21 March 2013 - Mbabane, Swaziland - With just 1000 days remaining until the Millennium Development Goals expire, health leaders from government, international agencies and civil society met in Swaziland today to launch an accelerated response to the TB and TB/HIV epidemics in Africa.
The health leaders signed the Swaziland Statement, committing them to work with Southern African Development Community (SADC) Countries to achieve the international targets of cutting deaths from TB and HIV-associated TB by half by 2015, compared to 1990 levels.
"The UN has given us a mandate that we have to achieve by 2015," said King Mwatsi III of Swaziland as he welcomed the delegation. "When 2015 comes, will we be able to say that we have met the challenges set?"
The African region is not currently on track to hit the international TB and HIV-associated TB mortality targets by 2015. Nearly 600 000 people died from TB in Africa in 2011 - 40% of the global toll. This means that Africa has now overtaken Asia - with its much higher population and number of TB cases - as the region with the greatest number of TB deaths.
The meeting was opened by the Prime Minister of Swaziland, Barnabas Sibusiso Dlamini. "The African continent has, since 1990, been hardest hit of all regions of the world with regard to the TB epidemic," he said. "I urge you to apply all your knowledge and your ideas for innovative and implementable solutions on how we can focus our efforts in the next 1000 days to halt the TB and HIV epidemics and achieve the Millennium Goals for our countries and for Africa."
By signing the Swaziland Statement, the delegates committed to exercise their political, economic and technical influence to maximize momentum for this issue. They also brought with them a package of TB and TB/HIV investments and supporting activities worth US $120 million to kick start the response.
The Global Fund to Fight AIDS, Tuberculosis and Malaria announced that it would commit US $102 million of new funding to TB programmes in SADC countries. The UK Department for International Development pledged US $220 000 to match funding from the private sector. The International Organization for Migration announced a US$ 6.5 million programme on health and mobility in the Southern African mining sector and the Stop TB Partnership announced that US $10 million would be dedicated to TB REACH projects in SADC countries.
A key stumbling block to progress is the extremely high TB/HIV co-infection rate in Africa. In 2011, 80% of the people living with HIV who fell ill with TB were in Africa. To tackle this, UNAIDS announced that it would work hard to coordinate efforts to tackle the two diseases and advocate for increased funding.
"We have the power to stop TB and HIV in their tracks," said Michel Sidibé, Executive Director of UNAIDS. "We must adopt zero tolerance for parallel systems for TB and HIV. If we don’t close the funding gap and focus on HIV and TB hotspots, sub-Saharan Africa could face the worsening disaster of HIV and drug resistant TB."
TB associated with the mining industry is fueling the regional co-epidemic. The proportion of people getting sick with TB is at least two and half times higher among miners than in the general population in South Africa and up to 20 times higher than the global average.
To that end, Asad Alam, South Africa, Botswana, Namibia, Lesotho and Swaziland Country Director for the World Bank announced that the Bank would conduct economic analysis on TB and mining to inform industry and government decisions; implement an action plan to harmonize the management of mining-related TB; and develop a costed, industry-led investment strategy to increase TB case finding and treatment.
"TB remains a major cause of death in our sub-region and we will not defeat HIV without a concerted offensive against TB," said Aaron Motsoaledi, Minister of Health of South Africa. "If HIV/AIDS and TB were a snake, I can assure you the head would be in here South Africa. And I’m repeating this to the mining sector - because mineworkers come from the whole sub-region; they come here to our mines to catch TB and HIV and take it back home. We must prioritize action in the hot spots, and one of the hottest of these is TB in the mining industry. The new partnerships that we are witnessing today between government, the corporate sector, and global agencies can and must drive our renewed effort in the next 1000 days."
Responding, Mike Teke of the Chamber of Mines said that the industry is in favour of collective action in support of the SADC Declaration on TB in the Mining Sector. "The private sector can serve as a best practice example on innovation and research and much can be learned from the sector in terms of financing," he said.
The delegation discussed the threat of drug-resistant TB. Dr Marc Gastellu-Etchegorry, International Medical Secretary for Médecins Sans Frontières (MSF) announced that MSF is making the scale-up of drug-resistant TB diagnosis and treatment a priority for this year and coming years, and is committing resources to being able to deliver the best care to the people it treats and overcoming the barriers to treatment scale-up.
Closing the meeting, Benedict Xaba, Minister of Health of Swaziland committed himself to the Swaziland statement and requested that the assembled delegation return to Swaziland in 1000 days to report on progress.
His continued support to the fight against TB was recognized at the meeting with a TB Champion Award, presented by Dr Amy Bloom, Chair of the Stop TB Partnership Coordinating Board. Minister Motsoaledi and Mphu Ramatlapeng, vice-chair of the Global Fund Board also received TB Champion awards.