Re-Designing care to break free from Disease Silos
If you thought Covid-19 is scary, think again, another lung disease out there is killing people every 20 seconds, and Covid-19 is making it worse!
Tuberculosis (TB) a 2000-year-old ancient global respiratory infectious disease has killed over a billion people across the globe and still affects over 10 million people annually. Covid-19 has set us back on our global TB care commitments. This growing challenge of the Covid — TB syndemic could be catastrophic to the future of health especially- lung health globally — impacting vulnerable groups in LMICs the worst.
The Costs of Lung Health
The accelerated global response to Covid-19 has garnered an investment of over $90 billion for drugs, vaccines, and all aspects of the disease in less than 2 years.
For TB — along with Covid-poverty is pushing us back on decades of efforts- many socio-eco-environmental determinant factors affect TB health outcomes like malnutrition, crowding, stigma along with outdated vaccines, long treatment regimes, drug affordability, or treating co-morbidities that worsen TB. According to the Stop TB Partnership -Global Plan 2018–2022, every dollar spent on TB prevention and care gives a Return On Investment (ROI) of US$ 43.7 making TB prevention and care scale-up one of the best investments under the SDGs. Then, how is it acceptable that TB R&D investments during 2019 were less than $1 billion?
The Global TB community is aware of the multi-sector complexities, lack of funds, and urgency. Revitalized politics coupled with improved access to quality care, could relegate the morbidity, mortality, and stigma long associated with tuberculosis, to the past.
Interestingly in LMICs apart from the non-utilization of public health systems — poor-quality care attributes to 60% of the deaths. The care that people receive is often late, inadequate, and poor- quality care is common across conditions and countries, with the most vulnerable populations worst affected. Timely preventive therapies, early screening, diagnosis, treatment, and follow-up can save lives. However — No one-size-fits-all approach can succeed. Evolving health needs, growing public expectations, and ambitious new health goals are raising the bar for health systems to produce better health outcomes and greater social value. A high-quality health systems approach could potentially accelerate our efforts preventing 900,000 deaths from tuberculosis each year. Here innovations can play a big role — they have the ability to strengthen existing health systems.
There cannot be a more opportune time for the Covid-19 and TB community to leverage and re-imagine patient care to look at improving the overall health outcomes. In the early days of the pandemic, there was optimism that TB technologies and systems could help end the Covid-19 pandemic. For example, molecular technologies widely used for TB are being used to test for Covid-19, and the BCG vaccine for TB is being tested for Covid-19. National TB program staff are engaged in the Covid-19 response. TB wards were re-purposed to serve as Covid-19 wards.
While the Covid-19 crisis has brought a great deal of attention to health, it is unclear whether such interest will sustain when the crisis dies out. Will Covid-19 create more disease silos, or will we finally see stronger health systems that can offer better primary healthcare? Will countries continue to invest in public health?
The Lancet — High-Quality Health Systems(HQHS) Approach optimizes health care in each given context by consistently delivering care that improves or maintains health, by being valued and trusted by all people, and by responding to changing population needs. HQHS are transformational and informed by four key values that- they are for people, and they are equitable, resilient, and efficient.
“Only one-quarter of people believe that their health systems work well”
A model, developed by Ian Mackay, a virologist, “ uses the imagery of the large holes in Swiss cheese to illustrate the fact that a single layer of protection will not be enough to stop Covid-19. Because of the “gaps” in each “slice”, the covid virus will always get through.” Of the many lessons from Covid-19, one is that- to effectively address a global pandemic we need a comprehensive rather than a limited approach that looks beyond isolated aspects of the disease. The globally used COVID Swiss cheese model adapted for TB best illustrates that ending lung health diseases- like TB and Covid requires multisectoral collaboration.
Limited budgets have forced programs and countries to give priority to only a few layers of the Swiss cheese model. We must end the scarcity that forces us to pit one effective interventional against another. As a community, we must work together and grow the pie, so that all layers of protection can be realized across disease areas. Covid-19 is proof that we can do this and get things done if we wanted to. An all-out comprehensive approach is the only way we might see an end to this airborne infection, and to the suffering of millions globally.
Global Fund is a country coordinating mechanism that works to unite the world to find solutions that have the most impact and take them to scale worldwide. GF has invested — US $4 billion a year to defeat HIV, Tuberculosis and malaria and ensure a healthier, safer, equitable future for all.
Some Impact Numbers: 38 Million lives saved through the Global Fund partnership, 5.7 people with TB treated in 2019
C19RM, the COVID-19 Response Mechanism supports countries to mitigate the impact of COVID-19 on programs to fight HIV, TB, and malaria and initiates urgent improvements in health and community systems. All countries, including regional/multi-country recipients, that are currently receiving funding from the Global Fund, are eligible to receive C19RM funding Eligible investments- C19RM will continue to fund the following areas:
(2) COVID-19 related adaption of programs to fight HIV, tuberculosis and malaria
(3) Strengthening health and community systems.
These three areas should also incorporate cross-cutting activities that bolster community responses to COVID-19. Activities to be funded are aligned with the relevant pillars of the WHO COVID-19 Response Pillar Framework. More information can be found in the technical guidance documents.