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Partner Perspectives
World Health Organization’s Mario Raviglione Talks TBBy Jed Levine
BUSINESS ACTION SAT DOWN WITH DR. MARIO RAVIGLIONE, DIRECTOR OF THE STOP TB DEPARTMENT OF THE WORLD HEALTH ORGANIZATION, to discuss why fighting TB is integral to the fight against HIV/AIDS and to elicit his thoughts on how the private sector can help.
What is the relationship between TB and HIV/AIDS?
The issue is obvious; when you have an HIV-positive person, the risk of TB for this person is very high. Often times, a person is treated for HIV infection with antiretrovirals and people don't think that at the same time you could, with an extremely inexpensive intervention, also sterilize the TB bacilli that he or she might be carrying.
What we are now saying is that where the two epidemics coalesce and coincide, joint interventions should be put in place. For instance, when you have a new TB case in a high-HIV prevalence area, you have to suspect HIV. You should test and offer counseling and offer the possibility of extensive care for HIV, including antiretrovirals.
What would it take to turn around the TB epidemic?
Most important is the full implementation of the Stop TB strategy. The number one component is proper case management, which means diagnosing the case as quickly as possible and treating the case effectively until the end. Second is addressing the issues of TBHIV and multidrug-resistant TB. Third is to keep in mind broader health system issues, including those of human resources, budgeting, and planning.
The fourth is the involvement of all providers, and this is a critical link to the issues of the corporate sector.
Fifth is involving the communities, because of the role of communities in both promoting the issue of TB control and participating in the care of the patient. And, finally, the issue of research into new tools.
Regarding the gaps in the response, if you go down into more technical details, it's the lack of human resources in many countries, particularly in Africa, where you have so few trained nurses and physicians.
In most countries today, drugs are available, but what is very weak in the overall system is the capacity to actually detect the cases promptly; there is also the implication there for the development of new tools— which we need to do.
What roles could the private sector play to support public health efforts on TB?
Companies can help with resource mobilization— bringing messages to places like Davos, messages that say simply TB control is a cost-effective thing or TB control is the responsibility of everyone. There are different types of campaigns that can increase the resources that are available today.
Companies can also contribute through education and awareness campaigns. If you think about big corporations, they could help very much in education campaigns that simply bring the message to the most peripheral level, like the rural areas of Africa. Imagine a company with presence in a small village in Africa. They can deliver a message that says if you are coughing see a doctor, and if you have TB there is a cure; that would already help people to be mobilized and perhaps go and be helped quickly.
What lifestyle practices and choices can companies promote among their employees to reduce their risk of contracting TB?
We go back to health education types of messages— it's basically information, education, and communication. In terms of lifestyle in general, the various factors that predispose a person to tuberculosis are clearly those related to issues such as malnutrition, alcoholism, smoking. There is still a long way to go to promote certain education interventions, to counsel employees in a way that is well explained and clear.
Again, it's an issue of developing and communicating proper health messages. This is something that can be done fairly easily by any company.
What message would you send to CEOs to support global efforts against TB?
Apart from the messages I mentioned before, I would simply say a couple of words: tuberculosis is a global disease; it still kills 4,500 people every day; it spreads by air and therefore can actually affect everyone. So I say: act up, join the fight, and we will all work to have the lives of people improved with the reduction of unnecessary suffering.
The role of the private sector is as important as is that of the public sector, which has to maintain, of course, the general leadership on conducting health programs. But in 2008, we cannot just rely on the governmental sector; there is a huge need for everyone to participate, including in the control of tuberculosis and in research that is necessary to develop better tools, better diagnostics, better drugs—including a vaccine that in the end will be a solution for TB control.