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Oct 15 – Global Handwashing Day (really it is!)

Global Handwashing Day was founded by the Global Handwashing Partnership in 2008 as an opportunity to “design and implement creative ways to encourage people to wash their hands with soap, especially during critical times”.

Well it’s certainly safe to say that almost all of us have been washing our hands a lot more in the last eight months which (let’s face it) have remained especially critical

We want to use this day, though, to pose another question entirely, which is this: In washing our hands to protect ourselves from one infectious infection, are we unconsciously complicit in washing our hands of another?

We ask this question because two years ago the political leaders of every UN member country committed to meeting a set of ambitious targets relating to ending TB by 2030, and these included a set of important interim targets for 2022.

The truth is that not all of these interim targets were likely to be met – that wasn’t their point: their point was that they had been agreed by all of the world’s leaders with the idea that serious effort would then be made towards meeting them. And anyway, even if they weren’t met, any effort towards meeting them would result in a much needed and long-overdue change of fortune for TB patients the world over.

So just how serious is TB?

It’s worth identifying just what a serious disease TB is. It’s the most lethal infectious disease on the planet – and this is in spite of the million deaths from the current coronavirus pandemic. What’s more disturbing, though, is that this status persists despite TB having been declared an official global emergency 27 years ago with various targets relating to its eradication having been set (and missed) several times over in the last three decades.

What’s more, in spite of all these targets being set, around one-in-six of those 10 million contracting TB each year are still dying from their infections. This amounts to a case fatality ratio of 16% - which is possibly as much as 20 times higher than those currently being estimated for the coronavirus (no-one’s agreed on this yet). What’s even wrse is the fact that this host of victims are still dying from TB infections despite there being a set of (very cheap) out of patent drugs that should successfully treat the disease in 95% of cases. (And sadder still as we’ll see, because of COVID-19 this year’s case fatality ratio for TB will inevitably be higher still).

So while you may have been drawn to this blog because of it honouring ‘Global Handwashing Day’ (and because you might have assumed it would relate to handwashing for reducing infection from the coronavirus) we hope that you will consider this day for a very different reason as well: because we fear that the world’s leaders are in the process of once again washing their hands of this ancient plague at a time when they simply mustn’t do so.

Of course, we fully recognise that everything in the world of infectious disease has currently changed because of the mutant coronavirus. Moreover, not for a second would we want to belittle the gravity of the current novel viral pandemic. But nevertheless, we can’t help but wonder whether the world’s leaders are (this very day) assiduously washing their hands in their respective bathrooms (and encouraging us to do the same in order to protect us all from one infectious disease) while at the same time metaphorically washing their hands of another one that is actually more dangerous and is anything but novel.

The monumental differences in budgetary resource

We are in no doubt at all that this handwashing is happening – the massive amounts of money being thrown at controlling the coronavirus pandemic dwarf the proportionately paltry budget annually awarded to controlling TB globally (and the pathetic shortfalls that are reported annually in meeting this smaller budget unquestionably confirms this further).

For example, the 2018 Political Declaration at the UN committed the world’s leaders to mobilizing US$13 billion annually to enable universal access to TB diagnosis, treatment and care by 2022. In 2018 (the last year reported on) they fell short of this goal by over US$ 6 billion (or nearly 50%).

The UK government, meanwhile, has so far committed at least £210 billion (roughly US$ 275 billion) to fighting the country’s COVID epidemic.

Let’s just remind ourselves of those numbers committed to TB by all UN member countries: the total annual global budget for TB set for the last reported year was US$ 13 billion – or a twentieth of what the UK has so far committed this year to COVID…. (and there was a shortfall to last year’s budget amounting to US$6 billion, so the actual amount globally mobilised to fight TB was a mere fortieth of what is so far being spent fighting COVID in this one industrialised country).

There was a further UN member state commitment to mobilize at least US$ 2 billion annually for TB research for new drugs and diagnostics – but in the last reported year the world only actually managed to commit a paltry 40% of this target.

In contrast so far this year the U.S. alone has already committed more than ten times this amount (over US$ 7 billion) just to COVID vaccine research (forget drugs and diagnostics).

So how many times over could those serial annual shortfalls have been met by the sorts of sums currently being thrown (just by developed countries) against COVID-19? And what difference could this have been making to the rolling death toll?

