Bali Summit: Coordinated TB-diabetes treatment needed across all levels of the health system

“We have the ability and responsibility to address a growing public health crisis that needs urgent action. I am here to say we at The Union accept this challenge. We have to unite efforts in the fight against TB and diabetes. And we must take action now,” said The Union’s Executive Director, José Luis Castro, in a speech that opened Stopping a Looming Co-Epidemic: A Global Summit on Diabetes and Tuberculosis.

The summit is convening 2-3 November in Bali, Indonesia and has gathered 100 public health officials, leading researchers, business and technology leaders and civil society representatives.

The increasing interaction of two diseases is projected to become a major public health problem unless action is taken to avert it. 

"A rapidly growing pandemic of diabetes could threaten tuberculosis control and sustainable development by increasing the number of [TB] cases, increasing fatality, and increasing the risk of relapse after treatment,” said Dr Dyah Erti Mustikawati, National Diabetes Mellitus Program Manager for Indonesia's Ministry of Health. “As a country with a high burden of TB and escalating rates of diabetes, Indonesia has instituted a DM-TB policy as a priority to call for and enable coordination between public health programs tasked with controlling TB and responding to diabetes."

Dr Richard Brostrom, TB Control Manager for the Hawaii State Department of Health, presented data showing that 41 per cent of adult TB patients in Hawaii are also living with diabetes. Moreover, more than half of adult TB patients across the Pacific Islands are living with diabetes. “Diabetes among adult TB patients in the Pacific Islands is the rule, not the exception,” he said.

Quentin Cooper, presenter of The Forum on BBC, served as moderator for the summit. In a panel discussion on ‘Blueprints for action: rationales and solutions for fighting the dual diseases’, he asked Dr Paula Fujiwara, The Union’s Scientific Director, what lessons we could learn from New York City’s multidrug-resistant TB epidemic 30 years ago, the response to which she led. Fujiwara stressed the need for leadership, starting at the national level then reaching to states and cities.

The need for stronger advocacy was a key theme stressed throughout the day, considering that TB efforts are vastly underfunded and governments of low- and middle-income countries often provide no resources for diabetes at all. 

Anand Madhab, CEO of India’s Jagran Pehel, called for involving the mass news media in advocacy efforts "from the beginning. Not merely as a watchdog, but as a vital partner. The mass media is still the most impactful and cost-effective means of shaping public understanding and stimulating debate," he said. In fact, the day before the summit opened, the Times of India reported the death of a laboratory technician, employed by Mumbai’s main TB hospital, from MDR-TB and uncontrolled diabetes. 

Cooper half-joked, “We need our own version of Star Wars: The Force Awakens. That starts with everyone in this room taking action together."

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