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by Gideon Lasco
MANILA (Philippine Daily Inquirer / ANN) – Indeed, TB is nothing less than a public health emergency – and our leaders must treat it as such. We must end an illness that silently but surely kills the lives of so many people.
Tuberculosis, as a Lancet editorial once said, is a "non-bady" disease. Nobody dies in a few days. It is not very contagious. it does not come with rashes, bleeding or other dramatic symptoms. And it's been so long.
And yet, in terms of impact, TB should be considered the public health crisis of our time. In India alone, TB kills more than 400,000 people each year. In relative figures, the figures are no less disconcerting in Indonesia and the Philippines: 107,000 and 26,000 annual deaths, respectively. Several other Asian countries are considered highly affected by TB, including Bangladesh, China, Myanmar, Thailand and Vietnam.
In addition, although tuberculosis has been documented since ancient times, the disease is evolving with the emergence – and continuing evolution – of multidrug-resistant and extremely drug-resistant strains (MDR-TB and XDR-TB). ).
Normally, the standard treatment for tuberculosis takes six months (an already difficult treatment), but these strains require even longer treatments, which use expensive drugs, often inaccessible. The increase of HIV and diabetes adds to the complexity of TB control, making the body particularly vulnerable to mycobacterial infection. HIV infection rates may decrease worldwide, but it is the reverse that occurs in countries like the Philippines. The incidence of diabetes, meanwhile, is increasing throughout the region.
The Asian ministries of public health are fully aware of the threat posed by tuberculosis – which slowly but surely destroys body tissues (usually in the lungs), resulting in organ failure that can, in turn, lead to the death. At a high-level meeting of the United Nations General Assembly last September, various health ministers reaffirmed their commitment to propose an "urgent global response to a global epidemic." The Philippine Secretary of Health, Francisco Duque, said that we could not continue to act as if nothing had happened.
In the same speech, Duque called for the adoption of new technologies to identify TB cases – as well as for greater integration of health systems to facilitate patient monitoring and surveillance.
However, various factors have hindered the implementation of existing efforts and the search for new approaches. Directly observed treatment with short-course (TB-DOTS) – cornerstone of TB treatment – has not worked in many settings due to the inaccessibility of the centers where patients are expected to procure their daily medications, lack of human resources and, unfortunately, even the shortage of anti-TB drugs. Many people do not complete the six-month treatment, which causes relapses and antimicrobial resistance. Patients with MDR-TB, on the other hand, find it even more difficult to obtain adequate medication and care.
Since the long-term difficulty of TB treatment is long-term treatment, some suggest rethinking (or refining) TB treatment itself, that is, considering alternative approaches (eg for example, training and empowering community health workers to administer drugs). Another approach is to continue developing new drugs that can shorten the months of treatment – or vaccines to prevent the disease. For many countries, tackling TB necessarily means coping with the rise of HIV.
There are also scholars and activists who point out that poor living conditions – for example, overcrowding, lack of ventilation, inadequate or substandard food – play an important role in determining who is contracting TB. . They rightly argue that it can only stop TB if we tackle its social determinants. While recognizing that "concrete ideas for action are rare", these voices nevertheless highlight the need to provide social and economic support to poor urban communities in the region, in a context of rapid and constant migration, and in the context of the poor. growing inequalities.
Ultimately, however, all proposed actions will have to depend on political leadership commensurate with the magnitude of the problem. In recent decades, world leaders have responded quickly and forcefully to perceived or actual threats to public health – such as at the height of the SARS outbreak in 2003, especially when they generate enormous public interest (and media attention). We need the same political support that will provide sufficient resources – both financial and human – to detect, treat and prevent TB; Strengthen local health systems, mobilize new technologies and address the social determinants of TB.
Indeed, TB is nothing less than a public health emergency – and our leaders must treat it as such. We must end an illness that silently but surely kills the lives of so many people.
The writer is a doctor, a medical anthropologist and an editorialist of the Philippine Daily Inquirer. The newspaper is a member of Asia News Network, an alliance of 24 regional media titles. This article replaces the comments of the Asian Writers Circle on issues of importance to the region this week.
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