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MESA: Estrategias para el control de la TB Topic: Declaración de Barcelona

noviembre 21, 2016
International TB Congress, 21 November 2016 José Luis Castro

Thank you for the opportunity to speak with you all today. In this room we have many of the world’s experts and leaders who are committed to changing the course of the TB epidemic. I will be focusing my remarks on the Barcelona Declaration, which is a political declaration. This is a very important document for our efforts to address tuberculosis globally.

First, some context in which the Barcelona Declaration came about.

It is remarkable, the shift that we have seen in the world’s response to TB. It was just a few years ago when the word, “elimination,” was almost a taboo word in the TB community. To speak of TB elimination, or of Ending TB, was controversial. It was provocative. We had a goal to end TB as a global health problem by 2050, but it was something that you only rarely heard people speak about.

That is not the case anymore. In fact, it’s just the opposite. Our community has come to embrace the goal of ending TB. In fact, we have set a goal to end the TB epidemic by 2030, and it is now up to us to do everything in our power to achieve it. To reach that goal it means we will need to have a bigger impact, and make faster progress, to a degree that we have not achieved before.

It is an extremely ambitious goal. It is a goal that will take huge changes in the way that we go about our work. If we carry on with business as usual, we will fail. It is as simple as that.

As you all know, just a few weeks ago, we received some disturbing news from the World Health Organization. Based on the data that WHO released for 2015, we now know that the global burden of TB is much higher than we previously thought.

Tuberculosis killed 1.8 million people in 2015.

The trends are heading in the wrong direction. Every day that goes by where we continue business as usual, 5,000 more people die from TB. At the same time, we are committed to the goal of ending the TB epidemic in just 15 years.

I think we all agree that we cannot continue this way. We must change the course of the epidemic, and we must do it quickly. We need a breakthrough. It is up to us.

When The Union was founded in Paris in 1920, it was founded by TB experts who knew that they needed a breakthrough. They founded The Union, and the breakthrough was the creation of the world’s first international organization with the mission of controlling TB around the world. This was a breakthrough in leadership and international organization.

By the 1950s, streptomycin had been discovered and was being used to treat tuberculosis, and Selman Waxman had earned the Nobel Prize for this discovery. This was a huge scientific breakthrough. It was also during this time that Sir John Crofton began treating TB patients with combinations of antibiotics, providing more promise than ever that we would one day see the end of tuberculosis.

In 1953, a year after Waxman earned the Nobel Prize, René and Jean Dubos published The White Plague, which remains one of the most important books about tuberculosis ever published. In that book they wrote, quote: “Tuberculosis is a social disease and presents problems that transcend the conventional medical approach . . . The impact of social and economic factors [must] be considered as much as the mechanisms by which tubercle bacilli cause damage to the human body.”

The social and economic factors are just as important as the medical factors. These words are just as true today.

Technical solutions are critical, but we all know they’re not sufficient on their own to end the TB epidemic.

As we all know, the first pillar of the DOTS framework is to have clear and sustained political commitment to supporting tuberculosis efforts. Political commitment is necessary to ensure we have enough resources, and that we have the right policies and laws in place to enable us to make progress against TB.

Within this this framework, political leaders, including parliamentarians, are as critical as doctors and nurses and medical researchers in the worldwide fight against TB.

Today, their commitment is more important than ever before. To end the TB epidemic, we need a political breakthrough just as badly as we need additional scientific and technical breakthroughs. We need a political breakthrough that is as transformative as the discovery of antibiotics was transformative for the clinical management of TB.

I believe that if we work together effectively as advocates, we can achieve that breakthrough and rally the political commitment we need to achieve the End TB Strategy.

In fact, I believe that today we are poised for a political breakthrough in the global response to TB, and that this breakthrough will be driven by at least three recent developments.

First, as we all know, TB is now the leading cause of death among the world’s infectious diseases. This unfortunate fact means that political leaders must begin to pay attention to TB at a level that they have not in the past. Second, TB drug-resistance has reached crisis levels. Last September we saw, for the first time ever, the United Nations General Assembly dedicate a high-level meeting to the issue of antimicrobial resistance. Last year we saw Prime Minister David Cameron’s government in the UK commission a review of antimicrobial resistance, led by Sir Jim O’Neill.

The UK Chief Medical Officer, Dame Sally Davies, called antimicrobial resistance a “catastrophic threat.” Drug-resistant tuberculosis is a key part of the AMR crisis—a crisis demanding attention on the global political agenda, alongside conflict, the refugee crisis, climate change and terrorism.

Third, and most importantly, for the first time in recent history we have a global network of elected officials who are committed to do their part to end TB.

