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Address by the Mister of Health Dr A Motsoaledi - Role of Parliamentarians in fight against TB

Speech by the Mister of Health Dr A. Motsoaledi debate on the role of Parliamentarians in the fight against Tuberculosis (TB), National Assembly, 4 September 2018

Honourable Speaker
Honourable Members of the National Assembly House
Distinguished Guests
Ladies and Gentlemen

Good afternoon

Allow me to express my sincere gratitude to you Honourable Speaker for having allowed us an opportunity to hold this debate. In fact, we must recognise the hard work of the Chief Whip of the ruling party, who worked hard to revive interest in the issue that must seize us as leaders. The issue that has given reason for this debate is of great importance beyond our provincial boundaries, beyond country borders, beyond ideologies and beyond party politics. I am speaking about a disease that we all grew up knowing - a disease called Tuberculosis or TB.

Honourable Speaker, when I was granted a similar opportunity to address both Houses of Parliament in November 2015, I informed Honourable Members that TB has been with us for centuries, although the bacillus was only identified on the 24th March 1882.

Over the past 200 years, TB killed more people than Small Pox, Malaria, Bubonic Plague, Cholera, Influenza, Ebola and HIV/AIDS, combined! The surprising thing is that despite, all of this evidence, the need to end TB has not result in much urgency among health activists, scientists, politicians and many world leaders.

As a fight-back strategy by the World Health Organisation (WHO) to push back this onslaught against TB, an organisation called Stop TB Partnership was formed around 2000. The Organisation has now been transferred from the WHO to UNOPS (United Nations Operations). It has got an international board which controls its activities. Its function is to coordinate the fight against TB globally. I have been a member of this international board since 2009 by virtue of coming from a high-burden country for TB.

In 2009 all the members of this board gathered for a whole week in Washington on a Retreat. The aim of the Retreat was to establish why TB is a great killer of people globally but it does not scare people into action, like other pandemics. It largely remains below the radar screen. In this Retreat we even invited experts in marketing to try and make us arrive at the right conclusion, but we could not arrive at any convincing answer to this quanondrum. Even the warning by our international icon, Tata Nelson Mandela, did not seem to do the trick. As you all know Tata Madiba is himself the survivor TB. In 2004 at the International AIDS Society Conference held in Bangkok, Thailand, this is what Tata Madiba had to say: "The World has made defeating AIDS a top priority. This is a blessing. But TB remains ignored. Today we are calling on the world to recognise that we cannot fight AIDS unless we do much more to fight TB as well".

I thought that well, maybe something good will come out of this over-exaggeration by the newspaper. I thought maybe at long last, such a headline misleading as it was, will spur people into action. Unfortunately that was not to be. The article just made a small bleep on the radar screen and disappeared immediately.

Let me share with this House some data on the size of the TB problem in our country. The WHO estimates that 438,000 people in South Africa get infected with TB every year. Put another way, today and every day, in our country, 1 200 people get infected with the TB bacillus or 50 every hour.

In addition, about 20,000 people get TB that is resistant to medication, and is much more expensive and difficult to cure, known as multi-drug resistant TB (MDR-TB). Because of our high HIV infection levels, almost 60% of South Africans with TB also have HIV.

These data put South Africa in the infamous league of 14 countries in the world with the highest burden of ordinary TB, MDR-TB and TB that is associated with HIV.

Honourable Speaker, we have a huge and complex multifaceted TB burden on our hands, which, as you may have heard from STATSSA, is the number one killer of South Africans. At long last the world is now beginning to take TB more seriously and South Africa and this Parliament must too. Although we still have a long way to go, never have global leaders been challenged to end TB as is currently the case. The global theme of "Wanted: Leaders to end TB" has been a rallying call to all leaders across various sectors of society to step up to the challenge posed by this curable disease.

In 2013 I was elected as the Chairperson of the Stop TB Partnership Board that I mentioned earlier. In this capacity, I was invited to participate in a high level meeting of Heads of State to debate the new global health security threat brought by Anti-Microbial Resistance (AMR). AMR is a growing phenomenon whereby microbes are no longer killed by long established drugs that have been used over ages. During the debate, I challenged the UN about the challenge of TB. According to information at my disposal, one-third of AMR is actually TB/MDR-TB.

So I raised the issue with the UN that if MDR-TB alone is responsible for one-third of AMR, how would we win the battle against AMR if we keep on ignoring TB.

I suggested that a high level meeting of Heads of State be called to debate TB as they did with other major epidemics like HIV/AIDS, Ebola and AMR itself. And I am happy to mention that such a debate is going to take place on the 26th of this month, and our President is going to participate.

