World Health Assembly approves resolution on combatting tuberculosis

The 67th WHA is taking place from 19-24 May. The adopted resolution is WHA 67.1 [pdf].

Members of a WHA committee on 19 May adopted without any further discussion draft resolution EB134.R4 [pdf] supported by over 50 countries, including the United States, Brazil, Canada, South Africa and China.

By passing it, member states have agreed to reach a global target of a 95 percent reduction in tuberculosis deaths by 2035.

The resolution is grounded on three pillars: integrated, patient-centred care and prevention; bold polices and supportive systems; and intensified research and innovation. It also reflects strong principles such as the protection and promotion of human rights, ethics, and equity.

Significant strides have been made toward achieving the 6^th UN Millennium Development Goal: “to have halted and begun to reverse the incidence of tuberculosis” by 2015 – through instruments such as Directly Observed Treatment Short Course (DOTS), the Stop TB Strategy, and the financing of national plans.

But a persistent gap remains.

More than 3 million people living with tuberculosis are not diagnosed and do not receive appropriate treatment, according to the resolution. “Specific strategies and support to accelerate progress in preventing disease and deaths, and to expand to needed interventions and new tools”should be taken by member states.

The magnitude of the problem of multidrug-resistant tuberculosis (MDR TB) was highlighted by a number of delegations because it createsgrave individual as well as public health risks. Canada urged actions against this “major concern for global health security” to be initiated.

In the case of people living with HIV, undiagnosed tuberculosis remains a major cause of death, especially in Africa. Various delegations, such as the Philippines, Canada, Togo, Haiti and Russia, stressed the importance of an enhanced joint action to address these dual epidemics through, for instance, increasing integration of primary care services.

Given the increasing flux of migration across the globe, greater cross-border collaboration between high and low incidence countries with regard actions to monitor and control mechanisms must also be taken by member states, according to the resolution.

Notably, investment in research, development, and implementation of new innovations for tuberculosis care and prevention is essential for the elimination of tuberculosis at the national scale. As the delegation of Russia said: “we need to note the importance of these basic elements and intensifying research and innovation.”

Two minor amendments were adopted. One of them was proposed by Thailand with regard to paragraph 4 subparagraph 1, to add “including the migrant population” after the word “vulnerable community.”

Speaking on behalf of the 47 countries representing the Africa region, Ethiopia also suggested the implementation of a glossary, which was seen as helpful by the secretariat and will be added without further delay.

During the interventions, Phumeza Tisile, a survivor of MDR TB in South Africa and a former Médecins Sans Frontières patient, called for actions to guarantee that “together we can ensure TB is curable.” Her speech is available here.

On 20 May, a related side event entitled “Global strategy and targets for tuberculosis prevent, care and control after 2015” was convened by the government of Brazil and the WHO TB department. The panel brought different keynote speakers to the major challenges in the fight against tuberculosis, and was moderated by Brazilian doctor Jarbas Barbosa.

Barbosa gave a detailed overview of the situation in Brazil, which is still at the 16^th position among the 22 high burden countries for tuberculosis.

However, due to a combination of efforts in the health sector and also in the fight against the poverty, Brazil has experienced over the last decade a 20 percent reduction in the incidence of the rate of tuberculosis. “Combining health sector with other sectors can be a great achievement,” he said.

Mario Raviglione, director general of the TB programme at WHO, highlighted the remaining major challenges in TB, notably the 3 million people who are still not treated and the increasing MDR-TB crisis.

But, with the adoption of the resolution by the committee on 19 May, “we are ready to get on board this time,” he said. The vision of a world free of TB, with zero TB death, disease or suffering by 2035 is quite ambitious but “why we cannot have this kind of powerful phraseology in our vision” as was seen for instance, in the HIV context he added.

Philippe Meunier, French minister of foreign affairs and ambassador for the fight against HIV/AIDS and communicable diseases, pointed out the need for innovation, said, “the time is right to initiate new ways to fight against TB.”

“Despite the tremendous efforts which have been made on this disease, what makes it very difficult is the fact that we do not have enough multi-disciplinary approaches and that we have to take care and take into account new realities, new potentials in terms of research,” he said.

Chairman of UNITAID’s Executive Board Philippe Douste-Blazy explained that intellectual property is one of the major barriers to access to new tuberculosis drugs, especially for MDR TB. In order to address this, they Board in June will discuss the possibility of extending the scope of the HIV-focussed Medicines Patent Pool to tuberculosis.

As Lucica Ditiu, executive secretary of the Stop TP Partnership, emphasised “it is time to accelerate our actions right now” because, “if we still decrease by 2 percent per year, it will take us up to the year 2180.” This acceleration can be done through innovation but also by using in a smarter way what is done now, she explained.

Source: Intellectual Property Watch