SA’s ‘remarkable leadership’ could turn global tide against TB

A doctor examines a patient with Tuberculosis. Picture: Gallo Images

A doctor examines a patient with Tuberculosis. Picture: Gallo Images

Following South Africa’s lead, the World Health Organisation updated its TB treatment guidelines to include bedaquiline.

In the run-up to the first-ever United Nations high-level meeting (HLM) on tuberculosis (TB) next week, the global health community has praised South Africa for its role in tackling the world’s deadliest infectious disease.

Heads of state, or their representatives, will gather in New York on Wednesday for the high-level meeting, to sign a political declaration that has been heralded as one of the most significant moves in the fight against TB to date.

“I think, for the world, South Africa has played an important role in the negotiations around the meeting, and showed remarkable leadership that should be applauded,” said Doctor’s Without Borders’ (MSF) Candice Sehoma.

The TB high-level meeting was proposed by Health Minister Aaron Motsoaledi in 2016 at another high-level meeting on health.

The TB summit, and the political declaration that will be ratified by countries there, has the potential “to turn the tide” against TB and it could be “a turning point in the fight against this terrible disease”, according to Dr Paula Fujiwara, the scientific director for the International Union Against TB and Lung Disease.

“We know that [these meetings] can be circuit breakers and you need look no further than the 2001 HLM on HIV which forever transformed that epidemic,” she said.

The HIV HLM galvanised the political will and resources used to tackle AIDS at a global level and a similar outcome is hoped for TB.

Following intense pressure by the United States, the first draft of the political declaration excluded references to public health safeguards that can be used to access affordable anti-TB medicines for poorer countries.

But on July 24, South Africa disrupted negotiations, calling for the declaration to include language around the World Trade Organisation’s Agreement on Trade-related Aspects of Intellectual Property (TRIPS).

TRIPS allow countries to use mechanisms to circumvent patent rights in the interests of making essential medicines affordable, particularly in public health emergencies.

“The lack of this language can only be interpreted as a move to protect the interests of drug companies at the expense of universal access and saving lives,” said Fujiwara.

Thanks to South Africa’s intervention, the final draft of the declaration now explicitly mentions TRIPS in the preamble but not in the sections of the document related to “actionable points”, according to Sehoma.

“We would have liked TRIPS to be incorporated in the operative language or actionable points. It was a compromise but it is still a very good thing to have in the preamble,” she said. “By taking a stance against a superpower like the United States, South Africa showed how serious they are in the fight against TB, and that we don’t care about profits, we care about human beings.”

The country has also received praise for the commitment that President Cyril Ramaphosa has made to attend the meeting and deliver a speech to representatives of UN member states.

“For us this is very significant because it shows that we are committed to dealing with the TB epidemic at the highest political level,” said Department of Health Deputy Director General Dr Yogan Pillay.

He said South Africa had also been a global leader in ensuring widespread access to the only new anti-TB drug developed in five decades: bedaquiline.

South Africa was the first in the world to officially include the drug in first-line treatment for drug-resistant TB, replacing some of the older existing medicines with significant side-effects, including deafness.

In August, following South Africa’s move, the World Health Organisation (WHO) updated its TB treatment guidelines to include bedaquiline.

Two thirds of all patients receiving bedaquiline are in South Africa, and because the drug is new and protected by intellectual property laws, the TRIPS language featuring in the declaration is particularly important.

Motsoaledi will also address the HLM in his role as chair of the Stop TB Partnership and has committed to implementing the political declaration as a matter of urgency, according to Pillay.

The declaration has many asks for countries, including committing to increasing global and domestic funding for research and development, finding the missing patients, ensuring broad access to affordable new drugs and ensuring that TB cases are properly monitored and reported.

The WHO released its annual Global TB Report this week which painted a grave picture of the status of the epidemic: 1.6 million people died of TB in 2017 despite the disease being preventable and curable.

It said that if TB efforts were not scaled up significantly, the world will not reach its goal to eradicate the disease by 2030.

Fujiwara congratulated “the extraordinary leadership that South Africa has shown” and for Ramaphosa’s attendance which, she said, “is highly significant”.

“As of 2016, TB has now surpassed HIV as the biggest infectious disease killer in the world. So the stakes [of this HLM] are really very high.”

– ANA-Health-e News

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