Researching the FT’s first Combating Tuberculosis report in the last few weeks, I was a little disappointed by the lack of dissonance. HIV and increasingly malaria activists have been important advocates in raising the profile of those killer diseases, and in highlighting important issues of disagreement. The TB community, by contrast, still feels neglected, small and even overly consensual.
Apart from the obvious but difficult demands for more funding, and more effective drugs, diagnostics and vaccines, there are important short term and less costly actions that could be taken. Here are a few thoughts on what more needs to be done. Do reply to disagree or add to them!
- More integration between HIV and other health services. Let’s not pretend in resource-starved countries that HIV activities have not sucked away staff, attention and focus from TB and other diseases despite the huge co-infection rates
- More work on prevention, with more aggressive active case detection efforts and tougher infection control measures including for healthcare workers
- A fresh assessment of the systems of international drug procurement, to provide greater transparency in pricing and the potential for pooled purchases or at least more accurate forecasting to create greater certainty of demand and incentives for manufacturers
- Greater innovation in developing simple communication tools, such as ways to explain clearly to patients how to breath deeply and improve sputum output
- More energetic and independent advocacy, identifying leading figures including those who have had TB, and getting them to speak out
- More efforts by employers in areas of high prevalence and poor healthcare provision of their responsibility to educate and support screening and treatment
- In the UK, the need to take responsibility for commissioning TB services beyond the level of individual primary care trusts, to remove the local and fragmented view that starves programmes such as Find & Treat from funding
- In Uganda, more efforts by the government to start funding its own programmes, improving salaries and conditions for health staff, and holding agencies responsible for failure to deliver medicines
Margaret McCartney
Clive Cookson
Andrew Jack