Hello, my name is Chapal Mehra. I am the convener of an organization called Survivors Against TB. I am a public health specialist and a TB advocate who works out of India and South Asia. Today. I'm going to be talking to you about why advocating for new TB tools is important and how issues of equity and barriers of access continue to confound a disease that has been around for centuries.

We all know that everyone has the right to the enjoyment of the highest attainable standards of physical and mental health. This as a right has enshrined in the 1966 International Covenant on Economic, Social and Cultural Rights.

Article 15 of that covenant also guarantees the right of all people to enjoy the benefits of scientific progress and its applications. This is what we believe should be guiding human progress and issues of access. However, a number of barriers can help keep people from accessing TB tools, which in turn keeps people from exercising their right to enjoy these highest attainable standards of health.

This of course is not just true of TB, but of numerous infectious diseases. And most recently, even of COVID.

For people experiencing poverty, medicines can be extremely expensive. And in countries like India, it has been found that the number one reason for pushing people back into poverty is often catastrophic health expenses.

Another issue we don't discuss enough about is stigma. We all know that stigma is a major barrier to access, especially for diagnosis and treatment. TB stigma is very, very powerful in many parts of the world and people are sometimes afraid that if they are seen accessing treatment or seeking out a diagnosis, that others will treat them badly as a result. Often, there isn't even a vocabulary to articulate what stigma is and how people are feeling debilitated because of it.

There is enough evidence to show that TB patients or TB affected individuals often receive stigmatized poor-quality care, even in reliable public sector, health facilities.

Stigma causes discrimination. This is a no brainer.

How does discrimination act as a barrier for key and vulnerable populations, such as migrants, refugees, indigenous people, women, and girls, people living with HIV and others.

In particular this discrimination effects those of certain sexual and gender orientations, who not only are at higher risk of other infectious diseases, but also suffer from extreme poverty and lack of agency.

Stigma and discrimination can manifest in many, many different areas. They can happen within communities. They can happen within your own family. They certainly happen within healthcare settings, in employment settings, educational facilities, and in policy and legislation.

The issue of gender is most confounding when it comes to stigma and discrimination. Gender bias also plays a role in access to TB tools.

While TB is more common among men across the world. In many communities, women, and girl face barriers to access when they do not have the freedom to seek medical care on their own, or when they experience low levels of economic independence and decision-making authorities. For instance, in high burden countries like India, and in other South Asian countries, we have seen that digital tools, for instance, remain inaccessible to women because they often do not possess, access to wireless internet or even a mobile phone.

Now we have all seen how the impact of COVID-19 has made it difficult for millions to access TB treatment. As a result of lockdowns that government have enforced to stop the spread of COVID-19, other major disruptions linked to civil unrest or natural disasters can also affect people's access to TB tools.

Tools that are simpler and require less technology to use them can make it much easier for people to access TB services during these kinds of environments.

It's very important to also underscore the fact that this is also a symptom of low investment in health systems more broadly, and also in health resources and health workers.

This is a critical aspect of making good TB care, but also good health services available anywhere in the world.

One of the things that we saw during the COVID-19 pandemic was that a large part of TB resources, not just testing facilities, but also health workers were reassigned to COVID response, leaving the TB-affected communities often very vulnerable and without any patient support.

Limitations on the use of new tools related to the intellectual property laws can also be a barrier to access. Now, this is an issue which has become relevant when a tool is developed and introduced. It is also an issue that affected communities have identified as being important.

When it comes to new TB tools, the UN General Assembly reaffirmed international agreements that allow government flexibility to reduce the price of essential medicines in order to improve access. Yet, the truth is that many of these, medicines, many of these tools still remain prohibitively expensive and often inaccessible to low income and high burden countries and communities.