Editorial 1: The road to ending tuberculosis
Introduction:
- In 1993, World Health Organization (WHO) declared tuberculosis (TB) a global health emergency. The response in the 30 years since has been short on urgency and long on processes. The current goal is to end TB by 2030, but clarity on definitions of ‘end’ and the means of verification are not fully in place.
About TB:
- TB is caused by a bacterium called Mycobacterium tuberculosis. Some of Mycobacteria cause diseases like TB and Leprosy in humans and others infect a wide range of animals.
- In humans, TB most commonly affects the lungs (pulmonary TB), but it can also affect other organs (extra-pulmonary TB). TB is a treatable and curable disease.
- TB is spread from person to person through the air. When people with lung TB cough, sneeze or spit, they propel the TB germs into the air.
- Common symptoms of active lung TB are cough with sputum and blood at times, chest pains, weakness, weight loss, fever and night sweats.
Drug resistance of TB:
- There are broadly 3 types of drug-resistant TB: MDR, XDR and TDR:
- Multidrug-resistant (MDR) Tuberculosis : It is a form of TB caused by bacteria that do not respond to isoniazid and rifampicin, the 2 most powerful, first-line anti-TB drugs. MDR-TB is treatable and curable by using second-line drugs.
- Extensively drug-resistant (XDR) Tuberculosis: It is a more serious form of MDR-TB caused by bacteria that do not respond to the most effective second-line anti-TB drugs, often leaving patients without any further treatment options.
- Totally drug resistant (TDR) Tuberculosis: when TB does not respond to ANY drugs whatsoever. It is the final and fatal stage of TB.
The Global Fund
- Following on the call first made in 2001 at the G7 in Okinawa, Japan, by Kofi Annan, and formalised at the next summit in Genoa, Italy, The Global Fund to Fight AIDS, TB and Malaria (GFATM) began disbursing the first round of money directed towards the global TB epidemic in 2003. 20 years on, the Global Fund has become the single largest channel of additional money for global TB control. But it remains hostage to the zero-sum games imposed on it from its donor constituents and between the champions of the three diseases the Fund was set up to provide additional financing for.
- Mandated with the task of mobilising and marshaling a disparate set of actors towards the goal of ending TB, the “Stop TB Partnership” got a formal presence on the board of the Global Fund close to seven years after it was constituted. The Stop TB board meets in Varanasi, India, this week, and will coincide with World TB Day (March 24).
- Despite constraints, the global TB response has been adapting to changes: the HIV response has inspired ‘engagement’ of those affected by the disease; the use of molecular diagnostic tools developed to respond to acts of bioterrorism 20 years ago are the current state of the art for diagnosing TB.
- Using social safety programmes to address the poverty drivers of the TB epidemic and leveraging the “mobile and computational data revolution” to improve treatment outcomes have also begun shaping the trajectory of global efforts to end TB.
Way forward:
- There are three key areas that remain under-served. Without strengthening or radically re-imagining them, the chances of success in ending TB by 2030 become slimmer. India’s leadership of the G20 and the focus on health could be catalytic to act synergistically towards ending TB.
TB Vaccine:
- The first area — and the one likely to take the longest to mature despite exciting developments — is in the development and wide use of an adult TB vaccine. The current one, delivered at birth and useful particularly for children, is 100 years old.
- The experience with the COVID-19 vaccine development process gives us an understanding an accelerated development of a vaccine. The pitfalls of equitable distribution seen with the COVID-19 vaccines should definitely be avoided.
Getting newer therapeutic agents for TB
- A few new anti-TB drugs are today available for widespread use, if only costs and production capacities weren’t constraints. Moving to an injection-free and shorter all oral pills regimen for TB (the current standard is for at least six months) will improve compliance and reduce patient fatigue.
- The effort to come up with a raft of newer drugs needs to accelerate so that when drug resistance shows up to the most recently introduced drugs, we will have newer therapies available. Current estimates of drug-resistant TB are discouraging at best and alarming at worst. Not having a ready pipeline of newer drugs is repeating a folly from the past.
Diagnostics
- There are exciting developments for use of AI-assisted handheld radiology with 90-second reporting and 95% plus accuracy for diagnosing TB. This is mature technology, and should be rolled out universally immediately.
