Joint opinion piece by Burnet Institute Director and CEO Professor Brendan Crabb AC and Results Australia CEO Ms Negaya Chorley. Originally published in The Guardian.
When the pandemic unfolded, vital resources were diverted away from TB, with infections going undetected, untreated and unmanaged.
Few non-Indigenous Australians have had the misfortune of encountering tuberculosis (TB), an airborne bacteria which spreads through the lungs and leads to a bloody cough.
For First Nations Australians, however, the rates of TB infection is six times higher than the rest of the population – with the Northern Territory’s Top End, Queensland’s Cape York and Torres Strait particularly impacted.
This preventable and curable disease, if left untreated, causes an agonising death as it eats the lungs from the inside out.
Prior to Covid-19, TB was the world’s leading infectious disease killer.
In 2020, 1.5 million people died due to this invisible global epidemic – marking the first time in a decade there was a rise in deaths.
While most parts of Australia reached its elimination strategy a decade ago, modelling suggests elimination in the Top End isn’t likely until 2066.
A disease of poverty and economic distress, vulnerability, stigma and discrimination, according to the World Health Organization, tuberculosis targets not just Australia’s but the world’s most vulnerable populations.
Yet it is within our reach to rid Indigenous and Torres Strait communities of TB for good in Australia by putting to work the healthcare system that is regarded as one of the most sophisticated in the world.
But to protect Australia against further devastation caused by growing infectious disease outbreaks, and most importantly to help our neighbours, we must extend efforts beyond our northern borders where TB is an even worse scourge for our region. We have the capacity to make a huge difference.
Two-thirds of the total global tuberculosis burden – more concerning, the multi-drug-resistant variant of TB – is in the Asia Pacific region.
One of Australia’s nearest and dearest neighbours, Papua New Guinea – just 4km away – saw 39,000 people contract TB in 2020, including 11,000 children. Some 4,300 people died, while 34.2% of all the TB cases are drug resistant.
As Covid-19 unfolded, vital resources were diverted away from TB to fight this new pandemic. An already fragile health system was pushed to the brink. Despite best efforts, TB went undetected, untreated and unmanaged at rates not seen in years.
Without treatment, a person infected with TB can transmit the disease to as many as 15 other people in a year. The person-to-person spread presents the most significant risk, but misused medication, wrong dosages and unfinished courses can all lead to drug or multi-drug-resistant TB.
Once resistant, a curable and preventable disease becomes increasingly highly transmissible, and harder and more complicated to treat, with devastating outcomes for patients and communities as a whole.
This not only poses a far greater threat to TB elimination efforts in countries such as PNG, but also to the health and economic security of Australia and our entire region.
If we have learned anything from the past two years battling the pandemic, it’s that airborne diseases don’t respect borders and can wreak devastating domestic and global havoc.
The world is at a crossroads. We can resume progress towards stopping TB or see it re-emerge in new and dangerous forms. Possibly right on our doorstep.
We know how to fight this disease. But we must decide to act.
The Global Fund to Fight Aids, Tuberculosis and Malaria is our best mechanism. Over the past two decades, in countries where the Global Fund invests, TB deaths have reduced by a third. It provided 77% of all international financing to combat TB in 2020.
One of the key strengths of the Global Fund is that it directs funds and resources to where the need is greatest such as PNG and the Asia Pacific, and it empowers countries to determine their own solutions.
In 2020, 4.7 million people were treated for the disease in Global Fund-supported countries. But for the first time in its history, overall progress in countries where the Global Fund invests went backwards.
In this period, programs supported by the Global Fund tested and treated one million fewer people for TB, a decline of 18%. For drug-resistant and extensively drug-resistant TB, the results were even worse – a decline of 19% and 37% respectively.
But there is good news.
The Covid-19 pandemic has been the catalyst for new innovations in the fight against TB, such as multi-month dispensing of TB medicines and using digital tools for monitoring and introducing patient-centred diagnostic approaches such as simultaneous screening for TB and Covid-19.
It proved we can fight both diseases at the same time.
Community health workers, laboratories, diagnostic equipment, disease surveillance systems and other investments in the fight against TB continue to play a pivotal role in the fight against Covid.
That is one key reason why Australia should, at a minimum, lift its commitment to the Global Fund by pledging $450m towards its Seventh Replenishment, to be held later this year. Its new strategy places integration at its core.
Infectious diseases don’t stand still. They either contract or expand. We don’t have the luxury of asking TB to simply tread water while we deal with other priorities.
We must learn from Covid and not allow ourselves to become the generation that enables this awful yet preventable disease to resurge.
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