Humanitas Global Development Blog

TB Elimination in the Post-2015 MDG Agenda

Guest post by Kari Stoever, VP of External Affairs at Aeras

For centuries, the resilient and highly adaptable M. tuberculosis microorganism has survived and thrived alongside its human host. Tuberculosis (TB) was first reported in the Greek literature by Hippocrates as the most widespread and fatal disease of the times. Historically described as the “Great White Plague,” TB was the cause of more deaths in industrialized countries than any other disease during the 19th and early 20th centuries.

By the late 19th century, 70-90% of the urban populations of Europe and North America were infected with the TB bacillus, and about 80% of those individuals who developed active TB died of it. Today, more than 2 billion people, almost a third of the world’s population, are infected with TB, and this number will continue to grow without effective preventative measures. New TB vaccines would be the single greatest tool in mitigating the epidemic.

March 24 is World TB Day, and while we celebrate the great progress made by the public health community in reducing TB deaths, we cannot forget that there are nearly a million more cases of TB in the world today than when the World Health Organization (WHO) declared TB a global emergency 20 years ago.

Current efforts to address TB through active TB case finding, rapid diagnosis, increased access to drug susceptibility testing, and the prompt initiation of effective treatment are essential to controlling the disease and minimizing its health impact given the tools and resources available today. But this strategy has clear limitations. Three million people with TB went undiagnosed in 2012, equal to one third of all those falling ill with the disease every year. Of the estimated 450,000 new cases of multi-drug resistant TB in 2012, only slightly more than one-quarter were notified. Overall TB incidence has been declining at a mere 2% annually, and at this rate it will take at least 150 years to achieve TB elimination.

Nowhere are the limitations of the current TB strategy laid out more starkly than in the WHO's post-2015 TB targets, endorsed by the WHO Executive Board for consideration by the World Health Assembly in May 2014. Even if current efforts are scaled up for maximum impact, WHO's targets illustrate that the expected progress against TB will still fall far short of the TB elimination objective. The achievement of WHO’s TB targets for 2035 depend on the introduction of a new TB vaccine or other new prophylaxis by 2025. These expectations show that innovation will be required if we are to achieve TB elimination as quickly as possible, and that new preventive TB vaccines will need to sit at the center of this effort.

A new model incorporating data from 183 countries demonstrates that a partially efficacious (60%) adolescent and adult preventative vaccine, delivered to a mere 20% of the target population, could potentially avert as many as 30-50 million new cases of TB by 2050, depending on the year of vaccine introduction.

Photo credit: Reuters/Mike Hutchings

With recent advances in research and development of new drugs, diagnostics and vaccines, we are turning the tide on tuberculosis. Over the past decade, investments in TB vaccine R&D have resulted in a robust global TB vaccine portfolio with over a dozen candidates being tested in clinical trials and even more novel approaches to TB vaccination in early stages of discovery and development.

We must leverage growing public concern to catalyze political will and resources for the development of new vaccines, drugs and diagnostics to significantly accelerate global efforts to eliminate this ancient plague. While no one should be denied access to life-saving treatment today, austerity measures demand that we invest in longer-term strategies that could ultimately save billions in treatment costs while protecting future generations from one of the longest lasting and deadliest epidemics of mankind.

This World TB Day, we want to highlight a population highly susceptible to TB: mineworkers in southern Africa. South African gold miners are reported to have the highest rates of TB in the world, and, due to their migratory nature, they are spreading TB all across the region. Leaders of 15 Southern African nations, known as the Southern African Development Community (SADC), have pledged to confront the TB epidemic in the mining industry through investments in treatment and control programs. But these efforts alone cannot eliminate TB as a hazard to miners. The most effective way to protect mine workers, their families, and their communities, is with effective TB vaccines.

Kari Stoever is the VP of External Affairs at Aeras, a nonprofit biotech advancing new tuberculosis vaccines for the world. She has more than 15 years of experience leading all aspects of nonprofit and research initiatives. To learn more on what Areas and their TB research and advocate partners are doing to address TB in the mines, click here

World Water Day 2014: The Water-Energy Nexus

by Kiana Davis, Humanitas Global

This year’s World Water Day draws attention to two of the world’s greatest challenges – access to clean water and consistent, reliable access to electricity. Both are crucial to the development, health, and prosperity of our growing population.

Last year on World Water Day, we asked you to imagine what it would be like if you did not have sufficient water for the most basic aspects of your daily routine, such as brushing your teeth or making your morning pot of coffee.

This year, as we reflect on the role energy plays in water consumption and vice versa, try to imagine not being able to turn on your lights, heat your home, or use any electricity for a whole day. What far-reaching effects would this have on you, your family, and your community?

For 2.5 billion people worldwide – most living in development countries - limited access to electricity, or no access at all, is their daily reality. In addition, 768 million people do not have access to an “improved water source,” or a source of water that is free from contaminates such as feces, parasites, and other pollutants and 2.5 billion still utilize latrines that are unhygienic. According to reports, the people who lack access to clean water sources and sanitation are frequently the very same people who lack access to energy.

