Regional Consultation on Accelerating Progress towards Ending HIV/TB/Malaria in SEAR
28-30 March 2017, Dhaka, Bangladesh
Honorable State Minister Mr Zahid Maleque and other dignitaries on the dias, representatives from Member States of the Region, partners from civil society and other UN Organizations,
A very good morning to you.
We are at a unique moment in humanity’s struggle against key infectious diseases, as Steve, my colleague and friend from UNAIDS, has just mentioned by highlighting the three I’s – Investment, Integration and Innovation.
Whereas the best we could once hope for was to bring a measure of control to the most serious of these diseases, today we are trying to end the HIV, tuberculosis and malaria epidemics by 2030.
This reflects a journey of steady, methodical achievement.
Drawing on robust political commitment and programmatic success, the South-East Asia Region reached the Millennium Development Goal target to halt and begin to reverse these epidemics.
From 2001 to 2015, the 11 countries of South-East Asia cut new HIV infections by almost half, malaria cases by 46% and malaria deaths by nearly 90%. The TB incidence rate fell by 18% from 2000 to 2015; associated deaths declined by one-third.
Today we possess the tools needed to defeat these diseases and achieve the Sustainable Development Goal targets. Nevertheless, to make this happen, a well-calibrated and rigorously implemented strategy is needed.
Though previous public health programming has – at times – created particular disease or issue-based silos, a more integrated approach is necessary. Indeed, there are powerful reasons why we must work together to address these three diseases.
First, HIV, TB and malaria each disproportionately affects the most vulnerable and those with the least capacity to respond. Vulnerability can be caused by economic, social or geographic factors.
Second, each is preventable and treatable.
Third, each disease is featured in the SDGs alongside clear numerical targets. The targets call not for an incremental decline, but for the end of all three epidemics.
Fourth, and finally, responses to these diseases are undermined by the same health system limitations. Health system improvements alone will not eliminate these diseases, meaning a more targeted approach within the UHC framework is needed.
By working together we can achieve greater synergy and efficiency while learning from one another. Indeed, this meeting is an important step towards doing this, and ensuring disease control programs work together to drive progress.
Ladies and gentlemen,
Ending these epidemics will not be simple. Indeed, merely continuing current trends – favorable as they may be – will leave us short of our 2030 goal.
Of the 3.5 million people living with HIV in our Region, less than half are receiving antiretroviral therapy. HIV viral load testing, which is essential for managing HIV, is routinely available only in Thailand. HIV stigma and discrimination – especially in health care settings – too often deters the most vulnerable from accessing the prevention and treatment services they need.
An estimated 1.4 billion people in South-East Asia, meanwhile, are at risk of malaria. Though seven countries reported reductions in confirmed malaria cases of at least 75% from 2000 to 2015, malaria remains endemic in every country in the Region except the Maldives and Sri Lanka.
The malaria burden, as well as patterns of infection, varies substantially between and within countries, preventing us from using a one-size-fits-all model for malaria control. Particular efforts are needed to accelerate malaria control programmes in India, Indonesia and Myanmar, which together account for 98% of the Region’s malaria cases.
Although South-East Asia accounts for only about a quarter of the world’s population, we represent nearly half the global TB burden. In 2015 more than 4.7 million people in the Region contracted TB and more than 780 000 died of the disease. The rate at which TB incidence is declining – between 1.5% and 2% per year – is too slow to reach the goal of ending TB by 2030, meaning progress must be accelerated.
As we work to face these challenges head-on, several key principles and strategic directions should guide our collaborative efforts.
First, political commitment must be sustained and converted into action. The push to end these three epidemics by 2030 – as well as to eliminate neglected tropical diseases – should be visibly and enthusiastically led by a national body empanelled by the Head of State. Doing so will enable countries to devise their own approaches to respond to specific national and sub-national needs. It will also demonstrate the urgent need for action.
We welcome important signs of political commitment to the TB response. The just-concluded meeting of health ministers issued the ‘Delhi Call for Action’ and declared TB a regional priority. Greater budgetary commitments for TB are being made. The new ‘Bending the Curve’ initiative will catalyze regional progress in TB control and promote optimal strategies towards ending TB.
Second, financial investments must be front-loaded rather than delayed. Decision-makers must understand that we can either pay for endgame strategies now or pay much, much more down the road. WHO is committed to helping countries estimate their resource needs. Indeed, recent WHO estimates show that we need three to four times more resources for TB and at least twice the present resources for HIV.
Third, communities must be empowered and engaged. Focusing on the most vulnerable will help ensure disease control efforts are equitable and inclusive, and that they respond to community needs.
As part of this, a range of key players – from persons suffering the diseases to CBOs and NGOs – can work to raise awareness and ensure appropriate services that leave no one behind. Their efforts will also combat stigma and help address the social and structural factors that increase vulnerability.
Fourth, we must strengthen our strategic information systems. Switching to case-based surveillance, for example, is an absolute must to end HIV, TB and malaria. It is imperative that data systems are aligned with Health Management Information Systems, that they reach the local level, and that they aid the performance monitoring of local programmes.
To make the most of this information, local authorities must have a strong understanding of the disease burden and the resources needed to tackle it. They must also develop local plans and indicators. Dashboards should be available to enable ministers and other decision-makers to visualize and understand in real time the needs, situation and gaps in each locality, and to take action accordingly.
Fifth, and finally, investments in research must be maintained and scaled up. To convert new knowledge into action, impediments to early adoption of innovations must be removed. At the same time, new communications technologies must be fully leveraged to increase access and improve retention in services. WHO pledges to help national partners do this, and to promote South-to-South collaboration on key issues such as regulatory review and registration of new products.
Since the year 2000, HIV, TB and malaria have together caused millions of deaths in our Region. They have devastated communities and households, diminished the life potential of countless children, and slowed economic growth and development.
Given HIV, TB and malaria’s unfortunate toll, envisioning a world in which these epidemics are no longer a threat is difficult. But taking a moment to imagine a world without them is important – and inspiring. Imagine families and communities being able to live, grow and work without fear of these leading infectious killers. Imagine a Region that is safer, happier, more just and more prosperous.
That is what this meeting is about. That is why we do the work we do.
This meeting has the potential to serve as a watershed in our regional response to HIV, TB and malaria. In our time together, let us learn from one another and find new ways to pursue our joint mission. Let us leave this meeting more committed than ever to a time-bound, results-driven approach to eliminate these and other communicable diseases.
I reiterate WHO’s full support for your efforts, and pledge WHO’s ongoing commitment to achieving success.
Let us take full advantage of the opportunity before us. Let us together end the HIV, tuberculosis and malaria epidemics once and for all.
Thank you very much.