors, healthcare professionals, workers, non-profit organizations, and other stakeholders. With only 21 months remaining for meeting the 2022 targets, the COVID-19 pandemic has put progress towards End-TB on hold while decelerating the progress towards attaining Universal Health Coverage. The theme also conveys that the global investment is at less than 50% of the US$13 billion per year pledged towards this end, while countries are falling extremely short of the agreed targets to find people with TB and provide them with the prevention, treatment, and care, particularly in case of children and those with drug-resistant TB. Moving forward towards TB elimination, Pakistan will need to encompass the transformation of the political declarations to End-TB by a concrete increase in the domestic governmental spending to reduce the funding gap of the National Strategic Plan, with improved surveillance systems in place to fulfil the unmet needs of people living with TB. It just cannot be business as usual. TB needs to be placed higher within health sector priorities to match its commitments made at international forums and serve poor and marginalized population segments most in need of TB care services.

So where do we go from here – essentially, we need to cast our net more broadly by rapidly scaling up services and reaching out for the marginalized and at-risk population segments by providing them with the requisite diagnosis and treatment facilities and preventive treatment to contacts of people affected by tuberculosis, and other people at risk. Our previous experience has shown that this will require the robust involvement of communities and civil society. Transcending sociocultural barriers to TB care services cannot be accomplished by the public health sector alone. We will also need to provide services that are integrated, community-based and gender-responsive, ethical, equitable and founded on the basic principles of human rights. We will also require the help of communities to ensure that preventive measures for tuberculosis are enacted at workplaces, schools, transportation systems, and other settings where people congregate.

And let us face it, we will need to mobilize adequate and sustained resources for universal access to the quality services outlined above, with the main responsibility falling on the provinces and federally administered territories such as Azad Jammu and Kashmir, Gilgit Baltistan and the Islamabad Capital Territory to bridge the funding gaps in the national/provincial tuberculosis strategic plans. Assertions of commitment alone are not effective unless backed up with concrete budgetary allocations. We also need to develop multisectoral mechanisms encompassing social safety nets to monitor progress towards ending the tuberculosis epidemic with high-level leadership while actively involving parliamentarians, local governments, academicians, private sector and other stakeholders within and beyond the health sector. End-TB efforts will also need social mobilization and mass awareness by the imaginative use of social media and other electronic media to achieve the December 2022 targets and accelerating the march toward the 2030 targets under SDG # 3 eliminating TB as a public health problem in Pakistan. To do anything less, will constitute a grave injustice to our coming generations. Meanwhile, the clock is ticking!

The writer is a senior public health specialist of Pakistan and can be reached at gnkaziumkc @gmail.com