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TB: Historic Killer, Changing Threat

27 Oct 2018

The second plenary explored the history and evolution of tuberculosis (TB), exploring lessons for the future from this ever changing global threat.

The session opened with presenter, Sebastien Gagneux, Associate Professor of Infection Biology and Head of Department at the Swiss Tropical and Public Health Institute, giving a short history of the microbe taking in the co-evolution of man, animal and TB.

Gagneux, who specialises in the genomic epidemiology of tuberculosis, said there was much to gain by evolutionary thinking – that it informed three key tenets of TB control: vaccine development, drug resistance and zoonotic TB.

“Evolution and Ecology do matter,” said Gagneux, pointing out that such an approach enables the field to make some key assumptions:

  • Tuberculosis is not a clone
  • T-cell epitopes conserved: relevance for vaccine
  • MDR/XDR: compensatory evolution matters
  • Animal MBCT – need to consider the full life cycle
  • orygis” – unrecognised spillover from cattle to human in South Asia.

Gagneaux´s presentation was followed by a comparison of the global response to TB and HIV by Adeeba Kamarulzaman, Dean of the Faculty of Medicine and Professor of Medicine and Infectious Diseases at the University of Malaya in Kuala Lumpur, Malaysia and the President-Elect of the International AIDS Society.

In her presentation, titled, History of TB health care, and implications for END TB Strategy; lessons from HIV, Kamarulzaman argued that the 1960s saw a reemergence of TB in industrialised countries but that there was a total failure to respond to the disease in the developing world, terming this period the era of neglect. WHO for instance has only two to three people working on TB in the entire organisation at that time.

She pointed out that when HIV emerged in the 1980s it was characterised very early on with a high level of community activism and engagement which lobbied for inclusion in the researched political agenda. The AIDS epidemic was consequently characterised by decentralisation, public education and literacy campaigns, peer led interventions and community mobilisation.

Community pressure was also a driving force behind the scientific agenda and over the past 35 years has resulted in a steady pipeline of HIV antiretroviral drugs research breakthroughs such as treatment as prevention and funding commitments towards finding a vaccine or a cure.

TB on the other hand, was driven by a top down medicalised response and this lack of a community driven response for so many years restrained the response from being perceived and treated as an emergency.

The difference between the two epidemics was epitomsied by the preferred take up of ARVs as opposed to TB drugs by coinfected people.

Kamarulzaman concluded by saying that the TB sector needed to continue to increase consciousness raising around the disease, that it was a disease that needed to be humanized in order that funding gaps for research into diagnostics, drugs and vaccine research were priotorised on the global health agenda.

This point was taken up by the final speaker, Dianne Stewart, Head of the Donor Relations Department at The Global Fund to Fight AIDS, Tuberculosis and Malaria. In her presentation Closing gaps, changing trajectories – Ending TB, Stewart reiterated the deficiencies in the TB response, deferred to again at the recent UN HLM on TB, and focused on the urgent attention going forward for more investment in research and political commitment.

Stewart also added that the TB response needed to amplify the implementation of those facets of delivery that already had a strong evidence base and proven track record of success – expanding dramatically prevention efforts and the need to diagnose more people and improve patient outreach.

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