Brad Tytel: Sustained Voices Will Lead to Sustained Commitment

One of my TB heroes—a man who has dedicated his life to stopping the disease—tells a story about how he first got involved with a killer everyone else seemed to have forgotten.

In 1990, he was a doctor at Muhimbili Hospital in Dar es Salaam, Tanzania. It was the first time he saw how TB and HIV conspired to kill more patients than over-stretched and under-funded health systems had any hope of treating. The hospital had only 3,000 beds for nearly 6,000 patients, so patients with HIV and patients with TB ended up doubled up in the same beds. Looking back, it is easy to see a recipe for disaster: patients with infectious TB in close quarters with highly immune-compromised neighbors. But the TB diagnostic was lousy, and by the time he and other doctors knew a patient had TB, that patient had almost certainly infected dozens of others.

With stories like these, why doesn’t TB have us all marching through the streets? Nearly two million people each year are dying of a disease that developed countries such as the U.S. “defeated” half a century ago. Twenty years after Muhimbili, the most commonly used diagnostic is still lousy and misses up to one-half of all TB cases. The drugs are old, have unpleasant side effects and take a minimum of six months to treat a patient. If patients don’t complete treatment—whatever the reason—they may develop and spread a more deadly form of drug resistant TB. There are doctors and nurses in the field doing their heroic best to stop the TB epidemic. But without more resources and new and better tools TB will continue to spread.

TB needs strong champions to push back against the neglect that led to a resurgent epidemic. If the history of the HIV/AIDS epidemic has taught us anything, it’s that effective advocacy and communications can shape the international response to a disease. At the grassroots level, TB patients, doctors and community activists need to demand better access to, and tools for, treatment and prevention. At the national and international level, advocates have to make the case for increased funding for healthcare and investments in research that will lead to improved tools and methods.

Fortunately, much progress is being made. Passionate, engaging and effective TB patient advocates and grassroots organizations have emerged, either independently or with support from international TB or HIV organizations. Many of these activists are joining forces with colleagues focused on other disease. At the November 2009 Multilateral Initiative Against Malaria Conference in Nairobi, Kenya, I witnessed a sizable and impressive demonstration convened with the help of several TB groups that called on President Obama and other leaders to meet their commitments to the Global Fund to Fight AIDS, Tuberculosis, and Malaria.

At the international level, funding for TB prevention and control has increased significantly, particularly through the Global Fund, UNITAID, and the US government. This is largely due to the efforts of TB advocacy organizations and increased attention to the dangers of TB/HIV and drug resistance. At the same time, many high TB burden countries, particularly those with emerging economies like South Africa, China and India, are now taking increased steps to stop TB—and there is hope that these gains could translate into assistance for countries like Tanzania.

There is still an enormous amount of work to do, and resources available for TB are still a fraction of what is needed. But sustained voices will lead to sustained commitment. By telling stories like that of Muhimbili and using those experiences to push for change, we can draw renewed attention to an ancient killer.

Brad Tytel is a Director at Global Health Strategies, an international consulting company that uses advocacy and communications to help ensure development and worldwide delivery of health technologies and information – including for TB.

Photo captions: Activists in Nairobi, Kenya, call on donor governments to stop TB, AIDS and Malaria – November 2009. Credit: Global Helath Strategies