It was here in the city of Barcelona where the first meeting of a group of parliamentarians interested in TB took place. It was during the 2014 Union World Conference on Lung Health.

The Right Honourable Nick Herbert, MP, from the UK parliament, was key in bringing that meeting together. Mr. Herbert is committed TB champion, and we are very fortunate for his leadership on tuberculosis. I had the pleasure of first meeting Mister Herbert in London several months before the Barcelona conference, and that was where he told me about his idea to create a global network of members of parliament who could work together to end tuberculosis.

And so with strong support from the UK All Parliamentary Group on Global Tuberculosis, RESULTS, the Stop TB Partnership, WHO and others, we worked together to convene the Global Tuberculosis Summit here in Barcelona. At that summit, the parliamentarians issued the Barcelona Declaration.

The declaration was a forward-looking document. It identified issues that are still on their way to becoming universally embraced as being a core part of our efforts – including the impact of diabetes on creating new cases of TB, and the need to address the severe social exclusion that TB patients face because of the stigma attached to the disease.

The issue of stigma, especially, goes beyond the clinical aspects of tuberculosis and recognizes, as Rene and Jean Dubos called attention to more than sixty years ago, that TB is a social disease that requires holistic approaches. Through the Barcelona Declaration, parliamentarians made clear, ambitious commitments.

They committed to use all the means at their disposal to generate sustained action from their governments, to secure the necessary funding for TB services, drawing from both domestic and international resources, and to place TB higher on the political agendas within their countries and globally.

They demanded that all patients everywhere, regardless of ability to pay, have access to fast, reliable diagnostics and high-quality care and treatment services. They called for a new model for conducting TB research and development that is suited to public health needs, and committed to supporting the development of new medicines, diagnostics and vaccines. And they insisted that patients and vulnerable communities be placed at the center of the response to TB, supporting civil society in their role to help ensure not only prevention, diagnosis and treatment, but also to end TB stigma and to support patients to have a much stronger voice.

Through the Barcelona Declaration, these members of parliament committed to establish the Global TB Caucus that would press for more effective responses to the epidemic that will secure an end to the TB epidemic within a generation, working with WHO, UNITAID, the Global Fund, the Stop TB Partnership, The Union, UNAIDS, and with NGOs around the world.

Following up on that first summit in Barcelona, fifty political officials from thirty countries gathered at the World Conference in Cape Town last year.

Today, the Global TB Caucus is a sustainable entity with a secretariat at the Stop TB Partnership. As of today, more than 2,000 members of parliament from more than 130 countries have signed onto the Barcelona Declaration, committing to take action against TB.

The Global Caucus is organizing into national TB caucuses and into regional networks now, too. For example, last March the national TB caucus in Georgia was launched, the Eurasian Parliamentary Group on TB was launched in June, the African TB Caucus was launched in July, as was a national TB caucus in Zimbabwe.

And last month in Liverpool, at the 47th Union World Conference on Lung Health, the first meeting of the Global TB Caucus Executive Committee came together, with parliamentarians from the UK, Kenya, Algeria, Cameroon, Nigeria, Zimbabwe, Uruguay, Australia, Philippines and Germany.

We have never before seen an organized network of members of parliament like this. Mr Nick Herbert gave a speech at the closing session of the Union World Conference in Liverpool, in which he said something that alarmed me.

He reminded us that the goals we set have committed us to ending TB in fifteen years. But at the current rate of progress, it will take more than a century.

The current commitments that we have simply are not enough. The ministers of health who came to Liverpool sat together for six straight hours, during which they described many challenges standing in the way of ending TB. They described political challenges caused by the absence of leadership.

Management challenges caused by weak systems and old technology being used in their programs. Technical challenges, caused by drug-resistance, comorbidities like TB-HIV and TBdiabetes, made worse by imperfect tools. Social challenges, caused by poverty and stigma.

This is why we need a political breakthrough, and that can only come about by having governments give much higher priority to TB than they have at any time in the past.

We need leadership at a higher political level, and by that I mean leadership at the highest political level. We need leadership from presidents and prime ministers. TB must be a priority of United Nations Secretary General-elect António Guterres…and TB must be a priority of the next Director General of the World Health Organization.

We all know that change is not easy—especially in the face of resistance.

And we also know that we are facing a significant amount of political uncertainty, not only in certain low- and middle-income countries but in Europe and the United States as well.

But if we stick together and support each other, and if we work with the Global TB Caucus to drive tuberculosis much higher on the political agendas nationally, regionally, and globally, then we can accelerate our progress toward TB elimination. 

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