Tuberculosis remains the deadliest infectious disease in the world, with 1.3 million deaths annually and over 10 million cases, primarily affecting low-income individuals in low-income countries. The COVID-19 pandemic caused setbacks in diagnosis and treatment, but in recent years, efforts to control the disease have gradually recovered. Cuts in global health funding pose a new challenge for this disease, adding to a historical lack of R&D and effective prevention and treatment tools, which have facilitated strains of the disease with high resistance to existing drugs.
On World Tuberculosis Day, we speak with Ani Herna Sari, a tuberculosis survivor and co-founder of the Rekat Peduli Foundation in Indonesia, an organization that works to support and empower people affected by multidrug-resistant tuberculosis.
Additionally, they provide training on Human Rights and Gender to raise awareness and strengthen communities. They also offer essential resources such as nutritional support, wheelchairs, and transportation assistance, ensuring that people receive the care they need. “Our goal,” Ani clarifies, “is to improve their well-being and facilitate their reintegration into society with dignity and real opportunities.”
After so many years of experience… which initiatives work best in the fight against tuberculosis?
Since tuberculosis is closely linked to poverty, combating it requires much more than diagnostics and treatments. It is essential to bring education and awareness programs to communities with limited access to healthcare.
The most effective initiatives are those that take a comprehensive approach. It’s not just about ensuring access to treatments but also about involving communities in the fight against the disease. The participation of survivors and local leaders helps reduce stigma and encourage treatment adherence. Additionally, providing psychosocial support, nutritional assistance, and economic empowerment programs significantly improves patients’ quality of life and increases the likelihood of them successfully completing their treatment.
In that way, you address not only the disease but also the social determinants of health…
It is impossible to effectively combat tuberculosis without addressing its social causes. Factors such as poverty, lack of adequate housing, malnutrition, and limited access to education directly influence the spread and treatment of the disease.
The most effective programs focus not only on medicine but also on improving patients’ living conditions. By offering economic opportunities, emotional support, and better access to food, we not only help ensure successful treatment completion and disease cure but also promote long-term tuberculosis control.
The tuberculosis vaccine used today was developed more than 100 years ago! One of the most hopeful pieces of news is the upcoming arrival of the MTBVAC vaccine (developed by Professor Carlos Martín’s team at the University of Zaragoza, Spain), which is already in an advanced (Phase 2b) trial stage but has faced funding issues… Are there problems in R&D funding for tuberculosis?
It is a major challenge. Despite being one of the deadliest infectious diseases in the world, tuberculosis receives less attention and funding than other diseases like HIV/AIDS or malaria. This is partly because it primarily affects low-income countries, where profitability for the pharmaceutical industry is lower.
Projects like the MTBVAC vaccine represent great hope, but their progress has been hampered by a lack of resources. Without sustained investment in research, the fight against tuberculosis becomes more difficult, especially with the rise of drug-resistant strains. Greater cooperation between governments, philanthropic organizations, and the private sector is crucial to ensure that these advances in vaccines and treatments are not halted.
Often, climate disasters (such as the Bangladesh floods) are directly related to the increase in infectious diseases. Does the fight against TB, malaria, and HIV also involve the fight against climate change?
Climate change and infectious diseases are closely related. Floods, extreme heat, and changes in weather patterns can disrupt healthcare systems, displace populations, and create environments where disease vectors—such as the mosquitoes that cause malaria or contaminated water that spreads tuberculosis—can thrive.
Reducing emissions, investing in disaster preparedness, and strengthening the resilience of vulnerable communities will not only help combat climate change but also contribute to reducing the spread of infectious diseases. The fight against climate change and infectious diseases must be considered part of the same global health agenda.
Regarding the One Health approach… it seems that on the fifth anniversary of the COVID pandemic, the world is forgetting what it learned, and global health funding is dwindling. How could this impact the fight against TB?
Yes, with this reduction in global health funding, the world seems to be forgetting the lessons learned during the pandemic. The decrease in global financing could have devastating consequences, especially for diseases like tuberculosis, which already receive less attention and thrive in places with inadequate or overwhelmed healthcare systems.
The “One Health” approach recognizes the interconnectedness of human, animal, and environmental health and is essential for tackling diseases like tuberculosis. Without sustained investment, we risk losing the progress made and facing an even greater health crisis in the future.
Perhaps the multilateral organization that has most transformed the fight against tuberculosis is the Global Fund. From your perspective, having seen and lived through it firsthand, what has it contributed over these more than 20 years? What role does international funding play in the healthcare systems of low-resource countries?
The Global Fund has made significant contributions in the fight against tuberculosis over the past two decades. Its approach, providing flexible, results-based funding, has been crucial in strengthening health systems, improving access to medications, and building the necessary infrastructure, particularly in underserved communities. By incentivizing measurable health outcomes and fostering partnerships between governments, civil society, and the private sector, the Global Fund has helped make the fight against tuberculosis more coordinated and effective.
In addition to the Global Fund’s work, the Stop TB Partnership and the Challenge Facility play an important role in supporting TB communities. These mechanisms, funded through resources allocated by France and the U.S., complement the Global Fund’s efforts by supporting demand creation and community-led initiatives. Notably, the Challenge Facility empowers communities to address local TB challenges while fostering demand for new TB vaccines and monitoring through community-driven approaches. These efforts are critical for the future success of TB programs, and communities should continue to be supported in these areas going forward.
In low-resource countries, international funding plays a vital role in bridging gaps within healthcare systems. It supports critical care and enables efforts to reach vulnerable populations that may otherwise be left behind. Without such funding, many countries would face major challenges in combating tuberculosis and other infectious diseases effectively. The financial assistance from the Global Fund, along with initiatives like the Stop TB Partnership and the Challenge Facility, has empowered nations to address these challenges, making a tangible impact in the global fight against tuberculosis.
Additionally, the Global Fund announced a new round of funding weeks ago. Given the current times… is its work and proper funding more important than ever?
Given the current situation, the work of the Global Fund is more relevant than ever. We are still facing the aftermath of the pandemic, climate change continues to impact global health, and inequalities in healthcare access persist. Tuberculosis, HIV, and malaria continue to cause millions of deaths, and without adequate funding, prevention and treatment efforts could be severely affected.
It is crucial that global commitment to health continues and that the necessary funding is secured to keep making progress in eradicating diseases that, although preventable and treatable, remain a threat to millions of people worldwide.
