March 24, World Tuberculosis Day, is an opportunity to focus on the people affected by this disease, the activists who are mobilizing to eradicate this pandemic by 2030, and to call for a faster and better coordinated international action to end the suffering and death from TB. At Global Health Advocates, we do believe it is essential to remind the importance of fighting this preventable disease of poverty, which remains one of the world’s biggest killers. This situation has been exacerbated by the Covid-19 crisis. This article underlines where we are at in the fight against tuberculosis and provides key recommendations from Bertrand Pfouminzhouer Kampoer, Regional Coordinator of DRAF TB.
TB in the world
According to the World Health Organization (WHO), every day, more than 4,100 people die from TB and nearly 30,000 people contract this preventable and treatable disease. TB is the leading cause of death among people living with HIV and is a major driver of antimicrobial resistance. Indeed, drug-resistant TB accounts for approximately one-third of all antimicrobial resistance deaths worldwide and poses a catastrophic risk to global health.
The consequences of the Covid-19 crisis
The Covid-19 crisis has undermined progress in the fight against tuberculosis. One of the main financing tools against the disease is the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria. Launched in 2002, the Fund has saved 44 million lives. Yet in 2020, for the first time in the Global Fund’s history, we saw a decline in key outcomes for all three diseases in countries where the Fund invests. The number of people treated for drug-resistant TB fell by 19%, while treatment for people with extensively drug-resistant TB fell by 37%. In total, the number of people treated for TB has declined by more than one million. In the countries where the Global Fund invests, between 2019 and 2020, there was a 6.5% increase in TB deaths.
Improving the fight against TB: Key recommendations from Bertrand Pfouminzhouer Kampoer
What changes need to be made in the fight against tuberculosis to meet the challenges set by the Covid-19 crisis? How can we eradicate this disease by 2030 and achieve the Sustainable Development Goal “Health and well-being” adopted by the United Nations? We interviewed Bertrand Pfouminhzhouer Kampoer, a Cameroonian activist who has been involved in the fight against tuberculosis for 20 years. He coordinates the DRAF TB network (Dynamique de la Réponse d’Afrique Francophone sur la Tuberculose), which is the regional coalition of communities affected by tuberculosis in 15 French-speaking African countries.
In 2022, Bertrand ‘s observation remains the same: people affected by tuberculosis are those who have the most difficulty accessing care, treatment and support services. Through the network of organizations he coordinates, he hopes to make the voices of French-speaking African communities affected by this disease heard, as they are less present in international governance bodies than English-speaking communities. Tuberculosis, a “forgotten disease” according to Bertrand, remains one of the most deadly diseases in the world, but the resources dedicated to it are inadequate. With the Covid-19 crisis, we have seen that in only a few weeks, a vaccine was found, whereas tuberculosis vaccine is a century-old and lacks efficacy. This shows that if the efforts were put in place, we could eradicate this disease. It is therefore a “health ethics issue” to help ensure that the voice of French-speaking African communities is heard effectively on these issues.
For Bertrand, the fight against tuberculosis is too often based on a clinical approach, which he considers too restricted and infantilizing for patients. In the response to the Covid-19 crisis, the use of community workers has been beneficial, and he would like to see the community-based approach expanded in TB control. Indeed, according to a study conducted by the DRAF TB network during the Covid-19 crisis, the community response facilitated the steps in the fight against the disease: by organizing the collection of salivary samples to establish the diagnosis, the costs of transporting screening were reduced and the fight against the disease was maintained. “Covid-19 has come to show us that when there are challenges in controlling an infection, the community approach can be used to facilitate key steps in the response”, Bertrand said. Thus, whether at the level of diagnosis, treatment, or patient support, all these steps were managed by community agents. For Bertrand, this model has proven to be effective: it is accepted by patients and directly contributes to the “paradigm shift” he advocates, reducing gender and human rights barriers to diagnosis and treatment.
In order to improve the fight against tuberculosis, it is essential to increase funding for tools to fight the disease. French-speaking Africa carries the highest burden of TB-related morbidity. This is why global actors must give assurances that this will change. It is therefore important to count on financial and political commitments, but also to rely on the community-based approach and take into account all the determinants that can affect the impact of the disease. Bertrand also advocates for more investment in tuberculosis in R&D and in health response mechanisms.