USAID Administrator Mark Green's Remarks on Ending Tuberculosis in India

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For Immediate Release

Thursday, November 30, 2017
Office of Press Relations
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Reference Lab Facility
Hyderabad, India

ADMINISTRATOR GREEN: Thank you. The speaker that you have just heard, especially are survivors of TB, as we would say in America, are a very difficult act to follow. They are very, very impressive.

Welcome, everyone. Today I think is a great day. Today is a hopeful day. It is another sign of how the U.S.-India friendship is lifting lives and offering promise of a brighter future. So, by way of introduction, I began my career in development 30 years ago as a teacher alongside my wife in a little village in Kenya. I remember my very first night in that village. I attended the funeral of one-year-old twin boys. They had died of measles, or so I was told. And I remember the headmaster of our school, an Indian, by the way, who lives in Kochi -- I remember what I said to him: "People don't die of measles." I was shocked.

A curable disease, one that we know how to teach, and yet there were children dying before my eyes. My headmaster and my very good friend, he said to me softly that night, that these children were dying of poverty. Measles just pushed them over. And he was showing me the greatest tragedy of all: women and children, young men and old, dying from diseases that we know how to treat, diseases that we know how to cure and conquer.

Over the years, unfortunately, I have seen that story play out too many times. In the West, it is a very common misconception that TB is on the verge of eradication. While we have made gains in the fight against TB globally, it remains the world's number one infectious killer. And India, as you heard, accounts for 25 percent of the world's TB cases. Every year, 420,000 people die from TB in India alone, one person every minute. But again, as we know, TB is detectible, it is curable. And that is the greatest tragedy of all. No one has to die from TB unless we allow it to happen.

But that also provides our greatest hope. If we dedicate ourselves to educating citizens on certain basic principles and working to improve health systems, then this truly is a battle that we can all win. There are barriers, there are challenges to our work. While TB is curable, if not treated promptly and properly, it can develop into a much deadlier and costlier strain that do not respond easily to available drugs. Approximately 150,000 Indians develop multi-drug-resistant TB each year.

Second, early detection and diagnosis is critical to survival and stopping further transmission. But unfortunately, too many places lack the tools necessary to accurately diagnose the disease at this early stage, when we all know that treatment can make the greatest difference. Finally, if we are truly going to eliminate the scourge of TB, if we are honestly and truly going to conquer this disease, we must overcome the stigma that too often holds back and harms the affected.

In India, as in many countries in the world, people often fear other friends and family and neighbors will treat them if they are diagnosed with TB. And when people do seek help, it is a struggle to complete the treatment because, as we heard, the disease affects their ability to work and earn a living. Some falsely believe that TB is incurable. Some falsely believe that the wealthy cannot get TB. Here in India, women report being isolated and discriminated against in their own homes, rejected by husbands, rejected by in-laws.

It affects them in commerce as well. As we know, as we heard, when a woman has TB, she may be barred from the marketplace where she sells her goods or shunned altogether, eliminating her ability to buy and sell. If she has employment, whether in the formal or informal sectors, the stigma may cost her her job. The isolation that often arises from stigma not only means a loss of income and economic opportunity, but it leads sadly to a sense of desperation. And that desperation can prevent afflicted women from seeking out the services needed to identify and to treat the disease. Because women often want to be treated anonymously due to the stigma that we heard of, they spend more for their treatment in the private sector, and they may not get quality care.

So, in India, TB kills more than three times the anybody of women than all cases much maternal mortality combined. All of this means that TB persists and spreads unnecessarily, for no reason. And so that is the tragedy. So, at USAID, we believe the purpose of our assistance must be to end the need its continuation. We know countries want to climb from being assistance recipients to development partners to fellow donors. And so, as a result, because we stand ready to walk at the side of our friends as they move along their journey to greater self-sufficiency and prosperity, we try to focus our efforts on helping partners to build their capacity to take on these challenges themselves.

