Last week almost 15,000 international delegates and world leaders gathered in Port Moresby, the capital of Papua New Guinea (PNG), to attend the Asia Pacific Economic Cooperation (APEC) Summit. APEC is a regional economic forum that was established in 1989 and is made up of 21 countries. It aims to “create greater prosperity for the people of the region by promoting balanced, inclusive, sustainable, innovative and secure growth and by accelerating regional economic integration.” This year, the APEC meetings were hosted in PNG, a low-income country with one of the highest tuberculosis (TB) burdens in the world. TB and antimicrobial resistance (AMR) were identified as priority issues with significant bearing on economic growth and development. As PNG’s hosting draws to an end, we look back on the impact of the Summit.
APEC economies signed up to a document called the ‘Port Moresby Statement on Ending TB through a Multi-Stakeholder Response’, which outlines specific commitments for the region with the aim of ending TB as part of the Sustainable Development Goal agenda. This kind of regional cooperation will be essential in ensuring that the promises made at the first UN High-Level Meeting on TB on 26 September 2018 are delivered on. The UN High-Level Meeting was the first time TB was discussed at this level and only the fifth such meeting on a health topic. Member States at the meeting signed a political declaration outlining steps to be taken against the disease. Follow up actions must include closing the global funding gap for care and prevention, reaching all people with diagnosis, treatment and prevention, increasing human resources at the local level, and closing the research and development funding gap for new drugs and a vaccine, including a treatment regimen that is shorter and easier.
In Papua New Guinea, the government’s commitment to ending TB is being translated into action. In Daru, where about 3% of the population have TB and 1 in 10 TB cases are multi-drug resistant, there is now systematic screening for TB of everyone over 10 years old. People who test positively get an immediate confirmatory test and commence treatment. Now, the treatment success rate for multi-drug resistant TB is 82%, markedly higher than the global average of around 55%. But there’s still a long way to go.
The high rates of TB overall in the country, however, are showing no signs of decreasing. In fact, rates of multi-drug resistant TB are actually increasing. Every day there are approximately 100 new cases of TB and 10 deaths from the disease. The fight against TB has been described as “akin to taking a knife to a gun fight”. In Papua New Guinea, it is easy to see why. There is a deadly combination of inaccessibility of health services, and insufficient TB treatments. It is essential that new tools are developed to fight the disease, and that the political commitments at APEC and the UN High-Level Meeting result in meaningful action.
Meii 2 Village. Photo Credit: Tom Maguire, RESULTS UK
Battling TB in Papua New Guinea can cause great personal social and economic upheaval. A person with drug resistant TB needs to travel to their health centre every day for the first 6-8 months of treatment for an injection, and is required to take a daily concoction of drugs thereafter. This disrupts people’s ability to work due to long distances (over 80% of people in Papua New Guinea live in rural areas) to the nearest health centre, involving transport costs, or intolerable side effects from the treatment. Health services are delivered via aid posts, of which there are about 800 in Papua New Guinea. However, only about half are operational, and even the ones that are operational might not have the right treatments for drug-resistant TB.
Meii 2 Village. Photo Credit: Tom Maguire, RESULTS UK
For this man, from Meii 2 Village, accessing treatment for drug-resistant TB requires a daily boat ride to Kerema Hospital for the injection and pills, followed by up to 2 years of approximately 20 pills each day. Personal battles with TB have a knock on effect locally and nationally. It is predicted that TB causes about $23.5 million annually to disappear from the country’s economy, due to the majority of people with TB being potential wage-earners, a decline in average productivity and loss of potential income.
MSF Hospital, Kerema. Photo Credit: Tom Maguire, RESULTS UK
For others, an aid post could be entirely out of reach. Dulcie, a five-month old baby, lost her mother to drug-resistant TB soon after she was born and is currently being treated for drug-resistant TB at the Medecines Sans Frontiers (MSF) TB hospital in Kerema, a seven-hour boat trip from her home in Kikori that costs about 300 kina (roughly £70). Her mother’s condition meant that she could not make the long trip to Kerema, and unfortunately her nearest health post did not have capacity to treat drug-resistant TB. This means that Dulcie cannot return home while she still needs treatment, so her auntie is staying nearby to look after her. It is not uncommon for children to have TB in Papua New Guinea. In fact, 26% of cases are in children, much higher than the global average of about 10%. Children are especially vulnerable to TB and in Papua New Guinea the risks are often even higher as families often live together in very close quarters.
Words on paper from the APEC and UN High-Level Meeting summits will be meaningless if individual countries do not deliver on them with concrete action. As we look towards Chile’s presidency of the APEC meeting next year, we hope that the region makes delivering on the commitments of the UN High-Level Meeting on TB a priority.