We may succeed in mobilising global leaders, but, ultimately, it is leaders within countries that will really get us over the line to TB elimination. This is why we are having this debate. I am also pleased that we have made significant progress towards launching our TB Parliamentary Caucus, thus joining many other countries that form the Global TB Caucus of Parliamentarians.

Honourable Members, a little bit about the genesis of Global TB Caucus:

In the annual world conference of the International Union Against TB and Lung Diseases held in Barcelona in 2014, the Executive Director of the Union, Dr Jose Luiz Castro, emphasised the need to engage parliamentarians in global efforts to fight TB.

Parliamentarians can play a crucial role in our fight against TB because by virtue of their position and roles, they make key decisions on health legislation and approve budgets of government departments, both of which are critical in the fight against TB.'

I attended the Barcelona conference in my capacity as the Chair of Stop TB Partnership Board. Also present at the conference was the Right Honourable Nick Herbert, a member of parliament of the United Kingdom who co-chairs the UK All Party Parliamentary Group on Global TB as well as 7 other MPs from France, India, Kenya and Tanzania.

We decided at this conference to launch the Global TB Caucus and I was requested to co-chair the Caucus with the Right Honourable Nick Herbert. The vision of the Global Caucus is a world free of TB.

To drive this vision, a declaration called the Barcelona Declaration, was adopted and is now in the form of a Pledge. I can't read the entire pledge given time constraints but will summarise its main tenants. The declaration states, among other things that, parliamentarians should demand that "every patient, regardless of who they are, where they live, or their ability to pay, [should] have access to quick, accurate diagnosis and high quality treatment, and that TB diagnosis and treatment never result in the impoverishment of patients or their families".

The Declaration further commits is signatories:

  • "To working across geographical and political divides in a non-partisan and inclusive fashion;
  • To engaging with civil society and all other stakeholders involved in the fight against the TB epidemic; and
  • To confront stigma and social isolation associated with the disease".

We will say more about the Global Caucus this evening when we launch the South African Parliamentary Caucus to which all members of Parliament are invited. I do hope that all Honourable Members will attend and sign the Declaration. I am grateful to Honourable Speaker together with Honourable Chairperson of the NCOP, for their role in ensuring that our Caucus will be launched this evening.

I cannot conclude my contribution to the debate without saying a little about the High Level Meeting. In preparation for this Meeting, the World Health Organisation and the Russian Federation hosted the First Ministerial Conference on TB in November last year. At this meeting five key issues were raised as what are not called the Key Asks which have found their way into the draft Political Declaration which after discussion at the High Level Meeting will be adopted.

These key asks are as relevant for us in South Africa as they are globally and I will summarise them as follows:

  • Ensure access to integrated people-centred services (diagnose and treat 40 million people with TB between 2018 and 2022 globally, including 3.5m children and rapid scale up of TB preventative therapy);
  • Leave no one behind through global and multi-sectoral collaboration (with special attention to the poor, vulnerable & marginalized people and communities);
  • Accelerate the impact of research and innovation (deliver by 2025 new, safe & cost-effective vaccine, point of care diagnostics, drugs and shorter treatment regimens);
  • Ensure sufficient and sustainable financing to end the TB epidemic (double annual investments from various sources, including for research and development); and
  • Provide bold leadership and multi-sectoral accountability (at national and global levels, including progress reports to the UN General Assembly in 2020).

From this list it is clear what we need to do in our country to end TB and where Members of Parliament can be helpful.

Honourable Speaker, let me conclude by reiterating what I said when I addressed this House in 2015:

Members of Parliament must be at the centre of challenges that face the citizens they represent.
Elimination of the TB epidemic desperately requires the leadership, advocacy and guidance of all parliamentarians and I humbly request you to join us in this fight.

I ask you to join leaders from various sectors of our community, including those that have survived TB. Some of them are here today, and I would like to introduce them to you:

1. Prince Nhlanaganiso Zulu, the son of his Majesty, King Zwelitheni, who had a lung removed because of TB
2. Gerry Elsdon, a business woman who had extra pulmonary TB of the womb, thereafter denying her the God given gift to have children
3. Thabo Pelesane, a municipal worker in Matlosana, who is also a vibrant community activist
4. South Africa's reigning beauty queen Tamaryn Green, a medical student who contracted TB while undertaking her practicals in one of our hospitals
5. Dr Thato Mosidi, and Drs Dalene and Arnie Von Delft who contracted TB while practicing as medical doctors, trying to save lives in our health facilities

These are our activists that survived TB and have partnered with the Department to spread the message: anyone can contract TB but TB is curable.

As I have said before, we must be the generation that finally rids South Africa of the scourge of TB! To achieve this all we have to do as leaders in society is to step up. Working together we can save the lives of those we lead. History will judge us harshly if we don't succeed.

I thank you.

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