Question: I am pleased to invite Ms Saima Wazed, WHO Regional Director for South-East Asia to share key perspectives on regional progress towards ending TB and the impact of drivers like climate change.
- Climate change is intertwined with the tuberculosis (TB) epidemic. It exacerbates many social and environmental risk factors associated with TB, leading to increased incidence, prevalence, and mortality. This particularly impacts the most vulnerable and marginalised persons.
- The WHO South-East Asia Region bears 45% of the annual global TB incidence and nearly half of the mortality.
- Thus, in the Region, any factor that increases vulnerability to TB, or influences transmission dynamics, disproportionately impacts regional and global progress towards ending TB
- There is a significant political commitment towards ending TB in SEA, but we will miss our targets at the current pace of progress because of a slow decline in the incidence rate – marginally more than 2% per annum since 2015, and unfortunately almost an unchanged number of deaths.
- Climatic events, extreme temperatures, and natural disasters often lead to population displacement.
- This increases the number of vulnerable people at risk of TB, and reduces access to health services.
- These conditions create an environment conducive to TB transmission and the development of active TB, while also disrupting diagnosis and treatment services.
- This worsens conditions for those already experiencing undernutrition and poverty, which are determinants of TB.
- Climate change also threatens food security.
- In SEAR, more than 1m people developing TB disease in 2022 have been attributable to undernutrition.
- A weakening food supply chain would have a spiraling effect on TB incidence and associated mortality.
- Climate change can also impact people’s immune status, leading to an increased breakdown of existing infections into TB disease.
- There are an estimated nearly 600 million people infected with the TB bacillus in SEAR
- Given this, the magnitude of impact of an increased breakdown to TB disease is alarming
- SEAR is highly vulnerable to climate change – in particular, Bangladesh, Bhutan, Maldives, Myanmar and Timor-Leste, followed by DPR Korea, India, and Nepal.
- Of these, Bangladesh, DPR Korea, India and Myanmar are high TB burden countries
- Nepal has a high MDR-TB burden, and Timor-Leste is among top 10 countries in the world for incidence rates.
- SEAR is highly vulnerable to climate change – in particular, Bangladesh, Bhutan, Maldives, Myanmar and Timor-Leste, followed by DPR Korea, India, and Nepal.
- Climate change will, therefore, have a devastating impact on progress towards ending TB
- A significant challenge is the limited availability of data on the climatic risk and spatial distribution of TB, as well as the resilience and adaptation capacity of TB programmes and vice versa. Evidence is growing on the various mechanisms by which climate change affects TB.
- Our health services need to be resilient to climate change, to ensure continuity of access even in case of natural disasters.
- We will need community empowerment to make them aware of impacts of climate change
- Grassroots engagement needed to work alongside health systems to ensure that the vulnerable people stay protected from the impact of climate change
- We need political and financial commitments - not just to end TB, but also to urgently tackle climate change.