Tuberculosis as a Marker for Achieving Universal Health Care: McGill TB Day
On March 22, 2019, the McGill International TB Research Centre held it’s 7th Annual TB Research Day at the McGill University Health Centre. The event highlighted molecular, social, and epidemiological research being done at the Centre to help end TB, fitting well with the World Health Organization’s theme for this year’s TB Day: “It’s time to End TB.” Tuberculosis claims over 1 million lives each year, and although treatment is available, there is threat from drug resistant strains as well as accessibility of medication in endemic areas. Most of the TB-endemic areas are developing countries with weak healthcare systems since “TB is a marker of poverty,” as stated by Dr. Joia Mukherjee, this year’s Keynote Speaker at the Research Day. Dr. Mukherjee is an Associate Professor of Medicine and Associate Professor of Global Health and Social Medicine at the Harvard Medical School, as well as the Chief Medical Officer of Partners in Health (PIH). Her work focuses on design and implementation of universal health care (UHC) in low-resource settings, driven by the belief that health is a fundamental human right.
This year’s keynote lecture focused on the connection between the Sustainable Development Goal (SDG) of UHC and the goal to end TB. According to Dr. Mukherjee, UHC consists of two components:: providing health care and controlling disease. It is in the latter that she believes we have lost sight of human rights. For example, even though TB has high burden and mortality it was deemed “medium priority” in providing access to diagnosis and treatment as part of UHC since it is hard to control. Such a decision not only hinders the progress made towards ending TB, but also displays a parochial approach to assessing improvement in achieving UHC.
Having played a role as an AIDS activist in Africa during the HIV movement, Dr. Mukherjee had insightful ideas about its lessons that may serve beneficial to tackle the neglect in ending TB as part of the SDGs. First and foremost, it is critical to stop blaming “stigma” for the lack of public response in seeking TB diagnosis and treatment. In her experience of working with PIH in Haiti to provide HIV treatments, posters about specific diseases did little more than putting the blame on the patient for denying themselves treatment. Instead, giving people free access to clinics, having the correct technology, and improving conditions of the healthcare facilities not only helped reach goals of HIV treatment, but also helped diagnose other diseases, including TB, as more patients pursued treatment. This observation strengthened her belief that a more robust healthcare system ultimately leads to better treatment of endemic diseases, a phenomenon often recognized as a “horizontal approach” for healthcare delivery. In contrast, the Millennium Development Goals were a “vertical approach” to healthcare that centered on curative care, and was focused on eradication of specific diseases. Although Dr. Mukherjee voiced her support for the “horizontal approach,” Dr. Madhukar Pai eloquently stated that TB researchers still rely on the vertical approach to get their message across and to obtain funding for research, since TB does not get enough attention due to its classification as a medium priority disease. Hence, it is important to proceed towards TB eradication using both the horizontal and vertical approaches. Finding the correct balance to employ both tactics will be a challenge for TB leaders worldwide as they tackle the disease.
In any case, it is undeniable that seeing a decrease in TB cases by altering healthcare systems is a good indicator of a population’s health. The common theme throughout history of achieving health-related goals has been persistent activism; people need to demand specific changes from the government. Whether a vertical or a horizontal approach is applied, public collaboration is necessary, and survivor stories need to be heard to understand the impact of TB on millions of lives each year. As Dr. Mukherjee mentioned, during the AIDS epidemic, in the eight years it took for anti-retroviral treatment to reach low-resource settings in Africa, 8,000 lives were lost each day. Therefore, it is crucial that the international community learn from this mistake and unite to provide universal access to TB treatment, no matter how “complicated” it may be to control or to treat drug-resistant strains. This mindset is useful not just to assess a population’s access to healthcare, but it is also critical to end this deadly disease.
Rafia Bosan is a U3 student pursuing a degree in Microbiology and Immunology. She has a strong interest in global health, especially pertaining to drug-resistant and emerging infectious diseases.