Being based in the USA and unable to travel because of the Covid-19 pandemic has made some of the normal advocacy work of TB Europe Coalition Co-Chair, Dr. Jonathan Stillo, much more difficult. However, the last year has provided some interesting opportunities.
On April 22nd, The World Health Organization’s European Office and TB Europe Coalition presented a webinar entitled: “Exploring Practical Opportunities for Civil Society and TB Affected Community through WHO National TB Program Reviews to Improve Collaboration and Accountability”. The presenters included Dr. Sayhat Hasanova of WHO Europe, Jamila Ismoilova of the WHO’s Civil Society Task Force on TB (CSTF), Oxana Rucşineanu of the Moldova National Association of TB Patients (SMIT) and TB Europe Coalition Board member, and Jonathan. He presented his experience conducting National TB Program Reviews in Romania and Moldova and advocated for including both civil society representatives and an affected community member in every review team due to the variety of types of expertise that members of both groups have. This is particularly important as human rights and people-centered care are key aspects of the WHO END TB Strategy.
Jonathan has been taking part in international exchanges sponsored by the USA State Department which bring health experts from Eastern and Central Europe to meet with their US counterparts for several years. One of these meetings involved a group of Russian medical staff and civil society members who work with Internally Displaced People in Rostov on Don. On April 22nd 2021, Jonathan met virtually with the same group to hear updates on the challenges that they face treating TB, HIV/AIDS, and hepatitis. He gave a presentation entitled: “TB in the WHO EURO Region: Human Rights, Patient-Centered Care, and Covid-19”. The participants described some of the same challenges that were discussed in the first meeting, including a lack of access to newer and repurposed TB drugs, the need for greater diagnostic capacity including GeneXpert and, also noted that TB notifications were well below where they had been in prior years. This is part of a global trend where TB case notification rates are about one-third lower than before the pandemic and is a major cause of concern not only in Russia but in the whole region.
On March 21 2021 Jonathan took part in a virtual meeting with doctors, nurses, and a Parliament member from the Republic of Moldova focused on strengthening the Moldovan health system. As one of the team members for Moldova’s last WHO National TB Program Review, Jonathan took the opportunity to discuss the substantial progress that Moldova had made in implementing the recommendations of the review and suggested areas where additional improvements could be made such as strengthening ambulatory care including for people with DR-TB, making the shorter DR-TB regimen available not just in the civilian health system but also in the penitentiaries, and Expanding the involvement of civil society organizations, including subcontracting to do patient support and activities.
Most recently, Jonathan was an invited panelist for a discussion on healthcare. The panel was moderated by Joanne Kenen, the Health Editor for Politico. The attendees included approximately twenty journalists from across Eastern and Central Europe. Topics of discussion included the challenges of combating Covid-19 while still providing necessary TB services, reaching rural populations with health care, and achieving the right to health. One of the topics that linked both the US and European experiences was the clear need to have strong support for public health at all times—not just when there is a crisis. Jonathan noted the challenges seen in the USA and around the world in terms of Covid-19 related case finding and how overwhelmed many local health departments are and compare it to the DR-TB outbreak in the early 1990s in New York where public health surveillance budget cuts ultimately resulted in a cost of more than one billion dollars to get the outbreak under control. Despite being thirty years ago, the lessons of that outbreak are still relevant as public health workers across the USA and Europe struggle with diseases such as TB which they normally deal with as well as the additional burden of covid-19. To close, Jonathan noted that investments made in public health during the pandemic are an opportunity that should be continued to help make up the ground lost in the fight against TB in the last year.