In this report, Olayinka Oyegbile, Deputy Editor, who attended the 50th Union World Conference on Lung Health held in Hyderabad, India, writes about the efforts to rid the world of tuberculosis.
THE recently held 50th Union World Conference on Lung Health in Hyderabad, India, was a conference with lots of promises and hope for the low and middle income countries of the world. Perhaps this was helped by the fact that it was held in one of those countries. It held so many promises for these countries because tuberculosis is still a problem that has continued to nibble at the lungs of many of its citizens, especially with the high cost of diagnosis and treatment of the ailment.
One of the first flickers of hope at the conference was the announcement that researchers were at the verge of getting a vaccine that might aid the world in the fight against the dreaded disease tuberculosis. The Scientific Director of the International Union Against Tuberculosis and Lung Disease (The Union), Dr. Paula Fujiwara, the host of the conference, had announced to the expectant crowd that “We are one more cautious, but exciting, step closer to a vaccine for tuberculosis (TB). A vaccine is the ultimate prevention tool and the announcement is welcome news, but as researchers discuss how to move the trial into its final phase, we simultaneously need to be doing all we can to prevent tuberculosis with medications that we already have at our disposal.”
TB kills more than HIV/AIDS
The World Health Organisation (WHO) has recognized TB as the most challenging infectious disease that humankind faces. According to it, it is estimated that in the last 200 years it has killed one billion people. At present Nigeria is one of the eight countries where tuberculosis is still prevalent.
Fujiwara had added, “TB is a disease that is preventable, treatable and curable, yet last year it killed 1.5 million people, more than HIV/AIDS. We cannot end the TB emergency unless we dramatically scale up prevention in those parts of the world where we are treating it. The cost of inaction is more unnecessary suffering and death.”
In arriving at the new vaccine, a team of researchers carried out critical phase of clinical trials and tested it on more than 3,500 adults in TB endemic regions of South Africa, Kenya and Zambia. Although the vaccine would still undergo tests on bigger level before being licensed by 2028, theWHO has promised to reduce the number of new TB cases by 90% and the number of deaths by 95% between 2015 and 2035.
As of now only eight countries account for two thirds of global TB cases; these are India with (27%), the highest, while Nigeria and Bangladesh have (4%), China (9%), Indonesia (8%), the Philippines (6%), Pakistan (6%), and South Africa (3%).
Although Nigeria has just four percent of the world population of TB patients, this cannot be said to mean it has done well or not at danger level. Efforts are being made at all levels to ensure that the tally is brought down considerably to protect its population. The journey to the eradication of TB is not a lone one for the country as it is receiving assistance from KNCV Tuberculosis Foundation, one of the world’s leading TB expert agencies, which has projects spread across 14 states in the country.
According to Dr Mustapha Gidado, Challenge TB Project Director, of KNCV TB Foundation at The Hague, Netherlands, the assistance from the USAID funded Challenge TB project is a five year programme that is now at its last year of implementation, “We (KNCV) partnered with the Federal Ministry of Health, the National Tuberculosis and National Control Programme and the projects supports 14 states in Nigeria including Katsina. The major intervention is to support the Federal Ministry of Health to ensure people who have symptoms of TB have access to quality diagnosis tools, prompt quality treatment and to ensure cure at the end of the day and our major strategy is to align with the national strategic plan for the country which ran from 2015 and also ends in 2020, so whatever Challenge TB projects does is aligning with the national strategic plan so the major interventions this project has done is to ensure that first of all, clients in the community have awareness to TB, they know the basic symptoms of TB and where to access care.”
He added that project has been able to ginger effective approach to community mobilization where persons in the community are made aware of TB through the use of mobile diagnostic units, with trucks equipped with permanent diagnostic tool and a digital X-ray machine. The agency’s assistance are not limited to these alone, it also through funding by USAID and other partners, places diagnostic machines in these facilities as well as renovate structures and ensure access to power, solar panels and inverters to keep and preserve their medicines.
The Katsina success story
Dr. Gidado is happy that the USAID funded project codenamed Challenge TB is meeting with success across the country. He observed that: “Challenge TB is happy to be part of the success story in moving the case notification of TB in the country across the states that we have worked. When we started using a baseline of TB notification, and based on the population of each of those states, by the end of these four years we’ve been able to demonstrate that the cases identified in these states have moved as far as 45%. So for us it’s a good success, and not just in terms of numbers. If one person is diagnosed of TB and he or she commences treatment and he’s cured, for us I think it’s something that should be celebrated.”
Of the 14 states across Nigeria’s six geo-political zones where it has been operating, KNCV is happy that it has along with its partners recorded huge success especially in Katsina State in the northern part of the country, “In terms of collaborating with government stakeholders, Katsina has stood out clearly and has demonstrated great results that can be attributed to commitment of the state government and the commitment of the state TB programme managers.” It has stood out among all the 14 states where the programme is on.
