Chapel Mehra, Survivors Against TB

When we are talking about access, I think the most important conversation has to be around human rights. We have to see the access to new tools in TB care as a fundamental human right. I cannot emphasize enough of this because I live in the highest burden TB country in the world. And we have seen how people have to struggle on a daily basis to access the right diagnosis and treatment, particularly around cases of drug-resistant TB.

And it's very important to understand that access to TB care, which is, until COVID arrived in the world, the number one killer disease - infectious disease - in the world should be seen as a basic human right.

These include the rights to life, dignity, freedom from discrimination, the right to privacy and confidentiality and others. It also includes the right to enjoy the benefits of scientific progress, which is a right that is essential for accessing new tools and to ensure that new tools are made accessible equitably within countries and around the world.

I think when we talk about issues of access these are very, very important to think about because issues of access are deeply linked to issues of poverty. They're deeply linked to stigma and discrimination.

How you access new tools is often determined by your gender or by your sexual orientation and what part of the world you exist in. COVID-19 has shown that ongoing pandemics do have an impact on how you access, not just new tools, but also old tools.

So when we think about access, I think it's also even in the most difficult of times, try and imagine scenarios which can be transformational. And when I mean transformational, I'm really talking about - look at the COVID-19 pandemic. In this short time, how many vaccines did we have? How much funding did we raise for COVID-19 vaccines, and how easily were they made accessible to billions of people across the globe.

Now imagine a scenario where you have possibly similar investments in a vaccine for TB. The science of this may be different. And, of course, a TB vaccine may take much longer to develop. But the question that lies before us is why is it that the investment in TB vaccines remains so low? And why is there that we are yet to see in so many decades an effective updated, TB vaccine, which could prevent possibly millions of deaths or at least reduce the burden of TB significantly.

Another question, an issue, that emerges is access to diagnosis. Now we've talked about barriers such as, the availability, the ability to afford good diagnosis. I really want to talk about the fact that today across the globe, there are hundreds of diseases where you can access a diagnosis very easily, very quickly, a very reliable diagnosis. But in TB, we are still using in many parts of the world, including India, really outdated tests.

You know, molecular tests are still not as widely available as they should be. And even at this point, a highly reliable and sensitive point of care test for TB and particularly drug-resistant TB, which is far more virulent and dangerous, is still way out of our grasp.

So these are issues - imagine if you could actually get diagnosed for drug-resistant TB within a day and get on the right treatment, or imagine if in a high burden country, all you had to do is take a TB vaccine every five to 10 years and ensure a certain level of immunity amongst your populations.

How many deaths could be avoided, how much economic losses could be avoided and how much inequity could we address?

These are scenarios that are important to consider also when we are thinking about issues of access, because they are, interwoven not just in terms of whether a particular diagnosis, diagnostic or treatment is available to you, but really, right from the genesis, whether we ever invested in creating that diagnosis or diagnostic or treatment.

You will be learning more about these barriers and how having new TB tools can eliminate these barriers later in this course. But here is the most important thing to remember - that disease exists, where poverty, stigma, gender bias, and many other barriers to access exist. Until you have a more equitable, people centered, gender friendly approach to health and to TB care, addressing the access to new TB tools may be a continuing challenge for now and for the future.