In the European Union, over 60 000 people a year contract a communicable disease that could not be a more stark reminder of the health inequalities that persist between different social groups. This disease is tuberculosis (TB). It is an airborne infection of the lungs, although extra-pulmonary TB also exists, and its symptoms include chest pain and a wracking cough.
While everyone can get it, the disease commonly affects the poorest and most vulnerable members of society, and often co-exists with other chronic conditions such as HIV/AIDS, diabetes or viral hepatitis.
On the occasion of World TB day, I call upon EU governments to join forces to eradicate TB in our territory and to contribute to the global fight against the disease.
Both globally and in Europe, there is a long term decreasing trend in TB cases. In the 30 EU/EEA countries, there was a reduction of 6% between 2012 and 2013[i]. Globally, TB cases are declining at a rate of approximately 1.5% per year[ii].
This is encouraging, but at the current rate of global decline, it will take the world more than 180 years to ensure that TB is not a public health threat anymore. We need to be more ambitious if we want to achieve the target to eliminate TB by 2050.
Looking at the EU, TB does not affect all countries evenly. Six countries have high incidence - Bulgaria, Estonia, Latvia, Lithuania, Portugal and Romania. Furthermore, high infection rates prevail in some of our big cities like London, Brussels, or Barcelona. These cities report a rate of new infections ranging from 27 to 44 cases per 100.000 people.
In addition, we are facing the threat of drug resistant TB. The disease known as multidrug-resistant TB (MDR-TB) is difficult to diagnose and treat. The European region accounts for nearly a quarter of the burden of MDR-TB in the world.It is most prevalent in Latvia, Lithuania and Estonia where resistance to at least one anti-TB treatment is reported for 28-37% of tested cases. This geographical imbalance highlights inequalities between EU countries in addition to social groups within them.
I consider the 30 million Europeans living in poverty almost as a 29th Member State – one that all too often falls outside social safety nets and for whom the principle of universal access to healthcare is forgotten. The poor, the homeless, prisoners, seasonal migrant workers, people who inject drugs and HIV-infected individuals are our fellow citizens who are the most susceptible to TB.
The only way to eliminate TB is by focusing our attention on these vulnerable groups, through timely diagnosis and adequate treatment, closing gaps in TB prevention and care. It will not be easy – very few countries are embracing efforts for vulnerable groups – but we have to do this as soon as possible. The new Global Plan to Stop TB 2016-2020 should put a strong emphasis on efforts to address vulnerable groups.
It is essential to look at the TB problem with a wider lens and also address the underlying social conditions that allow such diseases of poverty to propagate. A holistic approach is needed. Treatment must be accompanied by social support. Living conditions, education, transport, sanitation, access to safe and healthy food and clean water must all be addressed.
To do this, we need to work together – across continents, across the EU and across sectors, involving many sectors of government - ministries for health, education, internal affairs, employment, law enforcement and more. Also, the most affected countries should devote more efforts for the cause at national level.
These issues are on the agenda of a ministerial conference on 30 and 31 March, organised by the Latvian Presidency on the TB situation in the EU and Eastern Partnership countries. I hope commitment to fight TB will be reaffirmed by all EU governments.
For my part, I am fully committed to support EU countries to fight against TB. Through the prolongation of the HIV/AIDS Action Plan, the European Commission is increasingly focusing on an integrated approach to HIV/AIDS and co-infections including TB. In addition, TB is one of the priorities in the new EU Health Programme, and I intend to foster new initiatives to improve early diagnosis and the integration of care and to support EU countries in the development and implementation of national strategic plans and guidelines.
Looking at the global picture, over 95% of TB cases occur outside the 53 countries of the WHO European Region and over 99% outside the EU. However, the WHO European Region is unlikely to reach the MDG target to reduce TB mortality by 50% compared to 1990 levels due to the high drug resistant TB burden we face in this region[iii].
In addition, contributing to the global fight against TB is relevant to the EU as a major actor on worldwide improvement of health, reduction of disparities and protection against global health threats. It is also in our own best interest, as in some low incidence European countries 70-80% of TB patients come from outside the EU – mainly the Eastern Mediterranean, South-East Asia and Africa.
The work of the Global Fund to Fight AIDS, Tuberculosis and Malaria is vital. The Global Fund is responsible for targeting financial and human resources strategically, detecting and treating more than 12 million cases of infectious tuberculosis in more than 140 countries to date. The European Commission has been associated with the Fund for more than 13 years. Since then, we have contributed more than €1.5 billion to the Fund from the common EU budget and from the European Development Fund, to which all Member States contribute.
To conclude, TB provides us with a wake-up call on our shortfall in bridging social inequalities in health. The only hope we have in turning the tide against TB in the EU is first for all European countries to make it a priority and work holistically to address social inequalities, which are preventing the elimination of TB from Europe. And, second, to acknowledge that TB elimination is not achievable without addressing the global nature of the TB epidemic and the need for continued global investment and collaboration.
[i] Source: Report by the European Centre for Disease Prevention and Control and World Health Organization Europe “Tuberculosis surveillance and monitoring in Europe 2015”: http://www.ecdc.europa.eu/en/healthtopics/Tuberculosis/epidemiological_data/Pages/tuberculosis_surveillance_Europe.aspx
[ii] Source: “Global Tuberculosis Report 2014” by the World Health Organization: http://www.who.int/tb/publications/global_report/gtbr14_main_text.pdf?ua=1
[iii] Source: “Global Tuberculosis Report 2014” by the World Health Organization: http://www.who.int/tb/publications/global_report/gtbr14_main_text.pdf?ua=1