World Day of Social Justice: The right to TB prevention

On World Day of Social Justice, 20 February, The Union urges global leaders to implement effective TB prevention programmes as a matter of the highest urgency.

An article published this week in The Lancet Respiratory Medicine, led by Matthew Quaife of the London School of Hygiene and Tropical Medicine with co-authorship including The Union’s Professor Anthony Harries, shows that the long-term health outcomes, measured in ‘Disability-Adjusted Life Years (DALYs)’, have been hugely underestimated for tuberculosis (TB).

The article takes an in-depth look at the range and extent of post-TB health problems as experienced by many TB survivors, an area which has received comparatively little interest to date. DALYs are used to measure the sum of the years of life lost due to premature death and years lived with disability.

Prof Harries, Senior Advisor of Research at The Union, said: “TB is a curable and treatable disease. Yet when we talk about it in these terms, we diminish the long-term effects that many people suffer after receiving a ‘cure’. We must ensure we’re focusing not just on curing TB but preventing it before it begins.”

The report states: “One implication of accounting for post-TB ill health is a change in the prioritisation of TB programming. For example, the impact and cost effectiveness of preventative interventions will increase due to greater DALYs averted per TB episode prevented—particularly relevant in the context of recent vaccine trials and high-level political commitments to provide preventative therapy to 30 million individuals by 2022.”

The World Health Organization (WHO) has set targets to end the TB epidemic across the world by 2030 and at the United National High Level Meeting (UN HLM) on TB in 2018 global leaders committed to put 30 million people on TB preventative treatment by 2020. Specifically, world leaders promised to reach six million people living with HIV (PLHIV), four million children aged under five years and 20 million people in close contact with someone with TB disease.

Yet the world is not on track to reach those targets. To date just 1.8 million PLHIV, approximately 350,000 children under five years of age, and 79,000 household contacts of people with TB have received TB preventive treatment.

Prof Harries said: “This study further upholds The Union’s position that anyone, anywhere, who is at risk of developing TB must have the right to receive appropriate, timely and effective preventive treatment. Preventing TB everywhere we work is more than just sound public health policy – it is a human right to know a person’s risk of developing disease and to have the tools available to avoid falling ill."

Two Union studies have already clearly demonstrated the efficacy and value of TB prevention.

  • Final results from The Union’s TITI study showed that some 1,700 children under five years of age were saved from potentially developing TB in four countries in Francophone Africa thanks to TB preventive treatment.
  • And projects like DETECT Child TB in Uganda demonstrated that by equipping medical professionals with the knowledge and tools to diagnose and treat TB in children and providing access to care at the community level, TB prevention for children in resource-limited settings increased from five percent to 72 percent by the end of the pilot phase.

Read the WHO country-by-country breakdowns for information on where TB prevention is being embraced, and where there is much work still to be done.

Advancing Prevention is the theme of the 51st Union Conference on Lung Health in Seville, Spain, 21-24 October 2020. To find out more please follow @UnionConference and use the hashtag #AdvancingPrevention on Twitter and Facebook.