Countries are not doing enough to end tuberculosis – the world’s deadliest infectious disease – by 2030, warned the World Health Organization (WHO) on Tuesday, at the release of the latest Global Tuberculosis Report.

The report shows that worldwide, tuberculosis (TB) cases are falling too slowly to meet the targets set by WHO’s End TB Strategy.

The deadly disease, which usually infects the lungs and is transmitted through the air, remains one of the top 10 causes of worldwide deaths, and is the leading cause of death from a single infectious agent, above HIV/AIDS. This is despite the fact that global efforts have averted an estimated 54 million TB deaths since 2000.

It is unacceptable that millions lose their lives, and many more suffer daily from this preventable and curable disease.  –                       Dr. Teresa Kasaeva, WHO Global TB Programme Director

The report shows that almost a quarter of the world’s population, some 1.3 billion people, are at risk of developing TB during their lifetime, and around 10 million people are estimated to have caught the disease during 2017.

The geographical disparity in cases is stark, with 500 cases per 100,000 in some countries including Mozambique, the Philippines and South Africa; and fewer than 10 per 100,000, in high-incomes countries.

Drug-resistant TB remains a public health crisis, with more than 500,000 believed to have contracted TB resistant to rifampicin, the most effective frontline drug.

The report was launched in the lead up to the first-ever General Assembly high-level meeting on TB at UN Headquarters in New York on 26 September, under the theme “United to end TB: An Urgent Global Response to a Global Epidemic”. 
 

© UNICEF/Fani Llaurado

A child is vaccinated against TB and other diseases in Phnom Penh, Cambodia, in March 2017.

 
This high-level meeting comes in the wake of the Global Ministerial Conference on Ending TB, which took place in Moscow in November 2017, resulting in high-level commitments from nearly 120 countries to accelerate the response to eradicating TB.

UN chief António Guterres, speaking in June at a preparatory civil society hearing held at United Nations Headquarters,  said that, to win the fight against tuberculosis, it is necessary to tackle the “social drivers” of the disease – in particular poverty and inequality – head on, making greater efforts to provide universal health coverage and combat the growing threat of anti-microbial resistance.

“We have never seen such high-level political attention and understanding of what the world needs to do to end TB and drug-resistant TB”, said Dr Tedros Adhanom Ghebrayesus, WHO Director-General. “We must capitalize on this new momentum and act together to end this terrible disease.”

Whilst under-reporting and under-diagnosis are mentioned as major challenges in the fight against TB, the most urgent stumbling block is funding.
 

© UNICEF/Frank Dejongh

Mothers at the maternity health center in the village of Nassian, in the north-east of Côte d’Ivoire wait to have their children vaccinated against tuberculosis and other diseases. (file March 2017)

 
In 2018, investments in TB prevention and care in low- and middle-income countries fell $3.5 billion short of what is needed. Without an increase, the funding gap will rise to over $6 billion by 2022.

The report describes the 26 September high-level meeting as a “historic opportunity to put the TB response back on track”.

Doctor Teresa Kasaeva, Director of the WHO’s Global TB Programme, said that “it is unacceptable that millions lose their lives, and many more suffer daily from this preventable and curable disease. We need to join forces to root out this disease that has a devastating social and economic impact on those who are ‘left behind’, whose human rights and dignity are limited, and those who struggle to access care”, she said, adding that: “The time for action is now.”

At the end of her mission to the country, Ikponwosa Ero, UN Independent Expert on the enjoyment of human rights by persons with albinism, issued a statement on Monday welcoming Kenya’s “unique achievements”, saying that the country was set to become a regional leader on the issue.

People with Albinism are born with lighter than normal skin, hair and eye colour, making them sensitive to the sun and bright light.

“Kenya’s successes include the allocation of a substantial annual budget geared toward specific measures for persons with albinism, who had historically been left behind in the key sectors of health and education and had fallen prey to ritual attacks and the consequent insecurities,” she said.

“However,” she continued, “much remains to be done including access to justice and judicial remedies for victims of attack as well as socio-economic support for victims and their families to help restore their lives.”

“The provision of such devices would help break down significant barriers to education and finding indoor employment,” she elaborated, suggesting also that hospitals dispense sunscreen, which is frequently unavailable “because of poverty and distance.”

Ms. Ero welcomed the Government’s plans to remedy these barriers and strongly encouraged producing sunscreen locally, to help persons with albinism integrate more easily into the workplace.

“I also urge Kenya to create a brief but comprehensive national action plan, in line with the Regional Action Plan, to end violence and violations against persons with albinism as recommended by the African Commission on Human and Peoples’ Rights,” she added.

She recalled that the Sustainable Development Goals (SDGs) pledged to leave no one behind.

“I am convinced that Kenya is exemplifying this key principle. With improvements and continuity in its current positive trajectories, it will show the world some of the best practices for bringing those who are marginalized out of the fringes,” concluded the UN expert.

Ms. Ero will present a comprehensive report of her visit to the Human Rights Council, next March.

Independent Experts address either specific country situations or thematic issues in all parts of the world; they are not UN staff, nor are they paid for their work.

The United Nations Secretary-General, António Guterres, has welcomed the meeting between the Presidents of Djibouti and Eritrea, held on Monday in Saudi Arabia, as “yet another step in the consolidation of recent peace and security gains in the Horn of Africa region”.

