TB Science Meets Global Health Advocacy: Some Thoughts from Liverpool

Michelle Imison

By the time you read this I’ll be home from Liverpool, in the north-west of England. where last week, on behalf of RESULTS Australia, I attended the International Union Against Tuberculosis and Lung Disease (‘The Union’). The 47th World Conference, addressed a wide range of issues affecting adult and child lung health including air pollution, pneumonia, tobacco control – and, of course, tuberculosis (TB).

Global scientific gatherings like this – over 3000 people attended – are, as you’d expect, very much about new biomedical discoveries: in bacteriology, immunology, drugs and diagnostics, disease prevention, patient care and links between TB and diseases such as HIV and diabetes. So this got me thinking: what is the role of advocacy at a scientific conference?

First: it’s to keep a focus on people. In Australia we worked for a strong replenishment so that Global Fund-supported programmes can continue to build health systems and save lives. We also know from advocacy with our own MPs that the stories of individuals helped by these programmes are powerful. But the medical establishment and society more broadly aren’t always supportive of these people – especially if they are poor.

In Liverpool I met some patient advocates, including members of TB Proof from South Africa. Many of its members are medical and health professionals, some of whom have themselves survived TB. Their Unmask Stigma campaign is a reminder of how imposed psychological burdens of suffering can compound and worsen physical ill-health – and of the part we can all play in relieving those burdens.

Second: we have to act where we are, and advocacy at a conference like this is about paying attention to national context. As we know, although Australia’s own TB control is strong, Papua New Guinea, just to our north, suffers badly with multi-drug-resistant (MDR) TB. I know that RESULTS grassroots advocates are passionate about addressing injustices like this but we can also be rightly concerned about MDR-TB’s health implications for Australia, since it’s an airborne infection. Australia’s special funding allocation for TB in Western Province expires early next year, and we’re working to ensure that it is both renewed and expanded. There was strong interest in a paper I presented in Liverpool about the Australasian TB Forum, a regional grouping of researchers, policy-makers, patient advocates and others with expertise in TB who are working with us in this and providing a strong, local evidence base for RESULTS’ parliamentary advocacy.

Third: advocacy also involves acting in the wider international social and political landscape for TB. In the two days prior to the conference in Liverpool, I met with around 25 of my colleagues from ACTION, the global health advocacy organisation of which RESULTS International (Australia) is part. We talked about upcoming international opportunities to further the TB advocacy agenda:

  • co-ordinating our on-going work on and with the Global Fund (a lot of people continue to pay very close attention to how our AU$220m – and the rest! – will be spent)
  • the growing institutional appetite for action, particularly through the G20, on antimicrobial resistance – for which TB is the ‘poster child’,
  • continuing ACTION’s and others’ efforts to expand the inadequate pool of funding for research into and development of new preventive tools, drugs and diagnostics for TB
  • building on the work of the national, regional and global TB Caucuses. These groups of parliamentarians working to generate the political will and resources needed to end TB now number over 2000 members in 120 countries. Many of the co-Chairs of regional TB Caucuses met for several days in Liverpool – including Australian co-Chair Warren Entsch MP and his Asia-Pacific co-Chair Dr Helen Tan MP, from the Philippines. I had the privilege of meeting several of these regional co-Chairs, and can attest to their passion, knowledge and commitment to the task.

Long-term advocacy is about patiently and repeatedly pushing as many ‘levers’ as possible, at the right time, and taking advantage of opportunities and synergies that arise. It’s necessary because the obvious needs and good investments and smart ideas don’t simply rise to the top on their own. In the words of Global Caucus co-Chair Nick Herbert MP, TB has been for too long an ‘orphan disease’ – but it seems as though knowledge, resources and ambition are finally coming together in its favour. 2017 should be an interesting year in global TB advocacy – watch this space…