In the view of KNCV, the Nigeria TB programme of action is in the right direction because as of the current diagnosis report. Nigeria is among the countries that have shown significant increase in number of TB patients treatment in 2018, as there has been increase in the number of people put on treatment, according to the current TB Report. He added that, “I think our success in Nigeria is the ability to work with the government system and ability to stimulate the government system.”
Continuity of the programme
However, the concern of many citizens has always been as to how to sustain this programme after the exit of the donor partners, this Gidado has assured would not be a problem because the funders have worked with government officials and ministries and agencies in charge of this all along, so the fear of vacuum is not going to arise.
He said, “I am not so scared even if these project come to an end because we’ve provided certain capacity to the government system, we have provided equipment and technical know-how, so what they only need is some procurement and resources. So, in general our success is not only in the 14 states we’re also providing technical assistance to the central TB control programme on the know-how of so many things.”
The assistance has led to improved capacity building among practitioners as well as leading to procurement of diagnostic tools, as well as diagnostic capacity within the government facilities across the country. Cooperation and working relationships have also been built with different government agencies to ensure smooth working relationships. Among such agencies is the National Agency for Food and Drug Administration and Control (NAFDAC) for the fast tracking registration of TB drugs.
Also, Dr. Useni Sani, KNCV Senior Technical Advisor, who works with the KNCV/Challenge TB programme in Abuja and has the direct responsibility of supervising the programme in the country, believes the success achieved so far in the country needs to be sustained to make sure the momentum is not lost. It is expected that the reduction of the of the price of TB treatment drug which was announced at The Union conference would also trickle down to Nigeria and help in the fight against the disease. The breakthrough on reduction of the price for the treatment drug which was announced by the trio of Unitaid, the Global Fund and Sanofi, the global biopharmaceutical company manufacturing rifapentine, a critically important drug used to prevent TB was greeted with a sigh of relief.
The current price at $45 (about N16,020) was slashed to $15 (about N5,340) as a way of making the drug available to patients especially in poor and middle income countries, including Nigeria. This announcement however did not deter activists to ask for the reduction of price for GeneXpert MTB/RIF by Cepheid, a diagnostic corporation. Among the activists groups that mounted the protests were Medicins Sans Frontiers (MSF) and Treatment Action Group which averred that “substantial public and philanthropic funding supported the development of GeneXpert TB tests, and now the public is paying twice to access these essential tests at a high price.” David Branigan, TB Project Officer at Treatment Action Group added, “It is time that the public receives larger return on this investment, and that Cepheid lowers price of Xpert tests to $5 per cartridge, inclusive of service and maintenance.”
On the decision of the trio to lower the price of their drug, the Executive Director, The Union, José Luis Castro, said, “If we are to end the TB emergency, we need a prevention revolution. It is indeed timely that we are seeing such promising movement on all facets of prevention vaccines, drug prices and new drugs now we need to ensure that going forward, preventing wherever we treat becomes the new normal.”
On his part, the Unitaid’s Executive Director Lelio Marmora observed that “Effective TB prevention will be a game-changer in the global fight to eliminate one of the major killer diseases. This lifesaving drug has, until now, been completely unaffordable in developing countries. This agreement will help transform political commitment to tangible action.”
A quarter of the world’s population is infected with latent TB they have no symptoms, are not contagious and most do not know they are infected. Without treatment, 5% to 10% of these people 85 million to 170 million people globally will develop active TB, the form which makes people sick and can be transmitted from person to person. HIV infection makes people up to 37 times more likely to fall ill with the active disease. Close to 1.5 million people die of TB every year.
To ensure TB is eradicated in Nigeria, KNCV and its partners have extended their net of support to high fliers in the society and have support of such people as Mrs. Aisha Buhari, wife of the president and the wife of the Lagos State Governor, Dr. Ibijoke Sanwo-Olu, who is herself a medical doctor as Ambassadors to help propagate the gospel of stopping TB and regarding it as curable. There are also lawmakers at both federal and state levels that have signed on to the campaign. Hoping to help Nigeria achieve a zero-level of tuberculosis.
Ensuring access to diagnosis
One of the other issues that were also raised at the conference was easy access to diagnosis by patients and analysis of specimen taken in up to date laboratories and equipment. According to Mr. Kehinde Agbaiyero, Country Implementation Manager of SystemOne, a medical technology company, “creating a delivery system for timely treatment that the patient can and will comply with is critical to fighting this disease. Our technology makes accurate identification and prompt delivery possible in even the most resource-limited settings.”
He added that the company was in Nigeria to help in the deployment of technology to combat the disease and be able to identify the cases as soon as they are diagnosed and ensure they are placed under treatment. This is done under it diagnostic accountability, which helps to reach the gaps between the cases that are diagnosed and those that are placed on treatment.
Perhaps with all these cocktails of approaches to tackling TB, Nigeria might well be on its way to total eradication of the lung threatening disease.
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