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Fwd: Joint Statement on accelerating action to end TB: WHO Director-General with the WHO Civil Society Task Force on TB

By Erica Lessem | 29 Jul, 2019

Apologies for cross-posting--

Please see the below important communication from WHO and civil society
which, among other important items, encourages countries to transition to
an all-oral regimen to treat drug-resistant TB by World TB Day 2020 (24
March 2020)

Please push your country to make this switch to all-oral TB treatment.

Many countries are still using and even placing large orders for outdated,
toxic injectable agents. In addition to being painful and causing permanent
hearing loss and other damage, the injectable drug-resistant TB medicines
(amikacin, capreomycin, and kanamycin) have less high quality evidence for
efficacy than all-oral treatment options based on bedaquiline and
linezolid. Capreomycin and kanamycin are no longer recommended at all.

Instead, TB treatment programs are strongly recommended to use all-oral
regimens-- either:
 i) a longer regimen based on bedaquiline, linezolid, and
levofloxacin/moxifloxacin, plus cycloserine and clofazimine OR

ii) a shorter regimen under operational research which substitutes
bedaquiline for the injectable agent.

In solidarity,

---------- Forwarded message ---------
From: WHO Global TB Programme <>
Date: Wed, Jul 24, 2019 at 6:50 PM
Subject: Joint Statement on accelerating action to end TB: WHO
Director-General with the WHO Civil Society Task Force on TB
To: <>

Joint Statement on accelerating action to end TB: WHO Director-General with
the WHO Civil Society Task Force on TB
Latest news from the WHO Global TB Programme
View this email in your browser
*Joint Statement: Accelerating action to end tuberculosis* *WHO
Director-General with the WHO Civil Society Task Force on T*B

24 July 2019 | Geneva: The World Health Organization (WHO) Director-General
Dr Tedros Adhanom Ghebreyesus met with members of the WHO Civil Society
Task Force on Tuberculosis (TB) in June 2019, on the sidelines of the
annual meeting of the WHO Strategic and Technical Advisory Group on TB.
There was frank and constructive dialogue in the meeting, focused on:
urging countries to accelerate progress to reach the targets of the
political declaration of the UN High Level Meeting on TB; ensuring the
provision of the best possible diagnosis and care for people with TB and
drug-resistant TB, in line with the latest WHO recommendations; and
strengthening meaningful engagement with civil society at all levels of the
TB response. The Director-General and the WHO Civil Society Task Force on
TB agreed to issue this joint statement.

*The World Health Organization and its Civil Society Task Force stand
united in urging accelerated progress to end TB, in line with the
commitments made by Heads of State at the first United Nations General
Assembly High Level Meeting on TB. This will result in driving down
suffering and deaths caused by this top infectious killer. WHO and the
Civil Society Task Force urge countries, partners and other stakeholders

*1. Accelerate action to reach the targets of the political declaration of
the UNGA High Level Meeting on TB, including: treatment for 40 million
people with TB and preventive treatment for at least 30 million people for
5 years, the implementation of WHO’s Multisectoral Accountability Framework
and its monitoring at national and global levels.*
The bold targets in the UNGA High Level Meeting declaration
are intended to galvanize urgent national and global action to end the TB
epidemic. Dr Tedros has sent letters to Heads of State urging an
acceleration of the TB response. It is important for countries to translate
global targets into national and sub-national targets to monitor progress
and drive accountability. WHO is working towards enabling the adaptation
and use of the new Multisectoral Accountability Framework
by Member States and their partners at country, regional and global levels
in 2019. The proactive engagement of civil society in this effort is vital.

*2. Transition to an all-oral regimen to treat people with drug-resistant
TB by World TB Day 2020. *
In 2018, WHO issued new consolidated guidelines for the treatment of people
with multidrug-resistant TB (MDR-TB)
that could lead to major improvements in treatment outcomes and
quality-of-life for patients. A fully oral regimen is strongly recommended
as a preferred option for MDR-TB treatment. WHO and the Civil Society Task
Force strongly recommend that all countries transition to an all-oral
regimen for drug-resistant TB by World TB Day 2020.

*3. Identify best practices and champions to share lessons for rapid
implementation of new guidelines in countries.*
Some countries are making rapid progress in the implementation of the new
policies for the treatment of people with MDR-TB, TB preventive treatment
and Infection prevention and control. Lessons from these experiences should
be documented and shared widely to encourage widescale adoption and
implementation of WHO guidelines across all high burden countries.

*4. Strengthen meaningful engagement of civil society and affected
communities in the TB response.*
The members of the Civil Society Task Force applauded the efforts of WHO
Director-General Dr Tedros in engaging with civil society. The revamped
Civil Society Task Force was highlighted as a good example of meaningful
civil society engagement at the global level, and was recommended to be
replicated at the regional and country levels.