- Confirmatory diagnosis using nucleic acid amplification is ripe for disruption. India convened the InDx diagnostics coalition in Bengaluru for COVID-19. This, and other biotech startups, should be incentivised to break the complexity of molecular testing and price barriers with affordable high-quality innovations.
Conclusion:
- India’s G20 presidency this year, the Varanasi StopTB board meeting this week, and the United Nations High-Level Meeting on TB in September this year provide the perfect platform for India’s actions to speak loudly and will enable the world to get to the end of TB sooner.
Editorial 2: International Day of Forests 2023 | Healthy forests for healthy people
Context:
- The United Nations General Assembly (UNGA) declared March 21 as the International Day of Forests (IDF) in 2012. The IDF raises awareness on the indispensable role of different types of forests in supporting a wide range of benefits to human health that include food security and nutrition, thereby aligning with the 2030 Agenda of the Sustainable Development Goals (SDGs), particularly SDG 3 (Good health and well-being) and SDG 15 (Life on land).
Importance of forests:
- Forests provide habitat for 80% of amphibian species, 75% of bird species and 68% of mammal species. More than 18% of the total forest area is in legally established protected areas. Nevertheless, forest biodiversity remains under threat from deforestation and forest degradation.
- The United Nations’ Food and Agriculture Organisation’s (FAO’s) latest report ‘The State of the World’s Forests or SOFO (2022)’ states that forests cover 31% of the Earth’s land surface but the area is shrinking.
- Climate change is a major threat to forest health and this is manifested in a number of ways. For instance, there are indications that the incidence and severity of forest fires and pests is increasing.
- The COVID-19 pandemic also had a significant impact on forest value chains and trade in early 2020. There is a possible longer-term link between forests and disease. More than 30% of new diseases since 1960 are ascribed to land-use change, including deforestation, and 15% of 250 emerging infectious diseases have been linked to forests.
- Deforestation, specifically in the tropics, has been associated with an increase in infectious diseases such as malaria and dengue. Moreover, worldwide almost 90% of deforestation is driven by agricultural expansion such as conversion of forest to cropland or grassland for livestock grazing.
Way forward:
- FAO’s SOFO report (2022) suggests three forest-based pathways as a means for tackling local to global challenges —
- Halting deforestation and maintaining forests;
- Restoring degraded lands and expanding agroforestry;
- Sustainable use of forests and building green value chains.
- Government of India has launched a global movement on Lifestyle for Environment (LiFE), or Mission LiFE. This is designed with the objective of mobilising at least one billion Indians and other global citizens to take individual and collective action for protecting and conserving the environment. In India, at least 80% of all villages and urban local bodies are intended to become environment-friendly by 2028.
- As per the Economic Survey of India (2022-23), one of the quantifiable targets of India’s nationally determined contributions (NDCs) is to achieve an additional carbon sink of 2.5 billion to 3.0 billion tonnes through additional forest and tree cover by 2030.
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Important Government initiatives on afforestation:
- National Afforestation Programme (NAP)
- Green India Mission (GIM) under NAPCC
- Compensatory Afforestation Fund Management and Planning Authority (CAMPA)
- Green Highway Policy-2015
- Policy for enhancement of Urban Greens
- National Agro-forestry Policy and Sub-Mission on Agro-forestry (SMAF) etc
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Carbon sink:
- A robust forest ecosystem acts as a vital carbon sink. The Indian State of Forest Report (ISFR) estimates the carbon stock (which is the quantity of carbon sequestrated from the atmosphere and stored in biomass, deadwood, soil, and litter in the forest) of forests to be about 7,204 million tonnes in 2019, which is an increase of 79.4 million tonnes of carbon stock as compared to the estimates in 2017.
- Among the Indian States, Arunachal Pradesh has the maximum carbon stock in forests (1023.84 million tonnes), followed by Madhya Pradesh (609.25 million tonnes).
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Work of FAO:
- Food and Agriculture Organisation (FAO) bolsters GoI’s efforts on conservation of forest landscapes by fostering sustainable agrifood systems. FAO’s works in 8 States to promote diversification of crops and restoration of landscapes seek to mainstream biodiversity conservation, climate change, and sustainable land management objectives and practices into Indian agriculture to enhance multiple global environment benefits (GEBs).
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Conclusion:
- Governments and business entities need to direct funding for recovery towards long-term policies aimed at creating sustainable and green jobs and further mobilising private sector investment; and empowering and incentivising local actors to take a leading role in the forest pathways.