Water and energy are essentially co-dependent: water is necessary in the production of almost all forms of energy. Likewise, energy is needed to extract, treat, and distribute water. A study from The World Bank shows that 90% of all energy generated worldwide is “water-intensive" and projects that over the next two decades, energy consumption is expected to increase by 50%, while freshwater consumption by a shocking 85%. As demand for both freshwater and energy continues to intensify, resources around the world will be challenged and strained.

Those in developing countries and, already lacking adequate access to one or both of these essential resources,will undoubtedly suffer many of the harsh consequences of the rising consumption of water and energy.

As we celebrate this year’s World Water Day,we need to consider the best approaches and solutions to water and energy issues, and focus on the development of policies and practices that will lead to both energy security and sustainable water resources. 

 Learn more about this year's World Water Day celebrations by visiting UN Water. 

 

Guinea worm eradication: hopes and challenges

By Anna Diofasi, Humanitas Global

Earlier this year U.S. President Carter announced that guinea worm disease was nearing eradication. According to the latest data from the Carter Center, the number of reported cases in 2013 has decreased to 148 from 542 in 2012, with only four countries (South Sudan, Mali, Ethiopia and Chad) recording new infections. Nigeria, once responsible for half of guinea worm infections worldwide, has been certified as ‘guinea worm free’ by the WHO earlier this year.

The progress in its eradication has been especially impressive if we consider that just three decades ago guinea worm disease affected 3.5 million people a year in 20 countries worldwide. Assuming this trend continues, guinea worm disease will become the first parasitic disease, and, after smallpox, only the second human disease to be successfully eradicated.

Photo credit: http://www.cartercenter.org/

This is great news, both from a public health perspective and for poverty reduction. Guinea worm infections can be immensely painful, often preventing those afflicted from working or attending school for months. This economic burden on millions of vulnerable families has now been lifted, with wide-ranging positive effects on nutrition, educational attainment, and income generation. As this year’s Gates Annual Letter also highlights, health aid can be a phenomenal investment.

Important challenges remain, however, on the road to complete eradication. The WHO notes that finding and containing the last remaining cases is often the most arduous stage, as they tend to occur in remote and difficult-to-access rural areas. Political conflict and insecurity is another major threat to the final stages of the eradication process.

In South Sudan, where over 70% of new infections occur, the displacement of thousands of people due to political violence is making the continued monitoring and containment of new cases increasingly difficult. The South Sudan Guinea Worm Eradication program had to suspend operations in certain regions due to security concerns, though most village volunteers and field officers remain in place to ensure that progress in eliminating the disease continues.

Eradication efforts of other debilitating diseases, such as polio, have also been hampered by conflict and violence. In Syria, polio has re-appeared after 14 years of absence as vaccination campaigns fail to reach children in many rebel-held areas of the country. Somalia, declared polio-free in 2007, has seen the diseases re-emerge in 2013 following years of conflict that has made the provision of health services extremely difficult. In most cases, however, quick response by the international community and local health authorities has ensured that the spread of new infections was halted early on.

As a result of a concentrated global effort, with the active involvement of local communities, national governments, and international organizations, the eradication of guinea worm disease is within our reach. Successful vaccination campaigns across the world are bringing us closer to eradicating a host of debilitating and potentially fatal diseases like polio, measles, and meningitis.

At the same time, deworming initiatives across Asia and Africa have improved the lives of millions of children. Political conflict and violence can put eradication efforts at risk, but through engaging local communities and international donors, challenges presented by even the most precarious situations can be overcome.  

Women: Agents of Change

by Erica Oakley, Humanitas Global 

The first International Women’s Day was celebrated in 1911 in just a handful of countries. Today, the 103rd International Women's Day celebration is a global one. This year’s theme “Equality for women is progress for all” highlights the enormous role of women as agents of change.

The participation of women in leadership roles - across all levels of society - has increased greatly since the first International Women's Day, with many great improvements socially, politically, and economically; however there are great strides still needed.

Women are an essential and key building block to the building up of society. From the woman smallholder farmer that does backbreaking work to feed her family, to the woman elected president and leads a nation.

Photo Credit: UN Women in India

According to a 2013 paper commissioned by the World Bank, countries with women political leaders often see “higher standards of living with positive developments in education, infrastructure and health, and concrete steps to help make democracy deliver.”

Many examples of societal improvements under women’s leadership provided in the report include prioritization of childcare, water infrastructure, improved roads,reproductive rights, higher focus on education, poverty alleviation, focus on land rights and improved health care. 

Women's footprint on societal development does not stop at a political level. We know that women are just as influential as the movers and drivers of change at the household and community level as they are at the national level - if not more so.

When women are provided the resources, information, and opportunities to succeed, the impact on society is enormous. Their children are more likely to go to school, their families are more likely to receive the nutrition their bodies need, their incomes are more likely to increase, and the cycle of poverty is more likely to end. 

This International Women's Day, we should reflect on the societal, political, and economic contributions of women across all levels of society and applaud their efforts in raising their families, communities, and countries to a higher level. Women are agents of change and there is still much to be done.