Ahead of the historic United Nations General Assembly (UNGA ), which will host three high-level meetings on strengthening pandemic preparedness and response, delivering universal health coverage and ending TB, from September 20-22, the hope is that world leaders will reaffirm their commitment to delivering UHC by 2030 and invest more in health, including TB, says Prof Madhukar Pai, one of the top Lancet Commissioners and Associated Director, McGill International TB Centre.
“We must remember that every US$1 invested in TB yields US$46 in benefits. So, whatever India invests in TB will yield massive returns, both in terms of lives saved and future costs averted,” Prof Pai told The Indian Express in an exclusive interview.
This is a historic UNGA, with 3 high-level meetings. What is anticipated at the meet and what concerns will be raised?
This year’s UNGA will host three high-level meetings, on strengthening pandemic preparedness and response, delivering universal health coverage (UHC) and ending tuberculosis. The hope is that world leaders will reaffirm their commitment to delivering UHC by 2030 and invest more in health, including TB. There is also hope that all countries will agree on a pandemic treaty that is based on equity, fairness and transparency.
The biggest concern is that many countries are already cutting on health, and that virtually no new commitments or investments will be forthcoming.
Also, the pandemic treaty has been watered down to general statements and platitudes, with no real strong commitment to equitable sharing of technologies, transparency or accountability.
If this is not addressed, the world is doomed to repeat the same mistakes as the Covid pandemic: despite the global crisis, we saw that rich nations chose to hoard millions of vaccines and let them expire, rather than donate in a timely manner and save lives. We also saw rich nations actively block the TRIPS waiver. Relying on the generosity of rich countries or Big Pharma is a futile, even dangerous option.
As per reports the world is not on track to achieve health targets by 2030. Where does India stand on this score?
At the half-way mark (to 2030), the Sustainable Development Goals (SDGs) progress report paints a very scary picture. The SDGs are in peril. Among the key targets, a mere 15% are on track to be achieved by 2030. Nearly half of the targets that can be assessed show moderate or severe deviations from the desired trajectory. Furthermore, over one-third of these targets have experienced no progress or, even worse, have regressed below the 2015 baseline.
According to a recent study, India is not On-Target for 19 of the 33 SDGs indicators. The critical Off-Target indicators include Access to Basic Services, Wasting and Overweight Children, Anaemia, Child Marriage, Partner Violence, Tobacco Use, and Modern Contraceptive Use.
Health-enhancing and life saving interventions are out of reach for millions. Out-of-pocket spending on health has pushed several into poverty, as per reports. What needs to be done?
The entire global health security and pandemic preparedness agenda is tightly controlled by high-income nations and organizations based in the Global North.
It is time for Global South countries to claim the seat they have historically been denied at the global health decision-making table. It is time to abandon the charity, saviorism model of global health, and demand for a model that is rooted in justice, equity, human rights, and self-determination.
This means Global South countries must build their own infrastructure, make their own vaccines, medicines and other products, and be self-reliant. I am glad India is leading the way on this agenda (as seen during the recent G20 meeting), and has inspired other Global South countries. UHC means that all people have access to the full range of quality health services they need, without financial hardship.
If all countries invested adequately in health and UHC, then that is a genuine path towards protecting the poor from catastrophic health expenses. Sadly, most countries, including India, spend little on health. Even after the pandemic, our leaders have not learnt that health is indeed wealth. Without good health, economic growth is neither possible nor meaningful.
Lancet Commission on TB has made recommendations. What is most relevant and feasible for India?
India is still reliant on old technologies such as smear microscopy for TB detection, instead of rapid molecular testing that is recommended by WHO. Of the many recommendations by the Lancet TB Commission, I genuinely believe India is more than ready to replace old tools like smear microscopy with rapid molecular tests. This is a low-hanging fruit. India can also adopt shorter drug regimens and scale them quickly.
The most important thing is to learn from the RATIONS trial in India, and provide food to people with TB and their families. The trial showed that food works like a vaccine, and cuts the risk of household members developing TB. An early weight gain in the first two months was associated with 60% lower risk of TB mortality.
The other benefits were higher treatment success and better weight gain. I am hoping the Indian government, which funded the RATIONS trial, would act on the findings and make sure people with TB get food supplements. It may be easiest to do this via India’s vast PDS system (rations shops).
Using existing PDS channels to provide extra food rations to people with TB, and expanding the menu to include proteins such as pulses and millets, could be very impactful. This could also have positive effects on other diseases such as diabetes.
“We must remember that every US$1 invested in TB yields US$46 in benefits. So, whatever India invests in TB will yield massive returns, both in terms of lives saved and future costs averted,” the Professor said.
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