BICUTAN, TAGUIG CITY - The National Academy of Science and Technology, Philippines (NAST PHL), in partnership with the Philippine Tuberculosis Society, Inc. and the Philippine Coalition Against Tuberculosis, held a Science Policy and Information Forum on Tuberculosis (TB) Elimination on 20 June 2022 via Zoom and Facebook Live.
The virtual forum aimed to present the strategic enhancements and necessary activities for the Philippines to attain the TB elimination targets, particularly during and after the COVID-19 Pandemic. Experts and leaders were invited to substantiate the discussion on (1) current TB epidemiology and TB elimination goals, (2) government and private sector collaboration in the Philippine TB Elimination Program, and (3) the way forward for the country’s TB program.
In her welcome remarks, Academician (Acd.) Rhodora V. Azanza, president of NAST PHL, mentioned that TB remains a threat to the lives and livelihood of Filipinos despite it being a preventable and treatable disease. She also related TB with PAGTANAW 2050 and the need to use science, technology, and innovation (STI) to develop diagnostic and treatment innovations, combat drug resistance, and address its social dimensions.
Acd. Camilo C. Roa Jr., member of the Health Sciences Division and lead Academician for the forum, gave an overview of the forum. He presented the evolving global strategies against tuberculosis, from the Directly Observed Therapy Strategy (DOTS) in 1994 to the End TB Strategy 2016-2035, which aims to end the global tuberculosis pandemic and avoid catastrophic costs to affected families. To make this possible, he mentioned that case finding should be enhanced and treatment coverage should be increased. He added that the building blocks for improving health outcomes should be considered in achieving TB elimination.
Current TB Epidemiology and TB Elimination Goals
For the first session, the general situation on TB was discussed and it highlighted the fact that the disease remains a major health problem in the country. Dr. Mary Ann D. Lansang, Clinical Professor at the University of the Philippines College of Medicine (UPCM), reported that the Philippines is one of the top 20 high TB burden countries, 4th in terms of contribution to new TB cases in 2020, and 12th of the top 20 high Multidrug-Resistant TB (MDRTB) burden countries in the world. The COVID pandemic has also affected TB elimination efforts with a 37-44% drop in TB case notifications as compared to pre-pandemic levels. This has resulted in a more than 50% increase in TB-related deaths in 2020. Dr. Lansang also noted that the easing of quarantine restrictions, which permitted case-finding activities and patient consultation in health centers and private clinics has contributed to the gradual increase in TB notifications in 2021.
Dr. Ronald Allan M. Fabella, Technical Adviser at the Disease Prevention and Control Bureau, Department of Health, mentioned that the Philippines has a strategic TB elimination plan enacted into law through RA 10767, also known as “An Act Establishing a Comprehensive Philippine Plan of Action to Eliminate Tuberculosis as a Public Health Problem” as part of its commitment in eliminating TB and supporting the global call to end the TB epidemic. This goal to eliminate TB is via the “screen, test and diagnose, treat and prevent” cascade of care framework reinforced by the Universal Health Care (UHC) goals of accessible health services for all Filipinos. He noted that the transition to UHC requires strengthening primary care services to include TB services, rationalizing financing, and instituting mechanisms for prioritizing health technologies and services.
Dr. Kalpeshsinh Rahevar, Medical Officer for Tuberculosis of the World Health Organization-Western Pacific Region, noted future TB epidemic responses can be influenced by the ongoing demographic, economic, and epidemiological transition. He added that the key drivers of TB include alcohol use disorders, diabetes, HIV infection, smoking, and undernutrition. Dr. Rahevar also mentioned that the WHO has introduced a new response framework for the global and regional strategy to end TB using a combination of tools to attain the vision of a TB-free, healthiest, and safest region by 2030.
Government and Private Sector Collaboration in the PH TB Elimination Program: Best Practices and Perspectives
In the session on government and private sector collaboration, Dr. Elizabeth V. Cadena, chair of the Council on Tuberculosis of the Philippine College of Chest Physicians (PCCP), emphasized that professional societies can serve as powerful allies and can play critical roles in the DOH national TB program. She also presented the various initiatives of the PCCP, such as developing information, education, and communication (IEC) campaign materials, observance of World TB Day, and partnerships with local and international organizations. She mentioned that the PCCP has recently finalized an update on the TB Guidelines in 2021 following the development of innovations and DOH guidelines.
