<div dir="ltr"><div class="gmail_default" style="font-size:large"><br></div><br><div class="gmail_quote"><div dir="ltr" class="gmail_attr">---------- Forwarded message ---------<br>From: <span dir="auto"><<a href="mailto:dlegge@phmovement.org">dlegge@phmovement.org</a>></span><br>Date: Fri, Jan 19, 2024 at 2:01 PM<br></div><br><div class="msg-647105327405751356"><div bgcolor="#FAFAFA" link="blue" vlink="purple" style="word-wrap:break-word" lang="EN-AU"><div class="m_-647105327405751356WordSection1"><div align="center"><table style="width:154.62%;background:#fafafa;border-collapse:collapse" width="154%" cellspacing="0" cellpadding="0" border="0"><tbody><tr><td style="width:100.0%;padding:7.5pt 7.5pt 7.5pt 7.5pt" width="100%" valign="top"><div align="center"><table style="width:450.0pt;border-collapse:collapse" width="600" cellspacing="0" cellpadding="0" border="0"><tbody><tr><td style="width:450.0pt;padding:0cm 0cm 0cm 0cm" width="600" valign="top"><div align="center"><table style="max-width:450.0pt;border-collapse:collapse" cellspacing="0" cellpadding="0" border="0"><tbody><tr><td style="background:#fafafa;padding:6.75pt 0cm 6.75pt 0cm" valign="top"><table style="width:100.0%;border-collapse:collapse" width="100%" cellspacing="0" cellpadding="0" border="0"><tbody><tr><td style="padding:6.75pt 0cm 0cm 0cm" valign="top"><table style="width:100.0%;border-collapse:collapse" width="100%" cellspacing="0" cellpadding="0" border="0" align="left"><tbody><tr><td style="width:450.0pt;padding:0cm 0cm 0cm 0cm" width="600" valign="top"><table style="width:100.0%;border-collapse:collapse" width="100%" cellspacing="0" cellpadding="0" border="0" align="left"><tbody><tr><td style="padding:0cm 13.5pt 6.75pt 13.5pt" valign="top"><p class="MsoNormal" style="text-align:center" align="center"><span style="font-size:9.0pt;font-family:"Tahoma",sans-serif;color:#656565"><a href="https://mailchi.mp/phmovement/eb154-09_immunisation-17630401?e=5f3cea0f3e" target="_blank"><span style="color:#656565">View this email in your browser</span></a><u></u><u></u></span></p></td></tr></tbody></table></td></tr></tbody></table></td></tr></tbody></table></td></tr><tr><td style="background:white;padding:6.75pt 0cm 0cm 0cm;background:cover;background-size:cover" id="m_-647105327405751356templateHeader" valign="top"><table style="width:100.0%;border-collapse:collapse;min-width:100%" width="100%" cellspacing="0" cellpadding="0" border="0"><tbody><tr><td style="padding:6.75pt 6.75pt 6.75pt 6.75pt;min-width:100%" valign="top"><table style="width:100.0%;border-collapse:collapse" width="100%" cellspacing="0" cellpadding="0" border="0" align="left"><tbody><tr><td style="padding:0cm 6.75pt 0cm 6.75pt;min-width:100%" valign="top"><p class="MsoNormal" style="text-align:center" align="center"><img style="width:5.875in;height:3.2083in" id="m_-647105327405751356_x0000_i1030" src="https://mcusercontent.com/559d715f58f654accf3de987e/images/0b1bd6d2-85d4-c0fe-ef58-a4a1ab9cc235.jpg" width="564" height="308" border="0"><u></u><u></u></p></td></tr></tbody></table></td></tr></tbody></table></td></tr><tr><td style="border:none;border-bottom:solid #eaeaea 1.5pt;background:white;padding:0cm 0cm 6.75pt 0cm;background:cover;background-size:cover" id="m_-647105327405751356templateBody" valign="top"><table style="width:100.0%;border-collapse:collapse;min-width:100%" width="100%" cellspacing="0" cellpadding="0" border="0"><tbody><tr><td style="padding:6.75pt 0cm 0cm 0cm;min-width:100%" valign="top"><table style="width:100.0%;border-collapse:collapse" width="100%" cellspacing="0" cellpadding="0" border="0" align="left"><tbody><tr><td style="width:450.0pt;padding:0cm 0cm 0cm 0cm;max-width:100%;min-width:100%" width="600" valign="top"><table style="width:100.0%;border-collapse:collapse;word-break:break-word" width="100%" cellspacing="0" cellpadding="0" border="0" align="left"><tbody><tr><td style="padding:0cm 13.5pt 6.75pt 13.5pt" valign="top"><h1 style="text-align:center" align="center">TB morbidity reflects poverty and exclusion<u></u><u></u></h1><h2 style="text-align:center" align="center">TB control depends on confronting these drivers <u></u><u></u></h2><p class="MsoNormal" style="margin-right:0cm;margin-bottom:7.5pt;margin-left:0cm"><span style="font-size:9.0pt;font-family:"Tahoma",sans-serif;color:#202020">WHO’s Executive Board meeting this week in Geneva will consider a report on tuberculosis (<a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=70b318eccc&e=5f3cea0f3e" target="_blank"><span style="color:#007c89">EB154/10</span></a>) which shows that on every indicator the current levels of achievement are far behind what it takes to achieve the agreed global targets. Incidence and mortality continue to be high, treatment coverage stagnates, and preventive treatment rises too slowly. A considerable proportion of symptomatic cases are missed.