Image: Burnet Deputy Program Director (Health Security), Dr Suman Majumdar

On World TB Day 2017, Burnet’s Deputy Program Director of Health Security Dr Suman Majumdar is excited and optimistic about the latest advances globally and regionally in the fight against tuberculosis.

But he’s mindful also of sobering World Health Organization (WHO) data showing that TB was responsible for more deaths globally in 2015 – around 1.8 million – than HIV and malaria combined, making it the leading killer among infectious diseases.

“There’s a popular view that TB is a disease of the past, but it’s one of the most important health and development issues globally today, right now, and into the future,” Dr Majumdar said.

“And its elevation as the leading cause of death among communicable diseases highlights the enormous task ahead of us in the Asia-Pacific where the burden of disease is the greatest.”

Of the many initiatives on the drawing board, the United Nations General Assembly’s commitment to address TB at a high-level meeting in 2018, and a global Ministers of Health meeting on TB scheduled for later this year in Moscow, are widely regarded as potential ‘game changers’.

TB will be just the fifth health issue, after HIV/AIDS, Ebola, non-communicable diseases, and anti-microbial resistance, to be addressed by the UN General Assembly, and Dr Majumdar is hopeful of a global impact.

“Visionary political commitment is the first essential ingredient in an effective global response and we hope this can be translated into increased funding. One of the major gaps is the need to re-invigorate the TB research and development pipeline. In 2016 the funding gap was estimated at $1.6 billion,” he said.

Dr Majumdar said the United Nations’ Sustainable Development Goals, which include the elimination of TB as a public health threat by 2030, and the WHO’s End TB strategy (2015-2035) provide ambitious targets and lay down an enormous challenge to the global health community.

“We need to develop new tools, treatments, tests and prevention (vaccines) and optimise the implementation of what we are already doing,” he said.

“However, any progress towards the elimination of TB is threatened by the largely unmitigated spread of drug-resistant TB. Responding to this is a public health emergency.

“Drug-resistant TB treatment care is much more resource-intensive and costly to deliver and requires a functional health system.”

These ambitious goals and strategies are what we hope to realise in settings where the need is greatest, such as in Burnet’s RID-TB project to reduce the impact of drug-resistant TB (DR-TB) in Papua New Guinea (PNG).

The project is based in Daru, Western Province, where the rates of DR-TB are amongst the highest documented globally.

Burnet is part of a multi-stakeholder response, and the Burnet team in Daru, led by Dr Kudakwashe Chani, is working to support the provincial and national governments of PNG in their emergency response.

“The aim is to stop the DR-TB outbreak, that is, reduce the transmission of TB in hotspots,” Dr Chani said. “Since the project began in 2014, we have been able to stabilise the situation with high rates of treatment success, and we finally may be seeing a plateau in new cases.

“This is due to the significant investments of the Australian and PNG governments that include the early uptake of innovations that are being scaled up globally, for example, rapid diagnostic tests (GeneXpert), new TB drugs (bedaquiline) and patient-centred models of community based care. Daru is developing as a national centre of excellence for TB.”

One of the initiatives Dr Majumdar is proudest of is a new project to train a cadre of peer counsellors, who are people from the Daru community affected by, living with, or who have survived TB called TB-PALS.

“This has helped to engage the affected community in collaboration with our partner, World Vision, and empower them to be at the forefront of the response. But to go the next step and bring the rates down is going to require extra investment and new ways of thinking,” Dr Majumdar said.

“Under the leadership of the provincial health office and national department of health, the program is moving to the next phase where we need to go out into the community and screen everybody and do a search, treat, prevent strategy in Daru Island.

“With partners, we are currently planning this exciting initiative and seeking additional resources to implement it in the coming years.”

Burnet Institute is committed to the goal of eliminating TB as a public health threat by 2030, in particular the crisis of DR-TB in the Indo-Pacific, by accelerating the implementation of innovative approaches to TB management and research in high burden settings.

Burnet aims to achieve this by partnering with governments and agencies, non-government organisations, academic institutions, reference laboratories, civil society and implementing partners working to end TB.

By integrating discovery research, international development and public health approaches we are providing significant support to national TB programs to strengthen health systems, design and evaluate programs including using modelling and software tools, and building capacity for operational research.

Find out more about Burnet’s TB programs.