Remarks by UNICEF Executive Director Henrietta Fore at the High-Level Meeting on Tuberculosis
As prepared for delivery
NEW YORK, 26 September 2018-
I welcome this opportunity to shine a light on an issue that should be at the top of the global health agenda — tuberculosis in children.
We will not make progress in the fight against TB without a focus on the special needs of children and young people.
Over 600 children die from TB every day — nearly a quarter million each year. Almost all before their fifth birthdays. Millions of lives cut short by a disease we know how to prevent and treat. Each one, a tragedy.
They die not because we lack the knowledge to prevent TB.
They die because of health systems that fail to take into account their specific needs.
While the world has developed systems for TB prevention, surveillance, diagnosis and treatment for adults, children are still falling through the cracks. Ninety-six per cent of the children who die from TB never accessed treatment. Less than half of the 1 million children estimated to fall ill with TB are identified and registered by national programmes. Undiagnosed. Unreported. Untreated.
Perhaps they live with a parent or caregiver who has TB but no one takes a closer look at them. Perhaps they access child health services but their symptoms are misdiagnosed as effects of malnutrition. Or they live in a community without health care workers who are trained to recognize the risk factors of TB in children. Each failure in the system increases the risk of infection, disease and death.
The Childhood TB Roadmap released two days ago outlines a number of steps that global partners and governments can take to close these gaps in detection, prevention and treatment.
I’d like to briefly highlight two specific areas — improved and integrated primary health systems at the community level and doing far more on innovation.
First — we call for a change in health systems, specifically systems that can reach all children, including those in remote and fragile contexts, at the frontlines of this disease.
We need frontline health services that can deliver multiple interventions at the household and primary-care level — including TB screening, vaccinations and treatments for every child, as well as responses to malnutrition, pneumonia and HIV. We must also scale-up systems for automatically screening all sick children and pregnant women as a matter of course.
For example, in Uganda and Nigeria, UNICEF is working closely with governments and our partners to integrate childhood TB screening and treatment in maternal and child health programmes.
This includes scaling-up the use of community health workers to not only deliver these interventions, but to raise awareness of the importance of screening, prevention and treatment among local populations. As we increase the supply of health services, we must also increase demand for them — including in remote, hard-to-reach communities, which must be at the heart of our efforts.
And second — we call for more innovation to help address this challenge.
As health workers know, collecting a young child’s sputum for TB testing is difficult, time-consuming and not always accurate. The technologies that exist such as GenXpert have revolutionized TB diagnosis for adults, but they’re not well-suited for children — especially young children. — and need to be interpreted by well-trained health workers.
Can we make progress on rapid diagnosis techniques for TB, similar to the ones that “changed the game” for HIV and malaria?
Can we develop new vaccines and child-friendly treatments with shorter regimes to improve adherence rates?
Beyond new technology or new treatments, can we also scale-up relatively simple interventions — like instituting systematic screening in households where adults have TB?
Of course, these innovations require investment. Funding for childhood TB has increased in recent years — but not enough. Children represent about 10 per cent of the global burden of TB — but just three per cent of overall spending on research and development.
But investment follows political will. We must continue making the case that hundreds of thousands of young lives and futures are at stake — and over time, millions more will die from a preventable cause if we fail to give this issue the priority it deserves in the years ahead.
That’s why this event is so important —it’s an opportunity to put childhood TB at the top of the global health agenda, and call for more investment into innovative solutions, and integrating detection, prevention and treatment across our frontline health systems.
It’s a battle that can be won. Let us stand shoulder-to-shoulder with communities, health workers and children everywhere. Let us put an end to this entirely preventable disease, once and for all.