<br><br>The objective of 100% financial protection is still far off with over half the patients experiencing catastrophic health expenditure. Over 80% of people with drug resistant TB experience catastrophic health expenditure. The use of rapid diagnostic tests that were projected as becoming the first line of diagnostics for 100% of cases, has a coverage of only about 47%. Only two out of five drug resistant TB patients are enrolled in treatment. In terms of funding, the present budget available for TB in LMICs would have to quadruple to meet the target of $22 billion funding, and as of now over 80% of this funding is coming from domestic financing.<u></u><u></u></span></p><h3>Universal access to comprehensive primary health care<u></u><u></u></h3><p class="MsoNormal"><span style="font-size:9.0pt;font-family:"Tahoma",sans-serif;color:#202020">Critical to controlling TB is the need to strengthen and universalize access to primary health care so that fewer cases of infectious tuberculosis are missed and so as to ensure follow up and medication compliance. As many as 50 percent of those with symptomatic lung tuberculosis are not seeking appropriate care. Whereas active case finding will help, this needs to be done as part of routine work where health workers are in close solidarity and support of all families through regular visits, rather than a reliance on sporadic campaigns. Technology improves care for those who have entered the care cascade but does not touch the problem of the many who have not entered it.<br> <u></u><u></u></span></p><h3>Malnutrition, overcrowding, unsafe working conditions<u></u><u></u></h3><p class="MsoNormal"><span style="font-size:9.0pt;font-family:"Tahoma",sans-serif;color:#202020">The second major requirement for TB control is effective action on social determinants taken to scale. This depends on governments pursuing a development path that would reduce inequities and proactively reach out to the poorest and most marginalized. <br><br>Nutrition is critical. Recent studies have demonstrated that nutrition supplements lead to better patient outcomes and prevent the development of disease in contacts (<a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=6e267f12c7&e=5f3cea0f3e" target="_blank"><span style="color:#007c89">Bhargava et al, 2023a</span></a> and <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=93371c0033&e=5f3cea0f3e" target="_blank"><span style="color:#007c89">Bhargava et al 2023b</span></a>).<br><br>Governments must choose programmes and development pathways that eliminate hunger and malnutrition in the entire population. Both pandemics and wars aggravate the food crisis and create nutrition insecurity. Climate changes worsens with respect to food production, procurement and distribution. Mitigation and adaptation strategies must address these crises. <br><br>Other social determinants include housing (overcrowded shelters), poor working conditions with low wages, and occupational lung disease. While introduction of new technologies is welcome, the notion that TB can be eliminated without addressing social determinants is fantasy. <u></u><u></u></span></p><h3><br>Conflicted innovation system<u></u><u></u></h3><p class="MsoNormal" style="margin-right:0cm;margin-bottom:7.5pt;margin-left:0cm"><span style="font-size:9.0pt;font-family:"Tahoma",sans-serif;color:#202020">The report advises that “Overall, the development of novel tuberculosis vaccines, diagnostics and medicines and critical research projects is advancing slowly mainly due to inadequate funding.” Tuberculosis research and development investment of US$1 billion in 2021-2 is far below the United Nations global target of US$ 5 billion per year by 2027.” Global treatment targets are based on assumptions regarding a new range of technologies, in particular, a vaccine. Though work is underway, progress is too slow.<br><br>The promised shift from sputum microscopy to rapid molecular testing as the first line of TB diagnostics and for wider access to genomic testing for multi-drug resistance, would require considerable health systems strengthening and increased financial support.<br><br>The failure to go to scale with new technologies reflects supply chain barriers and intellectual property rights restrictions. These barriers are manifest as stockouts of anti-TB drugs including for drug resistant tuberculosis. Many of the drugs meant for MDR & XDR TB are under patent and are unaffordable for governments as well as civil society organisations working in tuberculosis care. <br><br>The report advises, “Wider availability of these (new) regimens requires improving supply and access to the drugs central to them, including through approaches that harmonize the interplay between trade, intellectual property and health.” Too many countries have failed to implement and utilise the flexibilities available under TRIPS, partly because of big power bullying but also misinformation by industry. A TRIPS waiver with the expansion of local production would be very useful. WHO must intervene more boldly to reform current trade and IPR barriers.