Following release of WHO TB report, a discussion examines how to end an epidemic

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Larry Gostin

Larry Gostin

“For some reason, diseases usually start equally among everyone in society, but every disease always falls down to the poorest of the poor,” Larry Gostin said Wednesday.

“Now we see that tuberculosis has fallen down to the poorest of the poor,” Gostin, O’Neill Institute Chair of Georgetown University and director of the World Health Organization Collaborating Center on Public Health Law and Human Rights said Wednesday, following the release of the WHO 2015 Global Tuberculosis Report.

In the wake of news that tuberculosis has surpassed HIV as the world’s leading infectious disease killer, Gostin was talking about how to end tuberculosis as a global threat.

For the poor, “we need justice, and we need global health with equity,” he said. The first step, he said, is to reach the most impoverished and marginalized people with appropriate screening, diagnosis, treatment  and support, instead of with interventions that are punitive and stigmatizing, including forced confinement.

TB will not end without new tools, including new prevention measures, treatment options, and a vaccine, Gostin continued.

The role of advocacy is critical too, he said.

“Enormous civil society advocacy,” he said, propelled research and development of HIV treatment, “And we don’t have the same advocacy for TB because the people affected are so poor and isolated.”

He added, “AIDS advocacy wasn’t pretty – it was rude, it was in your face.”

Funding for universal healthcare, which must focus on prevention as well as healthcare delivery, Gostin said, is also needed along with more funding to build stronger public health infrastructures.

The answer to ending the TB epidemic lies also in improved housing, better mental health services, services for drug addicts, income generation, and addressing a host of other social factors, Gostin said.

Gostin also said the Sustainable Development Goals should have better indicators, particularly for tuberculosis, and include benchmarks of success, monitoring and transparency. The United Nations, Gostin said, is unrealistic in not accompanying the SDGs with a funding strategy. The private sector, he said, will not foot the bill.

More than $5 billion was mobilized in a matter of months for the West African Ebola outbreak, said United Nations Special Envoy for TB Eric Goosby. Global TB donations come nowhere near that figure, he added, despite the fact that tuberculosis kills over 4,000 people every day.

Joanne Carter, executive director of RESULTS, said that the delayed release of the Obama Administration’s national action plan to combat multidrug-resistant TB is a “huge missed opportunity for US leadership.”

“We saw with HIV how you can drive down an epidemic – that’s the kind of resources and investments we need in TB,” she said. Countries most affected by tuberculosis are providing 87 percent of all TB funding, she said, and “in many cases we’re helping countries to be more ambitious and reach those they can’t reach,” Carter said.

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