World TB Day 2018 – Îți mulțumim (thank you) Lucica!

This is an important day for TB activists and stakeholders everywhere. This year is also perhaps the most important year for TB since 1993, and the Moxafrica charity would like to mark this by recognising the extraordinary contribution that Dr Lucica Ditiu has made to the growing global campaign to see tuberculosis brought under control.

No-one should pretend we’re anywhere near seeing this happen yet, but real momentum is now developing. Last year at a G20 meeting world leaders agreed that TB needs special attention. This year important further building blocks are falling into place – a fresh commitment from the new Director General of the WHO, and a high level meeting (HLM) at the UN scheduled in September. Much of this has been down to the orchestration, energy, commitment and determination of this feisty and indefatiguable human being.

Picture - Huffington Post

Lucica describes herself on Twitter as “a Romanian doctor that loves people”, but this is a bit of an understatement because it’s been the particular people that she’s chosen to love (and what she's achieved while doing it) which surely sets her apart from the rest of us.

Dr Ditiu has been the Executive Director of Stop TB since 2011 and in that time has navigated it away from the stultifying clutches of the WHO to allow it to act more independently and with infinitely more ambition than would otherwise have been the case. At the same time she’s been carefully nurturing a vital relationship with the Global Fund who quickly came to take her pressure extremely seriously and have worked closely with her in response. She’s also totally committed the Partnership to the incredibly ambitious post 2015 Plan to End TB, working tirelessly with that goal always in sight. And at the same time she’s done all she can to engender a sense of unity and solidarity amongst key stakeholders, not just the NGOs and the researchers, but equally the migrants, the miners and the marginalised (in other words the most vulnerable members of our vast and varied human family that are at most risk from this disease).

As she frequently points out, TB patients everywhere suffer from appalling stigma but Lucica has been as instrumental as anyone in changing this outdated image of TB infection.

In recent decades the contrast between HIV activism and TB activism has been stark. Whereas HIV activism grew and made a massive difference to the global response to the disease in the 1990s, little or nothing similar was happening the TB – and the results were obvious: TB was simply being neglected almost everywhere. But Lucica has been changing that, giving a voice to the previously voiceless and enabling them to be heard for the first time. TB patients now speak out about their infections and experiences in ways that simply didn’t happen before, and without question this has made a difference not just to the image of the disease but also to the political response to it.

The TB pathogen is a mycobacterium – and so is the bug that causes leprosy, incidentally. Apart from both diseases being so difficult to treat, they also have one other thing in common – those infected with them are widely shunned. But with TB this stigmatising hasn’t just been by society, it’s also been done by both politicians and media which helps explains part of the appalling state of the pandemic today. Dr Jennifer Furin (another TB expert , activist and ‘impatient optimist’) is particularly blunt on this issue: “Never underestimate the disdain that health ministries have for TB patients” she says (and she should know). So we shouldn’t underestimate Dr Ditiu’s achievements in this respect either: if health ministries have had such disdain then getting global political leaders on board is an even mightier challenge, but this is something that Lucica has nevertheless taken on with real ambition..

Recently she’s been seen on platforms engaging with leaders of some of the most populous nations on earth, ones which also have some of the highest burdens of TB and MDR-TB, and she’s had each of them committing to the cause. Those high burdens aren’t accidental, by the way – they’re because of long-term failures of these governments’ social contracts with their citizens in providing deficient national TB programmes resulting in truly appalling case finding rates. And yet rather than shaming them for their country’s neglect, she has instead been embracing them and infecting them with her own commitment at the same time as quietly allowing them to realise that they can build their own political capital from visible commitment of their own. (This is no easy line to walk and it isn't for the faint-hearted.)

But as Lucica surely knows herself, getting pledges and commitments out of politicians is only the first step anyway. The World Health Assembly has been making commitments about TB for over 25 years and yet the progress in driving this curable disease back into the dust (it originated as a bacterium in the soil) has been shamefully slow. There’s certainly plenty of evidence of a serial inability for health ministries to follow through on their pledges on TB. But somehow it feels like just might be different this time because of the momentum that Lucica herself has been personally instrumental in developing.

She’s also had to play an equally delicate game with leaders of the richer countries - the so-called ‘donor nations’ on whom the global fight against TB depends. Investment in TB control is economically a no-brainer in terms of a significant pay-back for every dollar invested, but getting that message across in the current era (particularly when the pressures from so many other humanitarian demands are mounting) has been no easy task. Furthermore, striking the balance between raising too much alarm (and thus engendering hopelessness) and promoting an anticipation of the real possibility of significant progress has been one of her hallmarks. Her personal style has surely made the difference here as well, not least in how she has always been visibly fighting for the underdog – to try and get all of us to have some idea of what it might be like to be a victim of this disease and to empathise with this.

Her message to all of us today is simple – “ask for more and stay united”. We will, Lucica, we will!

“We have a long way to go and it will be difficult” she recently told the Huffington Post, “but, we have to agree that we now have a great momentum for TB that we have never had before, [and] something so strong from the high burden countries: a desire, and an energy to end TB! Let’s do it!”

Thank you Lucica, Îți mulțumim!