NEW DELHI :
The Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) has saved millions of lives ever since it was launched in 2002. On the sidelines of his meeting with experts in India, executive director of Global Fund Peter Sands said the country’s goal of ending TB by 2025, five years ahead of the global target, is “stretching" even as he applauds the “step-up" and acceleration by the Modi government in fighting TB. Edited excerpts:
What are your top priorities?
The goal of Global Fund is very simple, which is to end the epidemics of AIDS, TB and malaria, the three biggest infectious diseases in the world, by 2030. When the Global Fund was first created in 2002, the initial focus was simply to stop so many people from dying, to save lives and it has been extraordinarily successful. The Global Fund partnership has saved about 27 million lives, but since then, we have broadened our vision of not just to save lives, but also to end the epidemics, because by ending the epidemics, you can save future lives.
India tops the list of nations with high disease burden. Given the magnitude of India’s TB crisis, which is staggering unless the disease is eliminated in India, the global efforts to end TB will have no meaning. Do you think India is on track to eliminate TB?
India is critically important to the global fight against all three diseases, but particularly TB, because India has approximately 27% of the total global burden of TB cases, and 33% of global deaths from TB. So, in a sense, India is the most important battleground for the fight against TB. If we have to defeat TB, we have to defeat TB in India. India is also very important for the fight against the other two diseases. India has the third largest population of people living with HIV, with about 2.2 million people. On malaria, India is the smaller part of the global challenge with about 4% of malaria cases. That’s actually the testimony to the great success that India has had in fighting malaria.
The important point is, India has shown remarkable leadership in acknowledging that there is a big problem with TB, which is absent in many countries. It is a kind of a forgotten disease. There has been a significant step-up in the number of cases that are identified and treated. Number of cases identified in 2017 was 2.15 million and, in 2015, it was 1.7 million. That’s a very significant increase. But to really get on top of the disease, we need to see a continuation of that trajectory.
Can India eliminate TB by 2025? Do you think it is too ambitious to set a target, which is five years ahead of the global target?
I don’t think either the Global Fund or India should be satisfied until we see a dramatic reduction in the number of people being infected with TB, and the number of deaths. But, we are seeing a significant step-up in both resourcing and determination and execution, and we are committed to working with the Indian government. The engagement of the private sector is critical because about 70% of the people affected with TB, their first interaction with the healthcare system is through the private sector. One of the critical elements to fight TB is to ensure that private sector partners play that part. I think 2025 is a great goal to set; it’s stretching, but it’s a great goal to stretch.
What are the major challenges to control TB in India?
Fighting TB is partially about fighting the disease and partially about the broader challenge of improving people’s health. The way TB works, a very significant proportion of Indian population has latent TB. They carry the bacteria, but they are asymptomatic. Probably around 40% of the population of India will have latent TB, but much more proportion of that turns into active TB. The reasons why it activates has a lot to do with other health conditions, environmental health that compromises and weakens the immune system. So, the fight against TB has to be seen as a part of the broader agenda to improve people’s health and well-being across the country. So, it’s very consistent with the broader “Ayushman Bharat" objectives of building up universal health care.
So you think Ayushman Bharat will be of help in fight against epidemics too?
If you look at the history of a country like Japan, after the Second World War, the biggest killer in Japan was TB and Japan launched a big national campaign against TB in 1951 and that turned into the platform for the whole universal health care coverage system which was launched 10 years later. The fight against TB can be used as a platform for the universal health coverage but also the more you build universal health coverage the more it makes your fight against TB successful. So, the two things run in parallel.
Do you think India has made enough investments in TB?
Definitely, there is a step-up in the government’s commitment. I was here last March when I joined Global Fund and I saw the PM was talking with determination about the fight against TB and there has undoubtedly been a step-up. It’s early days yet for the numbers of what had happened in the course of 2018. The numbers will show that there has been a marked acceleration in progress in the fight against TB. We will need to continue to see a step-up as there is still a lot to be done.
HIV got a lot of attention in terms of investments. Why don’t we see such investments in fight against TB? Is it because it is a disease of the poor?
I’m afraid to say TB has been a poor cousin. It attracts less R&D dollars and it doesn’t tend to have celebrity champions. It has not attracted as much political commitment or leadership. I think PM Modi is very clear on this. There aren’t many political leaders in countries who have taken as strong a stand on TB. You are right; this is a disease where lot of people sitting in Delhi, Mumbai, London or Geneva think either it’s over or it doesn’t affect them and one message I would give them is that they cannot afford to be complacent about TB because what we call Multi-Drug resistant (MDR) TB is an extremely nasty disease - very difficult to treat with high fatality rates.