Finally curbing pulmonary tuberculosis (PTB) in the Philippines may require strong political will, and its increasing incidence, despite government efforts, requires a higher level of commitment.
A few years ago, a well-to-do patient, whose husband had died of lung cancer, came to us for routine checkup, and was incredulous when the results of her chest X-ray showed she had TB.
It has always been thought that TB afflicts only poor families with far-from-ideal hygiene. Although this is generally correct, it doesn’t mean that affluent families are immune to this infectious disease, which remains one of the top 10 killers in the Philippines.
The World Health Organization (WHO) declared TB a global epidemic in 1974, and with the resurgence of other infections such as HIV-AIDS, the incidence and prevalence of TB have not waned in under-developed and developing countries.
The germ causing TB, Mycobacterium tuberculosis, is spread by droplet infection from person to person through the air, like when the infected person coughs or sneezes. A strong immune system can ward off casual exposure, so one should not be paranoid about talking to people who may look like they have TB.
However, if one has a weakened immune system, such as smokers, or has been taking care of someone with TB for a long period, one faces the risk of getting infected increases.
This may have been the case of the patient we cited whose husband died of lung cancer after a lingering illness. Lung cancer and PTB may coexist in the same patient.
My good friend, Dr. Camilo Roa Jr., the only Filipino to be elected secretary-general of the Paris-based International Union Against Tuberculosis and Lung Diseases (IUATLD), laments that up to now, more than 25,000 Filipinos are dying annually of TB. In Asia Pacific, we remain a “hot spot” for TB, with India, China, Indonesia and Pakistan.
Dr. Roa is presiding over the forthcoming 7th Union-Asia
Pacific Regional Congress on April 23-26 at the Philippine International Convention Center. The IUATLD, now simply known as the Union, was founded in 1920 and is the oldest global nongovernment organization (NGO) taking on TB, smoking and other prevalent lung diseases like asthma, chronic obstructive pulmonary disease (COPD) and pneumonia.
The Union has been actively collaborating with the scientific community, other health NGOs, the WHO, academe, civil society and various funding agencies. Dr. Roa says that it continues to push TB control through advocacy, international scientific meetings on lung health, and leadership courses. It also supports the development of new drugs and vaccines, and the implementation of novel treatment strategies against TB.
Because of inappropriate use of medications, multidrug-resistant TB (MDR-TB) is also increasing. Last year, the Union moved for the adoption of a short course, all-tablet treatment for MDR-TB.
The Philippine scenario remains a major challenge. Dr. Roa cites the latest National TB Prevalence Survey (NTPS) of 2016, showing that despite all efforts of the government and private sector, the incidence of TB is even higher today than 10 years ago. If the more sensitive molecular tests are used as basis, the estimated rates are more than three times the expected rates, with more than a million cases per year predicted in this country.
Even Health Secretary Francisco Duque III has sounded the alarm repeatedly, and even said during the United Nations High Level Meeting for TB in New York last year that TB work in the Philippines can no longer be considered as “business as usual.”
According to Secretary Duque, the Philippines is committed to “find and treat” some 2.5 million TB cases by 2022 to decrease the incidence of this lung disease by 23 percent. Beyond 2022, the goal is to finally eradicate TB. Based on the 2017-2022 Philippine Strategic TB Elimination Plan Phase 1, targets include the reduction of the number of TB deaths by half.
It may be worth noting that the Philippines has been acknowledged as one of the pioneers in the global fight against TB. Our Philippine Tuberculosis Society Inc. (PTSI), founded in 1910, even preceded the founding of the Union. The PTSI was organized by a group of Filipino physicians returning to the country after training abroad, and it is one of the “Legacy Members” of the Union.
“The PTSI built the Quezon Institute, which during its heyday housed over a thousand TB patients,” says Dr. Roa. When effective TB treatment was discovered and management became outpatient, QI maintained an outpatient clinic, which became a multiawarded model, with six active branches fanned out in various provinces.
Despite all the prevailing challenges, the WHO, the Union and other global stakeholders in the fight against TB are optimistic that TB can finally be globally controlled, if not eradicated, by 2030. Included in the more ambitious sustainable development goals (SDGs) program for 2030 is the End-TB Strategy that aims for a 90-percent reduction in TB-related mortality and an 80-percent decline in TB incidence by 2030.