Pakistan’s absence from TB moot ‘depresses’ health specialists

Islamabad : With the President and Prime Minister abstaining from the United Nation’s High Level Meeting (UN HLM) on Tuberculosis scheduled in New York on September 26, Pakistan—a country which ranks 5th among the 30 high-burden TB countries—has not only squandered a rare opportunity to sensitize the global community about its specific challenges and opportunities to reverse the TB epidemic, but has also missed a historic chance to shape the world’s future response to the disease.

The UN HLM, which will result in a Political Declaration on TB, endorsed by heads of state, is being seen as the most significant political meeting ever held on TB. The Declaration will form the basis for a coordinated global response to TB.

“According to WHO, there were an estimated 510,000 incident TB cases in Pakistan in 2016, with 44,000 TB deaths. More than 95% of the budget to fight TB in Pakistan comes from The Global Fund. The federal and provincial governments together have not been able to commit more than US $80 million for the next three years, which means that we face a fiscal gap of about US $250 million. Punjab is the only province to have approved a PC-1 of US $34 million, which is a good start, but is not enough. The rest of the provinces have no approved PC-1s to date,” a high official working for TB control confided. “In a grave situation like ours, highest possible level of representation at the UN HLM on TB could have made a huge difference,” another TB specialist added.

An agreement to hold a dedicated UN HLM on a specialized topic is taken in exceptional circumstances through a UN resolution and vote, with the purpose of reaching agreement on cooperation measures and solutions on important global issues among Heads of State and government. As such, Pakistan’s absence from the process is being termed by health specialists in Pakistan as “truly depressing.”

Ironically, nobody even from the Ministry of National Health Services, Regulation and Coordination will be attending the important session. Pakistan will be the only high TB burden country not present to sign the important Declaration, thereby missing a chance to voice its commitment to galvanizing the kind of multi-sectoral action required to end the TB epidemic.

The UN HLM on TB will be the biggest and best opportunity to raise the political priority for TB control at a time when TB remains the world’s deadliest infectious disease even though global efforts have averted an estimated 54 million TB deaths since 2000.

“Fewer people fell ill and died from TB last year but countries are still not doing enough to end TB by 2030,” the World Health Organization (WHO) warned at the launch of the 2018 Global TB Report, released in New York on September 18. The report calls for an unprecedented mobilization of national and international commitments and urges political leaders gathering for the first-ever UN HLM on TB to take decisive action.

To meet the global target of ending TB by 2030, countries need to urgently accelerate their response by taking measures such as increasing domestic and international funding to fight the disease. The WHO report provides an overview of the status of the epidemic and the challenges and opportunities countries face in responding to it.

Overall, TB deaths have decreased over the past year. In 2017, there were 1.6 million deaths (including among 300 000 HIV-positive people). Since 2000, a 44% reduction in TB deaths occurred among people with HIV compared with a 29% decrease among HIV-negative people. WHO estimates that a quarter of the world’s population has TB infection.

Underreporting and under-diagnosis of TB cases remains a major challenge. Of the 10 million people who fell ill with TB in 2017, only 6.4 million were officially recorded, leaving 3.6 million people undiagnosed or unreported. Treatment coverage lags behind at 64% and must increase to at least 90% by 2025 to meet the TB targets.

One of the most urgent challenges is to scale up funding. In 2018, investments in TB prevention and care in low- and middle-income countries fell US$3.5 billion short of what is needed. The report flags that without an increase in funding, the annual gap will widen to US$ 5.4 billion in 2020 and to at least US$ 6.1 billion in 2022.A further US$ 1.3 billion per year is required to accelerate the development of new vaccines, diagnostics and medicines.