*Download the Joint Statement of the WHO Director-General and Civil Society
Taskforce on accelerating action to end TB*
*World Health Organization, *
*Global TB Programme*
20, Avenue Appia, CH-1211, Geneva, Switzerland
Tel: (+41) 22 791 4695.
For more information please go to

*About the WHO Civil Society Taskforce:*
In November 2018, WHO’s Global TB Programme revamped *Civil Society Task
Force on TB
to provide a platform for discussion and harness the untapped potential in
engagement with community and civil society stakeholders at all levels. The
task force is a culmination of the commitments made by the WHO
Director-General to strengthen civil society engagement with WHO, as
discussed at several consultations with civil society representatives,
starting from the first WHO Global Ministerial Conference on Ending TB
which took place in Moscow in November 2017, the 15-16 January 2018 WHO
consultation between civil society representatives and WHO DG and
leadership, followed by a face-to-face meeting at the Delhi End TB Summit
in March 2018 which culminated in the UN Interactive Civil Society Hearing
and the UN High Level Meeting on TB in 2018. WHO is committed to ensuring
meaningful engagement with civil society and affected community partners
and Civil Society Task Force is a platform established to facilitate this

*Copyright © World Health Organization | 2019 | All rights reserved. *



SOPHAN SAM Replied at 11:37 PM, 29 Jul 2019

Thanks for sharing.
We are Cambodia is on the way in line with this recommendation.

Claudia Mutaquiha Replied at 12:35 AM, 30 Jul 2019

Thank you for reminding. In Mozambique we are going to start this
recomendation this year.


A terça, 30/07/2019, 05:46, SOPHAN SAM via GHDonline <>

Mesfin Bekele Replied at 12:55 AM, 30 Jul 2019

thanks for your email.
we have decided for injection free DR-TB treatment options for >65% of
cases thinking others may not be eligible for this regimen so,
individualized and standardized short term regimen will stay as
option.Injection free DR-TB treatment will be started soon few months back
because of procurement delay but other primary preparations has been

Abdul ghafoor Replied at 12:56 AM, 30 Jul 2019

Thanks Erica for sharing a very important document.Pakistan has started all
Oral Regimen for DRTB Treatment and is planning to conduct operation
research on Modified STR.

Llang Bridget Maama Replied at 2:32 AM, 30 Jul 2019

Thank you Erica, the kingdom of Lesotho we have since started the all oral formally since 2018. We have opportunity to also do individualized regimen. Our advantage is that we also are in a multi country
studies, prospective observational study and a clinical trial so most of our patients have been on all oral before the new Who guidelines
Our country contributed to the design of the regimen as well.

Erica Lessem Replied at 9:57 AM, 30 Jul 2019

Thank you all so much for sharing experiences and the important progress
being made in the Kingdom of Lesotho, Pakistan, Mozambique, and Cambodia.
That is great to hear! Please document and share your experiences so we can
all learn from them.

Mesfin Bekele, I didn't see where you are working, but that is great that
the majority of patients will get injection-free treatment. I am curious
from where the estimate came that ~35% of patients would not be eligible?
Evidence shows the drugs in all-oral regimens are well-tolerated and there
is little pre-existing resistance. Many patients are not eligible for
shorter standard regimen due to intolerance to drugs or pre-existing

Procurement delays are often a challenge but there are resources to help
with this, for example the Global Drug Facility can often provide useful
guidance and work with programs to meet their needs.

If you or your program is encountering difficulties switching to all-oral
regimens it has questions, I'd be happy to connect you to experienced
technical assistance providers. Please feel free to email me at

All my best,

jeetesh singh Replied at 11:36 AM, 30 Jul 2019

Erica with the way bdq accessibility is an issue and also dlm how can oral regimen be used for every dr Pt ?

I wonder .


Erica Lessem Replied at 12:18 PM, 30 Jul 2019

Dear Jeetesh,
That's a great question. It would be good to know which accessibility
challenges you're experiencing in your setting.

In my opinion, at the global level the biggest challenges are the high
pricing ($400 for BDQ and $1700 for delamanid per six-month course, in most
high burden settings ) plus lack of registration of delamanid.

Activists have been calling for change on both of these fronts.

However, this is not an excuse for countries to not implement the best
standard of care. Indeed, with political will, even these issues are not
insurmountable. Import waivers can temporarily suit when registration is
pending or not yet initiated, and the cost of suboptimal treatment
(morbidity and mortality, ongoing transmission, disability) with older
drugs far exceed the higher price tag of the newer drugs. South Africa,
which has a huge burden of DR-TB, has pioneered the switch to bedaquiline
as part of DR-TB treatment for all. We've seen even on this thread many low
and middle income countries find ways to finance the switch to all oral,
and donors are prepared to support. Perhaps those who've noted they have
switched to all oral or are starting to can comment on how this was done?

I think governments that are not committed to the switch in a timely
fashion (ie, immediately, as news of the change in the WHO guidance has
been out for a year now, since August 2018) need to hear from clinicians,
patients, and others demanding the best care to motivate them to make the
necessary changes.

And of course continued advocacy is needed with donors to provide more
explicit financing for the switch to all ora, and with companies to lower
the price and expand registration.

I look forward to hearing others' thoughts on specific access challenges
and how they've been overcome in settings!


SOPHAN SAM Replied at 6:17 PM, 30 Jul 2019

Thank Erica for wrapping up..

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