India's drive to conquer and eliminate TB is an inspiration to all of us, and it's a great example of a country and a cause that we hope to lift up. We are excited to see so many across India making the fight against TB their own fight, from those at the top of the government down to the private sector and even into the world of popular culture. Take Bollywood star Amitabh Bachchan -- I did my very best -- who, after his own battle with TB, took up the cause and now is a great and powerful champion. He is a champion for the importance of early detection and appropriate treatment. He saw that taking steps early to address the disease saved his life. And today, he is out to show all of us that any person, even the most famous entertainer, but also the most remote villager, is vulnerable to TB, but also with early detection, can stop this global killer dead in its tracks.

And as many of you here today are showing, you don't have to be a movie star to take up this fight. Earlier, I heard stories from truly brave TB survivors and their families. I learned more about the barriers to testing and treatment that they have faced on a daily basis, including discrimination. I heard personal stories from Alma and Nandida and Cedric about how they were stigmatized after their diagnosis and how that initially discouraged them from seeking treatment. They felt isolated, they felt alone. But with their courage, they persisted. They got treatment. They got better. What courage. They are inspirations to all of us, and we all salute you for being great leaders.

They overcame any barriers and today are patient advocates who support others, those who are struggling with stigma. And the government and Prime Minister Modi has made the elimination of TB a key development priority. He has declared that he will take every step necessary to make India TB-free by 2025. And I think if we get to 2023, we will make him especially happy. The Ministry of Health and Family Welfare has developed a bold, comprehensive strategy plan to battle TB. And the Government of India has increased its budget against TB significantly, substantially.

As friends of India, we are grateful for these ambitious efforts, and we are committed to working with you to see the day when India is TB free. We are partnering closely about the Government of India to reach every person with TB, cure them through timely treatment and to prevent new TB infections.

For example, today, I saw a device called Gene Expert that USAID helped to bring to India. And the Government of India is now scaling up and increasing. It has cut the diagnosis time from six weeks to two hours, and it provides a much more accurate result. And it tells us when the TB is drug resistant. This is a game-changer. This is a major victory in the battle to end TB. But as we all know and as we have heard, to truly end TB, we need a holistic and patient-centered approach. And as Amitabh and the survivors I met this morning are showing us, this must start with an effort to ensure early and accurate diagnosis, and it must overcome stigma.

Even as India continues to rise and as our development relationship with India naturally evolves, we pledge to stand with you, to walk with you in your battle to end this terrible scourge. We do so not only because it is the right thing to do, but because communicable diseases are a shared responsibility for all of us and a global health security threat. In this fight, your success is our success.

Today, I am proud to announce that USAID will launch a new effort to fight TB stigma here in India, focused on the challenges that women in particular experience here. It is a first step, as we intensify our partnership on this front, and as we walk together over the next few years, to build that TB-free India. Through this effort, partners will test new approaches to reaching women to ensure that they have what they need to obtain accurate, quick diagnosis and timely care. We will tap into the reach of India civil society organizations to share stories of life after TB. We will launch mobile phone applications that can lead women to skilled, sympathetic care wherever they are. And we will work to build a body of evidence on the most effective ways to eliminate the stigma around TB. But this is a grassroots effort. It is not our effort. It is not the government's effort. It is everyone's effort.

So, we will work at the community level to dispel and destroy those myths associated with TB, improve [inaudible] equitable access to early diagnosis and treatment and provide the social support that people with TB so desperately need. And we will also take steps to treat the spirit of those who are struggling. This effort builds on the long-standing strong partnership between the Government of India and the friends of India at USAID. And we know as we press forward that we can't, and we won't do this alone.

Over this last week, I have, myself, witnessed the robust strength and dedication of India's private sector to spark the conversations, to foster the innovations that drive change. And so, we encourage all of our partners to join us as we work with the Government of India to end TB. The U.S. Government is committed to playing our part, and together all of us, we can overcome the barriers to TB care, and we can, and we will make TB a disease of the past. I salute the brave champions who are here. I salute the Government of India for taking up this cause. We promise to walk with you in this journey. Thank you.