Dr. Cleotilde How, chair of the Philippine Pediatric Society (PPS) Committee on the Handbook on Tuberculosis, presented the critical role played by the PPS towards TB elimination and the need for the organizational alignment of PPS to the national framework of TB care and prevention. PPS conducted a survey to gain insights on childhood TB care, which can be used to revise existing childhood TB policies and guidelines. Results of the childhood TB needs assessment survey showed various key areas of concern by PPS respondents and identified the need for more extensive coverage for specific regions to uncover unique gaps and needs.
Mr. Benjamin Q. Avancena, vice president of the Philippine Tuberculosis Society, Inc., presented the essential role of non-government organizations (NGOs), particularly in the government and private sector multi-sectoral collaboration of the Philippines TB elimination program. According to Mr. Avancena, NGOs possess flexibility, speed of implementation, and innovation that makes them ideal to put together a model for TB delivery care, which is implementable, effective, and practical and can be replicated by the government.
Governor Dakila Carlo E. Cua of Quirino Province and Provincial Health Officer Dr. Mila Villar discussed the important role that local government units play in TB elimination. Honorable Cua also presented his LGUs’ exemplary practices in TB management and treatment.
The Way Forward for TB Elimination
In the final session of the forum, Dr. Marissa M. Alejandria, professor at the UPCM Department of Clinical Epidemiology, presented the three essential pillars of the WHO End TB Strategy with a primary focus on the third pillar referring to intensified research and innovation. She noted that in the End TB Strategy, the third pillar of the strategy, is “critical to break the trajectory of the epidemic and reach the global targets.” New tools for TB elimination that were also projected to be available by 2025 include a vaccine, novel point of care tests, and shorter, effective treatment regimens for TB and latent TB. To maximize the impact of these new tools, she recommended that research to optimize implementation and impact is required while the promotion of innovations is necessary.
In terms of TB innovations and uptake, Dr. Lalaine L. Mortera, Private Sector Adviser of the USAID TB Innovations and Health Systems Strengthening (TB IHSS) Project, emphasized the importance of new tools and innovations to reach the 2035 targets in global incidence rates. She presented the latest TB innovations, such as rapid molecular testing, ultraportable digital x-ray, and the application of artificial intelligence in reading chest x-ray results. She also noted that to ensure the uptake of innovations, TB response should be (1) patient-centered and responsive, (2) based on evidence, and (3) ready for integration under the context of universal health care.
Dr. Carlo Irwin A. Panelo, professor at the UPCM Department of Clinical Epidemiology, presented the substantial economic burden of TB and the means for securing financing for TB under UHC. He emphasized that TB care is funded mainly through out-of-pocket spending. Based on their recent findings at USAID ProtectHealth, the cost of TB treatment can range from 4,092 pesos for latent TB to 374,630 pesos for multi-drug resistant TB infection. He recommended that NAST PHL should push for an operational plan from within PhilSTEP1 (Philippine Strategic TB Elimination Plan Phase 1) to match elimination targets and test models and approaches prior to scaling up.
Former Senator Teofisto D. Guingona III described the role of politics and political will in the elimination of TB. Sen. Guingona gave real-life examples based on his experience that can be used as opportunities for early detection and addressing the TB problem through its health and socio-economic dimensions. Also, as a Board Member of the PTSI, Sen. Guingona emphasized the need for state and non-state patrons who will champion and help solve the TB problem.
Dr. John Mark S. Velasco, Outstanding Young Scientist and Research Associate Professor at the UP Manila Institute of Molecular Biology and Biotechnology, delivered the synthesis of the virtual forum, while Acd. Jaime C. Montoya, chair of NAST PHL Health Sciences Division, formally concluded the morning’s proceedings. Acd. Montoya noted the inclusion of TB as a priority communicable disease in the 2016-2022 National Unified Health Research Agenda and the funding of systemic improvements and projects to strengthen TB control efforts in communities by the DOST through the Philippine Council for Health Research and Development (PCHRD). Acd. Montoya concluded by reiterating the call for multisectoral collaboration and continued vigilance in fighting TB during this pandemic. (Ryan John Pascual/ NAST PHL)
The discussions and policy recommendations presented during the virtual forum are going to be incorporated into a science advisory on TB Elimination to be penned by Acd. Roa.
The National Academy of Science and Technology, Philippines (NAST PHL) is an attached agency to the Department of Science and Technology (DOST) mandated by law (Executive Order 818 s.1982) to serve as adviser to the President of the Republic of the Philippines and the cabinet on policies concerning science and technology in the country. For more updates, follow NAST Philippines’ (@nastphl) social media accounts.