It is not natural disasters but manmade barriers that block access to TB care

Shobha Shukla, Bobby Ramakant– CNS
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 #HealthFor All 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).
Like justice, health is never given, it is won
“Like justice, health is never given, it is won,” said a media release by United Nations joint programme on HIV/AIDS (UNAIDS) on International Women’s Day.
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 res- ponse,” 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. Even data of TB in children for example has started coming forward from high TB burden Nations only since the past decade. But richer Nations of the Global North were diagnosing and treating drug-resistant TB, TB in children or extrapulmonary TB (TB of body parts other than lungs). “We cannot have double standards,” rightly said Dr Lucica Ditiu, who was speaking at the 2024 World Social Forum (WSF 2024) in Nepal. Since Dr Ditiu has taken charge of the global Stop TB Partnership in Geneva in 2011, TB guidelines are uniform for rich and poor nations alike.
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 and complemented with nutrition, along with ending tobacco and alcohol, and preventing diabetes, other non-communicable diseases, hunger, poverty, HIV, and a range of other TB risk factors. Are Governments not committed to deliver on addressing these TB risk factors, alongside ending TB by 2030 (as they have promised)?
“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 tests to diagnose TB early (such as molecular tests recommended by the World Health Organization–(WHO), 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 who has made a seminal contribution towards shaping India’s TB response in various capacities since 1976 onwards. He was speaking in the End TB Dialogues hosted by CNS at the 78th National Conference of Tuberculosis and Chest Diseases (NATCON), in Thrissur, Kerala.
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 and a thought leader on point-of-care and point-of-need diagnostics, spoke in the recently concluded World Social Forum 2024 (WSF 2024). He wondered that when less than a quarter of the world’s popu- lation 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 cha- llenges are way more profound in the Global South?
(To be contd)