<br><br>However, without comprehensive primary health care and action on the social determinants, the introduction of a new and costlier technologies will take up a larger share of public health budgets, giving the suppliers higher profits, but with only slow progress towards TB control.<u></u><u></u></span></p></td></tr></tbody></table></td></tr></tbody></table></td></tr></tbody></table><p class="MsoNormal"><u></u> <u></u></p><table style="width:100.0%;border-collapse:collapse;min-width:100%" width="100%" cellspacing="0" cellpadding="0" border="0"><tbody><tr><td style="padding:6.75pt 0cm 0cm 0cm" valign="top"><table style="width:100.0%;border-collapse:collapse" width="100%" cellspacing="0" cellpadding="0" border="0" align="left"><tbody><tr><td style="width:450.0pt;padding:0cm 0cm 0cm 0cm;max-width:100%;min-width:100%" width="600" valign="top"><table style="width:100.0%;border-collapse:collapse;word-break:break-word" width="100%" cellspacing="0" cellpadding="0" border="0" align="left"><tbody><tr><td style="padding:0cm 13.5pt 6.75pt 13.5pt" valign="top"><p class="MsoNormal" style="margin-right:0cm;margin-bottom:7.5pt;margin-left:0cm"><span style="font-size:9.0pt;font-family:"Tahoma",sans-serif;color:#202020">The full PHM commentary on this item (<a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=b8522b5eac&e=5f3cea0f3e" target="_blank"><span style="color:#007c89">here</span></a>) provides more detail and references. See also Tracker links to <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=c427f19f7f&e=5f3cea0f3e" target="_blank"><span style="color:#007c89">previous discussions of TB</span></a>.<u></u><u></u></span></p><p class="MsoNormal" style="margin-right:0cm;margin-bottom:7.5pt;margin-left:0cm"><span style="font-size:9.0pt;font-family:"Tahoma",sans-serif;color:#202020">The WHO Tracker and PHM item commentaries are produced as part of <b><span style="font-family:"Tahoma",sans-serif">WHO Watch</span></b> which is a project of the <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=36c505c551&e=5f3cea0f3e" target="_blank"><span style="color:#007c89">People's Health Movement</span></a> in association with <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=c5f7e4cb64&e=5f3cea0f3e" target="_blank"><span style="color:#007c89">Medicus Mundi International</span></a>, <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=5f2834e381&e=5f3cea0f3e" target="_blank"><span style="color:#007c89">Third World Network</span></a> and a number of other civil society networks. WHO Watch contributes to democratising global health governance, through new alliances, new information flows and by broadening the policy discourse.<u></u><u></u></span></p><p class="MsoNormal" style="margin-right:0cm;margin-bottom:7.5pt;margin-left:0cm"><span style="font-size:9.0pt;font-family:"Tahoma",sans-serif;color:#202020">See the WHO Tracker page for this EB154 session (<a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=81ae229eb3&e=5f3cea0f3e" target="_blank"><span style="color:#007c89">here</span></a>). See PHM’s <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=e7f630cd91&e=5f3cea0f3e" target="_blank"><span style="color:#007c89">integrated commentary</span></a> on the full agenda of EB154 (or read the <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=f52d0a635d&e=5f3cea0f3e" target="_blank"><span style="color:#007c89">flipbook version</span></a>). To ensure that you receive Update Alerts <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=42f0e09db4&e=5f3cea0f3e" target="_blank"><span style="color:#007c89">subscribe</span></a> to the Updater. <br><br>You can support WHO Watch by forwarding this Item Alert, by publicising the <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=22a569df00&e=5f3cea0f3e" target="_blank"><span style="color:#007c89">Tracker</span></a>, by inviting others to <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=4392b379a1&e=5f3cea0f3e" target="_blank"><span style="color:#007c89">subscribe to GHG Reports</span></a>; and by following us on social media via @PHMglobal and @WorldHealthWatch.<u></u><u></u></span></p><p class="MsoNormal" style="margin-right:0cm;margin-bottom:7.5pt;margin-left:0cm"><span style="font-size:9.0pt;font-family:"Tahoma",sans-serif;color:#202020">To provide feedback 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