It doesn’t bear thinking about - or rather, actually it really DOES bear thinking about!

Vaccine research – more revealing differences

Then let’s take a look at vaccine research – the talk of the town for rescuing us all from COVID-19 so that we can all get back to normal (whatever that is).

Back in April (technically only a month into the pandemic) the WHO announced that there were already over 70 candidate vaccines in some stage of development for the coronavirus across the world and since then, God knows how many billions of dollars have been being invested in them.

Meanwhile, eight years ago Dr Peter Small (of the Gates Foundation) observed that ten years earlier (i.e. in 2002 which was a full nine years after TB had been officially declared a Global Emergency) “all of the TB vaccine researchers in the world would have fitted into a minivan”.

Let’s be generous here and assume he meant a Toyota Hiace van as used as public transport all over the Global South. If so Dr Small meant that in 2002 fourteen researchers were trying to investigate a way to protect the world from the ravages of TB – at a time when the disease was easily taking 2 million lives a year (and actually may even still be doing so given the continuing paucity of surveillance).

In fact we’d state with some confidence that TB has almost certainly killed at least 40 million since the turn of this current century and that there’s still no new TB vaccine in sight (though much more money has indeed been invested since and candidate vaccines do finally now exist).

Recent Targets for preventative treatment for tuberculosis

Meanwhile, how about those important interim TB targets that global leaders set for 2022 (reminding ourselves that this was unanimously set by all UN member countries)?

Well here's one of them: our global leaders committed to ensuring access to TB preventive treatment for “at least 24 million household contacts of people with active TB” by 2022. Please bear in mind that such preventative therapy is an obvious, cheap and effective way of stifling the headwaters of the incessant river of death that is global tuberculosis. In fact, preventative treatment is almost the only way of defeating any infectious disease (ask the epidemiologists and those researchers working on a COVID vaccine).

Well in 2018 (which was the first year of the five year target) the sum total of household contacts who were put on preventative therapy wasn’t a fifth of 24 million as might be hoped. It was actually less than a fiftieth (or numerically less than 430,000).

This year’s impending Global TB Report

Later this month we should see a new Global TB Report published by the WHO. This one will be reporting specifically on 2019, only in the last few weeks of which anyone in Geneva would have heard of a new infectious virus rearing its ugly head in Wuhan.

In other words, there will be no accurate assessment at all as to how these TB targets will have further suffered in the current conaviral year (2020): we’ll have to wait another twelve months to learn that. But anyone with the finger on the pulse of the tuberculosis pandemic already has a very good idea of how TB control will have suffered because:

- National TB programmes in all TB endemic countries have had their resources (both financial and human) ‘borrowed’ to fight COVID.

- TB suspect cases aren’t showing up at TB clinics for diagnosis and treatment in normal numbers because (like all of us visiting health centres everywhere) they're scared of contracting the novel coronavirus if they do so (something which is doubly tragic considering that TB is anywhere between five to ten times more dangerous than the coronavirus).

- TB patients have interrupted their treatments for the same reason, or because drug supplies have stocked out because of COVID-related logistical issues.

- And so both incidence and mortality rates are expected to rise significantly over the next six years.

It’s not epidemiological rocket science: the first three factors above will inevitably lead to more disease down the road, along with many more deaths and also more drug-resistance.

So please, world leaders, don’t allow is to collectively wash our hands of this ancient killer at the same time as we continue to wash our hands for COVID-19. TB has killed at least 50 million since 1993 when you first declared it to be a Global Emergency. Surely that’s enough now? Meanwhile the death toll from COVID-19 has only just broached the million mark.

And also, once we have finally learnt how to manage this coronavirus please don’t turn your eyes away again from those who still die from TB simply because almost all of them are poor and so have voices which generally remain unheard (because we know that’s why you've washed your hands of them in the past).

It’s your job as global governors to protect all of the members of our human family which doesn’t just mean those in the richer nations. It includes the poor and the powerless – essentially the most vulnerable of all.

To quote Paulo Freire, the Brazilian philosopher who was intent on teaching mankind how best to engage critically with the state of our world and so participate in its transformation:

Washing one's hands of the conflict between the powerful and the powerless means to side with the powerful, not to be neutral.

His words are as relevant today on this Global Handwashing Day 2020 as on any other.

So as you wash your hands today and tomorrow, have a think about it... whose side are you on?


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