Statement at HIV/TB Global Leaders Forum
Dr Margaret Chan
Director-General of the World Health Organization
Excellencies, heads of state and government, President Sampaio, heads of UN agencies, representatives of civil society, ladies and gentlemen,
First and foremost, let me thank President Sampaio for launching this timely initiative. This Global Forum puts the spotlight on a strategic error that needs to be corrected: the uncoordinated approach to two epidemics that are closely interrelated, in mutually deadly ways. Previous speakers have rightly stressed the importance of integrated services.
Separate services do not make sense. Not for operational efficiency. Not for progress in reducing morbidity and mortality. And certainly not for patients.
TB is the most common life-threatening disease among people living with HIV and, in Africa, is the number one killer. Untreated, TB can kill within weeks, also in patients receiving antiretroviral therapy.
Nearly 3 million people in low- and middle-income countries are now receiving antiretroviral therapy. But where is the benefit if a person receives these life-prolonging drugs for AIDS, yet dies quickly from TB?
If the drive towards universal access for AIDS aims at reducing morbidity and mortality, then this drive simply must incorporate TB services. There are no technical obstacles standing in the way. WHO’s TB and HIV departments have developed a 12-point approach for integrating activities for the two diseases, from the grass roots level to national policies. This approach must now be taken to scale if we want to see good results.
Success stories tell us that we can, indeed, set our sights high. I am referring in particular to the striking progress in countries like Kenya, Malawi, and Rwanda. The First Lady of Rwanda has described the measures that led to an integration of these services in her country.
On average, half of the people with TB in Africa who are tested are found to be positive for HIV. But almost 80% of Africa’s TB patients are still not being tested for HIV. This is a missed opportunity on a huge scale, as testing is an entry point for life-saving interventions. Other effective approaches, such as intensified case finding for TB, preventive treatment, and infection control, are likewise underused.
Ladies and gentlemen,
We need to act with urgency. Ironically, a situation that we have long taken for granted – that TB is a curable disease – may actually be a window of opportunity that can close.
Earlier this year, WHO released a report indicating that multidrug-resistant TB has reached the highest levels ever recorded. Even more ominous is the emergence of extensively drug-resistant TB, which is virtually impossible to treat. To allow this form of TB to spread would be a setback of epic proportions, effectively taking treatment options back to the pre-antibiotic era.
We must urgently address the need for better tools, and make this a priority for research and development. A problem of this magnitude deserves something better than diagnostic tests that date back more than a century and drugs that are almost 40 years old. Clearly, the need to invest in R&D cannot be over-emphasized. We also need to strengthen human resources, as other speakers have noted.
We need to tackle the perennial problems, seen throughout the developing world, of inadequate numbers of staff at primary care level, weak or non-existent laboratory services, and poor management of drug procurement and the supply chain.
Here on this landmark occasion, I commit WHO on two fronts. First, I can assure you that our HIV and TB programmes will further strengthen their joint support to countries as they accelerate HIV/TB interventions. Second, we will do all we can to foster research for better diagnostics, drugs, and vaccines. Given the magnitude of preventable suffering, nothing less is acceptable.