The first plenary of the 51st Union World Conference on Lung Health focused on tuberculosis (TB) prevention tools, an area commonly afforded less attention than diagnostics and treatment. But now bold targets for TB prevention have been outlined in the recent UN High-Level Meeting on TB, setting the focus for the overall theme of the conference: Advancing Prevention.
Watch the plenary recording on demand
Dr Jeremiah Chakaya Muhwa, Past President of The Union, opened the session reminding delegates that “while global attention has focused on COVID-19 we need to remember that old enemies have not gone away.”
“The World Health Organization (WHO) latest annual report that tells us that approximately 10 million people developed TB in 2019 and 1.4 million died of the disease, the question is: Is there hope, will humanity ever conquer this disease?”
Giving a review of the last hundred years since the advent of the BCG vaccine, Professor Helen McShane, Director of the Oxford NIHR Biomedical Research Centre, spoke on the future for TB vaccination.
Evaluating the BCG vaccine, which has been around since 1921, Professor McShane spoke about the problem of its variable efficacy, with some studies showing no efficacy at all.
“What we need is a vaccine which less variable and more universally protective” said McShane, “after decades of neglect, there has been huge progress in this field in the last 20 years. It is critical that we continue this momentum.”
Rovina Ruslami of Universitas Padjadjaran, Indonesia spoke about the practical realities of implementing tuberculosis preventive treatment (TPT) effectively in healthcare setting. With a quarter of the world’s population estimated to have latent TB infection and with 5-10 percent set to develop active TB, TPT is a key component of the End TB Strategy.
Ruslami highlighted the fact that current TBT implementation is falling short, and is being impacted further by COVID-19. She emphasised the WHO recommended approach of a shorter regimen for TPT, and spoke about a study following TPT administration in Indonesia, which identified “a huge policy-practise gap”.
Citing a study indicating that of those people requiring TPT, only 30 percent went on to start treatment, Ruslami spoke about the intervention needed to address this gap. Looking at a study which trialled a logical framework for targeted interventions that rely on local data and stakeholders. This study showed that these interventions were cost-effective and had an impact in LMICs, indicating positive steps for effective implementation of TPT.
Arne von Delft, a doctor and founder of the organisation TB Proof, gave an emotional address based on his personal experience of TB after his wife’s diagnosis and treatment for drug-resistant TB, his ongoing experience of latent TB, and his work trying to advocate for better care, treatment and support for people diagnosed with TB.
“Do our lives matter so little to you?” Von Delft raised a rallying call against the changing guidelines for preventive TB treatment, which have withdrawn the requirement to test and treat people who been in close contact with someone diagnosed with TB, particularly in low income/high TB burden countries.
He went on to talk about what it means for him to be “TB proof”, not just in the sense that he has latent TB, but in his status as a white man in South Africa. Von Delft stressed that his immunity isn’t just the antibodies that prevent his contracting viral TB, but he has a political immunity. “White privilege meant that people like me were exempt from getting TB. And because people like me couldn’t get TB, people like me didn’t care about TB. Being TB Proof doesn’t refer to white blood cells, it refers to whiteness”.
“This is the truth about being ‘TB proof’ – if you get TB you stop mattering, because people in positions of privilege want to believe they are immune in every way.” He stressed, “This is why our first vaccine was our last, despite being lousy. This is why our TPT options haven’t changed in 63 years… And why the World Health Organization’s guidelines are so out of touch.”
“People with TB matter less. Black lives matter less.” Said Von Delft about why TB treatments have not progressed far enough. In closing, he urged the audience to, “Think about TB as if it were affecting us and our loved ones. Actively attack every thought and system that punishes people for being different. Only then will your excellent intensions translate into excellent care for everybody.”