A doctor examines a tuberculosis patient in a government TB hospital in India. (Source: AP Photo)
Tuberculosis is the child of poverty, and also its parent and provider. – Archbishop Desmond Tutu
The World Health Organization released in October 2015 its latest Global Tuberculosis Report, and it makes for grim reading for Asia and the Pacific. One of the oldest diseases known to man, is now again among the world’s top killers, overtaking HIV and AIDS. Almost 6.2 million cases or two-thirds of the global TB burden are estimated to be in Asia, with 40% in just three countries: India, Indonesia, and the People’s Republic of China. Revised estimates for Indonesia show a much higher TB burden of a million cases per year, representing 10% of global cases.
In addition to people getting sick and dying, the burden of TB is underlined by the costs associated with productivity losses and treatment, which can reach 4-7% of GDP according to previous World Bank estimates. These costs and deaths are expected to increase if the world cannot control the rising numbers of multi-drug resistant TB.
A recent report by the Independent Review on Anti-Microbial Resistance on multi-drug-resistant TB—an increasingly common and dangerous form of the disease—showed that in a “business-as-usual” scenario multi-drug-resistant TB could account for one-quarter of all deaths from drug-resistant infections by 2050, causing as many as 75 million premature deaths. This means an additional 2.6 million people could die every year from multi-drug-resistant TB, a figure equivalent to the number of people perishing from AIDS during the height of the epidemic in 2002. Most of these deaths would take place in Asia and the Pacific. Multi-drug-resistant TB could potentially cost the global economy as much as $16.7 trillion, and slash global GDP by 0.63%.
But there is room for hope. Although the region accounts for two-thirds of all global cases, it only reports 40% of the fatalities. Indeed, countries in Asia and the Pacific have responded well in treating TB, contributing to mortality falling by around 40% despite having the same number of new TB cases in 2014 as in 1990. Clearly, once political commitments are made, resources mobilized and health systems strengthened, countries in Asia and the Pacific have done good work in managing TB. Japan showed this 20 years ago when it tackled and controlled TB by strengthening its primary care system. However, much more needs to be done.
Fortunately, parliamentarians in many countries are increasingly turning their attention to the TB threat, and in September 2015 the Asia Pacific TB Caucus was launched as the first regional network of the Global TB Caucus, an international network of lawmakers committed to the fight against the disease. Co-chaired by MPs from Australia and the Philippines, the regional caucus includes representatives from India, Viet Nam, the Philippines, Australia, Indonesia, Papua New Guinea, the UK and New Zealand, and aims to build the political will to accelerate progress towards ending this disease. Caucus MPs vowed to take action both collectively and individually to drive progress against TB by working with national parliaments, regional and global organizations.
ADB is working on a broader regional health security agenda that aims to support efforts by ADB’s developing member countries to prepare for and implement necessary policies as well as mobilize resources to effectively tackle TB, malaria and other communicable diseases – not only within their respective borders but in collaborative action with other countries. Different financing instruments are currently being developed to support this strategy, including intensified health system interventions to address TB and particularly multi-drug-resistant TB.
TB is a threat to global and regional health security, given its airborne transmission and increasing resistance to existing antibiotics. It is a problem that cannot be resolved within countries alone. And with the large share of the burden of TB in Asia and the Pacific, it is a global problem that requires innovative solutions, political and financial commitments, and collaborative work from countries in Asia and the Pacific.
By Eduardo P. Banzon, Senior Health Specialist, Sustainable Development and Climate Change Department, Asian Development Bank