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April 26, 2018

Speech given to Global TB Caucus – Parliamentary Consultation

I feel privileged to have this opportunity talk about why our efforts to end tuberculosis and to address NCDs are not separate struggles, but are actually closely interconnected. 

It’s one thing to know this in the abstract. But in the lives of patients everywhere, it is an urgent reality.

There was a young woman in India named Kavita Viskawarm. The Union produced a video with her to tell her story.  Kavita developed a fever and went to a doctor who gave her a blood test and diagnosed her with typhoid.

This was early in her third pregnancy. And for the first few months of her pregnancy, she was OK. But as time went by, her fever did not improve, and she developed a severe cough.

Kavita went to a private clinic, where a different doctor prescribed her more medication. But her symptoms continued for months. Around the time in which she was due to give birth, she was extremely sick – so sick that she lost her child. The typhoid diagnosis was not correct.

Eventually, Kavita was diagnosed with both TB and diabetes. Her story is a tragic reminder of why we need to address tuberculosis and NCDs together.

For some time now, we’ve known that TB and HIV work together, and we have to address both diseases together in an integrated way. In the same way, more and more people’s lives are threatened by a combination of TB and NCDs.

This year, as all of you know, the United Nations General Assembly is devoting two full days to issues of health, with back-to-back high-level meetings on TB and on NCDs.

We cannot let this opportunity pass us by. The progress we have made against tuberculosis is threatened by the global rise of NCDs.

TB and NCDs have some of the same drivers. Tobacco use, alcohol abuse, malnutrition and poor diet—these are drivers of both TB and NCDs.

One of the most serious rising challenges to ending TB is the global rise in diabetes. Diabetes weakens the immune system, making people with diabetes two to three times more likely to get active TB.

Diabetes affects around 400 million people today, and if we don’t stop it, about 600 million people will be living with diabetes by 2035. In China alone, the International Diabetes Federation forecasts that diabetes prevalence will increase to 10 percent of the population in 2035. And conservative models suggest that this increase in diabetes would offset the current downward trajectory of TB incidence by at least 3 percent.

In some regions of the world, nearly half of TB patients suffer from diabetes. We must address TB and diabetes together, in an integrated way. We’ll never be able to end TB if we don’t.

We’ve seen a similar thing happen before, with TB and HIV. Archbishop Desmond Tutu, who nearly died from TB himself, tried to describe the danger at the time. He said to imagine TB as kindling. Then he said to picture HIV as a match.

During the early years of the AIDS epidemic, TB skyrocketed. Eighteen countries in Africa saw TB rates quadruple. But the world was slow to act, despite clear evidence that HIV was fueling the spread of TB.

We don’t want history to repeat itself. Currently, around 11 percent of TB patients are coinfected with HIV. According to the World Health Organization, those living with TB and diabetes now account for 15% of all tuberculosis cases.

We have an opportunity to head off TB-diabetes before we see the worst of its impact.

Collaborative work on TB and diabetes has started, but has not yet taken off. Many actors need to become more actively involved, from the highest political levels to civil society and patient organizations.

Just as sub-Saharan Africa bore the brunt of the TB-HIV epidemic, South Asia is facing a co-epidemic of TB-diabetes.

The WHO classifies India, China, Indonesia, Pakistan and Brazil as high burden countries for TB. Soon, these same countries will have half the world’s people living with diabetes. We must act urgently.

What I have described here today is not just a health issue. The fight against tuberculosis and the rising NCD epidemic is a matter of human rights. This is why the theme of The Union World Conference in The Hague later this year is Declaring Our Rights. We must put the global response to TB and to NCDs on a strong human rights foundation.

People must have access to adequate, complete healthcare that takes proactive measures to ensure the best health outcomes.

People must be protected from predatory industries whose products threaten their lives and livelihood. Which is why we must insist that the manufacturing, marketing and sale of tobacco are incompatible with the human right to health.

And people must be able to access healthy, nutritious food.

If we want to get the most out of the UN High-Level Meetings on NCDs and TB, we must accept that we either address these issues together, or we fail to address them at all.

The outcomes of HLMs on TB and NCDs will impact the future of the world’s health for years to come. We are not on the path to ending TB. We are not on the path to controlling NCDs. This is our time to set a new course.

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