Mr. Guterres said in a statement from his Spokesperson that he hopes the encounter in Jeddah between President Ismaïl Omar Guelleh of Djibouti, and Eritrean President Isaias Afwerki, will “initiate a process to settle all pending issues between the two countries and lead to greater peace, stability and development in the region”, and expressed appreciation to the leadership of the Kingdom of Saudi Arabia for its efforts in facilitating this dialogue.

The simmering conflict between the two countries started over 10 years ago and stems from a border dispute over the status of Dumeira Mountain and Dumeira Island, off the coast of both Djibouti and Eritrea, which have been claimed by both nations.

The meeting in Jeddah follows a request made in July by Djibouti’s ambassador to the UN, Mohamed Siad Doualeh, for help in settling the dispute with Eritrea.

On Sunday, the UN chief applauded another major step for peace in the region with the signing of the peace agreement between Ethiopia and Eritrea, which ended decades of hostilities over a disputed border area.

Around 6.3 million children under the age of 15, died from mostly preventable causes last year, the equivalent to 1 child dying every 5 seconds, according to a new report compiled by a group of United Nations agencies. Newborn babies account for half of the deaths.

The new mortality estimates study, was released on Monday by the UN Children’s Fund, together with UN Children’s Fund UNICEF, the World Health Organization WHO, the UN Population Division and the World Bank.

According to Laurence Chandy, UNICEF Research Director, major progress in reducing child mortality has been made in the last quarter century, with the toll dropping by more than half since 1990, but “millions are still dying because of who they are, and where they are born.”

Children from Sub-Saharan African are disproportionately affected, with half all deaths of under-fives, taking place in the region. One third are in Southern Asia.

He added that, without urgent action, 56 million children under-five will die between now and 2030, and half of them will be new-borns but that, “with simple solutions like medicines, clean water, electricity and vaccines, we can change that reality for every child.”

Most deaths of children aged 5 and under are due to preventable or treatable causes such as pneumonia, malaria or complications during birth.

For older children, between the ages of 5 and 15, injuries become a more prominent cause of death, particularly road accidents and drownings.

Even within countries, wide disparities are found, with under-five mortality rates on average 50 per cent higher in rural areas than in urban areas. Education is also a factor, with those born to uneducated mothers more than twice as likely to die before turning five than those born to mothers with a secondary or higher education.

Reacting to the study, Tim Evans, Senior Director of Health Nutrition and Population at the World Bank, said . “Ending preventable deaths and investing in the health of young people is a basic foundation for building countries’ human capital, which will drive their future growth and prosperity.”

With parliamentary elections one month away and a major ministerial conference planned for November in Geneva, the United Nation’s Special Representative for Afghanistan briefed the Security Council on Monday, noting that “preparations are on track” but that many challenges lie ahead, including increased security concerns.  

“It is a time for important decisions in Afghanistan”, said Tasamichi Yamamoto, who heads the UN mission in the country (UNAMA). “These decisions will affect the fundamental fabric of the society and future of Afghanistan”, he added, referring to the parliamentary elections slated for 20 October – the first time since 2010 – and the 28 November ministerial conference in Geneva, co-chaired by the Afghan Government and the UN.

Among the positive developments cited by the Special Representative, candidate lists were finalised on time for the printing of ballots, more than nine million Afghans are registered to vote, and various safeguard measures for fraud prevention are now in place.

“I have met many Afghans across the country who have impressed upon me their desire to exercise their right to elect their representatives. Many will face considerable risks to do that,” he explained, stressing that while “preparations are on track” for the elections, he remains “very concerned” over security and political challenges that “could jeopardize the tight timelines and derail the elections”.

“Political concerns must be addressed through institutional mechanisms and not through blockades”, the head of UNAMA noted, urging “all political actors and institutions to perform their duties, act responsibly, and to think of the Afghan people, bearing in mind the country’s bitter past”.

The four-decade conflict continues to wreak destruction and death across the country. In July, UNAMA released figures highlighting the tragic toll the conflict has had on civilians, revealing that the first half of 2018 was the deadliest for Afghans since the Mission began documenting casualties in 2009. 

Insecurity is also taking its toll on journalists and aid workers. This year alone, 13 journalists have lost their lives and many more were injured; 23 aid workers were killed, 37 injured and 74 abducted, making Afghanistan the second most dangerous country to work in the aid sector.

“Each death is an individual tragedy. But it is also a tragedy for the country: reconciliation becomes harder with each life lost.” The UN Special Representative stressed that “all sides must realize that there is no military solution to the conflict” and that “equal participation and full involvement of women” in all efforts towards peace and security must be ensured.

In February, the country witnessed “unprecedented political space for peace” when the Government extended an offer to the Taliban to engage in talks without preconditions, leading to a temporary ceasefire in June and another one in August which was not reciprocated by the Taliban.

“Whatever setbacks may lie ahead, we are in a better position now than at any time in the past 17 years to commence the process which would lead to talks for a negotiated end to the conflict”, Mr. Yamamoto said, proposing measures “to build confidence” such as prisoner releases and improvements on agriculture, education and health in contested areas.

Mr. Yamamoto concluded: “In 2001, former Secretary-General Kofi Annan began his Nobel Peace Prize speech with a few simple words: ‘Today in Afghanistan a girl will be born’. That girl is now almost a woman, who soon, will be old enough to vote; old enough to attend university; old enough to pursue the vocation of her dreams. Will she be able to? I am sure that that girl will be watching closely the developments of the next few months.”