Groundbreaking WHO conference in Moscow

By Dr. Lena Fiebig | APOPO Head of TB

How APOPO backs the WHO commitment to end TB by 2030

We were very encouraged by the news last week that at the World Health Organization (WHO) conference in Moscow, 75 global Health Ministers announced a groundbreaking agreement to take urgent action to end tuberculosis by 2030. APOPO wholeheartedly supports this initiative to rid the world of this devastating disease.

This was the first WHO Ministerial Conference in the Sustainable Development Era in Moscow in which delegates from 114 countries came together with the aim of accelerating progress towards ending the TB epidemic by 2030.

The ‘Moscow Declaration to End TB’ comes hard on the heels of the release of the WHO Global TB Report, which underlined the higher than expected burden of death and disease due to tuberculosis, something very concerning to us at APOPO. In 2016, there were an estimated 10.4 million new cases worldwide, and over 1.7 million deaths, including 0.4 million among people with HIV. Tuberculosis is among the top ten causes of death worldwide killing five thousand people every day and this must be brought under control.

More than 1,000 participants took part in the two-day conference from 16-17 November 2017, which was attended by ministers and country delegations, as well as representatives of civil society and international organizations, scientists and donors.

The end result was a collective commitment to strengthen action on four fronts:

  1. The first pledge was to rapidly move to achieve universal health coverage by strengthening health systems and improving access to people-centred TB prevention and care so no one is left behind.
  2. Secondly, was the assurance that sufficient and sustainable financing would be mobilized through increased domestic and international investments to close implementation and research gaps.
  3. The third commitment was to advance research and development of new tools to diagnose, treat, and prevent TB.
  4. Finally, the ministers vowed to build an accountability framework to track and review progress on ending TB, including multisectoral approaches.

The declaration also promised to minimize the risk and spread of drug resistance and do more to engage people and communities affected by, and at risk of, tuberculosis.The Ministerial Conference in Moscow will inform the UN General Assembly High Level Meeting on TB in 2018 in New York, a historic opportunity to place TB as a global political priority.

The declaration is relevant to APOPO through pledges one and three:

Strengthening health systems and improving access

One of our great frustrations at APOPO is that most deaths from TB could be prevented with early diagnosis and appropriate treatment. The WHO points out that global efforts to combat TB have saved an estimated 53 million lives since 2000 and reduced the TB mortality rate by 37%. But they go on to point out that progress in many countries has stalled, global targets are off-track, and persistent gaps remain in TB care and prevention.

Clinics are often underfunded, underequipped and suffer from power shortages that disrupt testing. They also use conventional smear microscopy which is slow and its accuracy can be significantly and negatively affected due the limitations above. In Sub-Saharan Africa, up to 50% of TB-positive patients are sent home with unconfirmed diagnosis. When left untreated, these patients can then pass the pathogen on to up to 15 other people within a year, creating a TB vicious cycle.

These ‘missed’ TB positive patients usually include the most vulnerable and those without proper access to care – the elderly and young, people living in poverty, people in remote communities, those with HIV, miners and migrant communities. The TB epidemic can only be successfully curbed if we are able to find the missing 4.1 million who go without treatment.

APOPO’s rat detection technology helps to fill the gap by acting as a “failsafe”. It does this by re-examining samples from patients with presumptive TB delivered from partner clinics in Tanzania and Mozambique, and returning the results within 24-hours in time for patients to receive on their return to clinic. Due to their unique speed and sensitivity, when combined with conventional tuberculosis diagnostics APOPO's TB Detection Rats (HeroRATs) have proven to increase detection rates of public and private clinics by about 40%. This means more TB-positive people are put on treatment before they can infect other people and prolong the vicious TB cycle, saving many more lives in the process.

The third WHO pledge is also significant to APOPO: Advance research and development of new tools to diagnose, treat, and prevent TB.

APOPO is building a strong research team, comprised of highly skilled researchers, students, doctoral and post-doctoral scholars. The team is conducting various behavioral studies at its R&D headquarters at Sokoine University of Agriculture, in Tanzania aimed at informing and optimizing detection rat training techniques through a better understanding of the rats' themselves, including how they learn about odors they smell in the world

The goal is to better understand of APOPO scent detection technology in order to improve accuracy and speed, and explore other applications that can address other prominent social issues.

Current TB related studies include investigation of target odour variables, length of rat indication time, effect of diet on performance. As well as this is a study into the volatile organic compounds that TB bacteria excrete and the rats detect, and a study in Tanzania, Mozambique and Ethiopia into the possibility of deploying the rats to test samples from prisoners, a known risk group for tuberculosis. In partnership with other non-profit and community based organizations APOPO pilots an innovative digital tool to improve treatment initiation and adherence rates among TB patients to link case detection to cure.

The outcomes of the Moscow conference are very encouraging to us, but there is still work to be done. Significantly the WHO also pledges to mobilize funding for TB response. Although we at APOPO believe that we can truly make a difference, funding is essential to our own positive outcomes. Therefore, we urge global stakeholders and donors to continue to support the battle against the world biggest killer by an infectious disease, and only then can we hope to eliminate it as a public health problem by 2030.