It is an honor to be part of this important occasion, as we join the global community in commemorating World TB Day.
Today, March 24th, marks the 134th anniversary of a discovery that changed the world. On this day in 1882, Dr. Robert Koch announced the discovery of TB bacillus, the bacteria that cause tuberculosis.
The world was a much different place. Doctors and health care workers were not aware of what caused many diseases or how they were transmitted. TB – which was referred to in those days as the “white plague” or “consumption” – was the cause of more deaths in industrialized countries than any other disease during the 19th and 20th centuries.
Dr. Koch’s groundbreaking research opened the way for diagnosing and curing a disease that many thought was hereditary rather than contagious. Preventing the spread of tuberculosis became the motivation for some of the first important large-scale public health campaigns.
Today, we gather to recognize this important discovery and the global progress made in addressing TB. Over the last few years, life-saving advancements in screening and diagnostic approaches have been made. Successful partnerships, like the one between the United States and Botswana, have advanced the global body of knowledge about the TB epidemic.
However, despite a century of unprecedented medical progress, TB remains one of the world’s deadliest diseases – there were more than 1.5 million TB-related deaths worldwide in 2014 alone.
The HIV epidemic makes people more susceptible to TB. In Botswana, an estimated 60 percent of TB patients are also living with HIV. Botswana is also experiencing a growing problem of drug-resistant TB. This type of TB does not respond to treatment with the usual drugs. The World Health Organization (WHO) estimates Botswana had over 150 patients with multi-drug resistant TB in 2014.
The theme of World TB Day is Unite to End TB. The United States is working with Botswana to achieve a goal of a Botswana free of TB.
Our partnership dates back more than 20 years. In 1995 when I was serving at the U.S. Embassy in Gaborone, we began research collaboration with the government of Botswana to fight TB and later HIV. That partnership was called BOTUSA. I’m sure many people here today remember that name.
That partnership resulted in improvements in TB diagnostic capacity, infection control in facilities; epidemiological and operational research to introduce and evaluate a new promising diagnostic test; and ground breaking clinical trials in preventive TB treatment that informed WHO TB and HIV guidelines.
Research continues under our important collaboration. Through a study called RIFASHORT, we are currently engaged with the Medical Research Council, Ministry of Health and University of Botswana to find ways to improve and shorten the TB treatment regimen and address the challenges of treatment interruption. This is important because if treatment is interrupted, patients may not be cured and instead develop resistance to life-saving drugs.
Globally, Botswana is among the top high TB/HIV burden countries and has been identified by the WHO as a priority country for the global TB/HIV response. Botswana has made great strides: it is one of five countries that have consistently achieved high rates of TB patients knowing their HIV status since 2011 and now many TB patients living with HIV start antiretroviral treatment right away.
The U.S. government through the President’s Emergency Plan for AIDS Relief has invested more than $40 million in the last decade in TB/HIV control in Botswana. This investment supported community based TB Care and the Ministry of Health to update guidelines to better manage TB and ensure quality program monitoring. It also supported the training of health care workers to better manage TB and provide laboratory support and technical assistance.
I would like to commend the Government of Botswana for considering the adoption of the Test and Treat policy, which will not only ensure the best care for individuals living with HIV but will also be a key strategy to curb the TB/HIV epidemic in Botswana by preventing active TB disease. However, it will not be enough to control the TB epidemic. Innovative TB care and prevention strategies will be needed to reducing TB incidence and end the socioeconomic burden of TB in Botswana.
We have made tremendous lifesaving progress together. But like our battle against HIV, we have much work to do. Together, with international and local partners, the private sector, all of us, must unite and commit to ending TB.
Kea Leboga. PULA!