28 October - Lille, France - Dr Lucica Ditiu, the Executive Secretary of the Stop TB Partnership, has called for greater boldness in the way that the world speaks and acts on tuberculosis (TB).
"In TB, we need to shake things up, we need a greater feeling of urgency, we need to show if we are unhappy about it," she said in an address to the annual conference of the International Union against Tuberculosis and Lung Disease.
Despite figures which show a slight decline in the number of people becoming ill with TB each year, Dr Ditiu said we need to remember, and be outraged, by the fact that more than 1.4 million men, women and children continue to die from a curable disease.
"Whichever way we look at the numbers, we have a huge number of people out there who are getting TB, suffering from TB and dying from TB," she said. "In the hour that we are talking now, 160 people will die from TB, out of which 63 will be women. Can you imagine that? Can you think about that? Every minute I speak, a woman dies with TB!"
Individual suffering should be at the forefront when global targets are set, Dr Ditiu said. "We don't seem to be very ambitious in TB, we don't think of the lives of people," she said.
"We have incredible situations where patients are told 'you have TB, but we don't have the drugs. I'll put you on a waiting list'. This - in the year 2011. For me this is outrageous," Dr Ditiu said.
"If you speak to a cardiovascular surgeon, he might say that he has had five deaths in his ward this year, but you know what he aims for next year, he aims for zero. You won't find him aiming for four next year," Dr Ditiu said. "So why in TB, where the drugs to treat someone with normal TB cost 25 dollars, are we saying we will reduce numbers by 5%. I don't feel the anger, I do not feel the urgency."
As well as calling for a change of tone, Dr Ditiu said that people working on TB need to be more ambitious about reaching the three million people who fail to access quality TB diagnosis and treatment each year, in particular by reaching out to vulnerable groups. "In TB, we have cases that are undetected, unreported and untreated. Most of these people come from poor, vulnerable groups. They are shy, scared, lonely, they don't know their rights or what to fight for," she said. "I have a feeling that we are just taking the low-hanging fruit, the people that come to our hospitals and clinics. We need to shift towards those people that are not on our radar."
To reach these people, more partners must be involved, Dr Ditiu said. "We will never change the figures dramatically unless we scale up, working with and empowering the people suffering, civil society and communities."
Dr Ditiu called for the development and roll out of new tools in order to accelerate progress on TB, citing the introduction of the Xpert MTB/RIF diagnostic test as a huge step forward. "We still need a proper point of care diagnosis test, we need new drugs and we will never achieve the boldest targets without a vaccine," Dr Ditiu said. "But we should not step back and just wait for new things. We can still do a lot with what we have. After the first year, we have seen a 20% increase in case detection rates from our TB REACH programme. This shows that it really works if you just have people focussing on the unreached and previously unreachable, using the tools that you have."
Dr. Ditiu said that she was shocked by a report by the Treatment Action Group showing that investment in TB research has reached a plateau. "This is unacceptable," she said. "As if we had too much and now it is time to slow down. I will do whatever it takes and I call on you all to fight for at least a 10% increase in research funding by the next UNION meeting in Kuala Lumpur."
Closing her address, Dr Ditiu said that it was up to everyone working on TB to take an active role in transforming the fight against TB and to work in partnership. "We need to work together and only by understanding what each of us can bring to the equation, treating each other with respect, understanding and transparency, will we advance anything," she said. "I think it's in each of us to be agents of change, to change the way in which you look and interact with people, to be able to challenge, criticize and to be bold. If we really believe we can defeat TB."