Q&A: Why Moldova has moved to keep TB on the agenda

Moldova is a country where tuberculosis still has a significant impact, despite a fall in cases in recent years. The country saw 74 cases per 100,000 people in 2020, compared with an average of nearly 10 per 100,000 in 2019 across the European Union and European Economic Area. Multidrug-resistant TB, or MDR-TB, poses a notable threat.

COVID-19 and the war in neighboring Ukraine have meant TB is competing for resources and attention, while the influx of refugees from Ukraine to Moldova has also had the potential to ratchet up TB cases in the country and the surrounding region.

Nonetheless, plans are afoot to tackle the problem head-on, with the relaunch of the Moldovan TB Caucus at the end of 2021 to help drive progress on TB elimination.

Dan Perciun, the head of the health committee in the Moldovan Parliament and head of the Moldovan TB Caucus, spoke to Devex about why it’s so important to keep the disease on the agenda, why having a national caucus benefit this goal, and how it can be done amid multiple competing interests.

This conversation has been edited for length and clarity.

The National TB Caucus in Moldova was relaunched at the end of 2021. Could you give us some context on how this came about?

It was relaunched because Moldova has a significant issue with TB and the rate was not decreasing as fast as we would have wanted to see. I feel it was important to have it, since it’s a crucial issue, and to make sure it’s on the parliamentary agenda. It’s a good instrument to educate ourselves as parliamentarians and know more about the situation in the country.

We are a decision-making body both when it comes to amending and improving [laws related to TB], and in terms of budget allocations and prioritization of financial resources. Having us on board is also important for other stakeholders; the broader the alliance, the easier it is to draw attention to TB and fight for limited resources.

How is TB currently being dealt with in Moldova and what are the most prominent challenges?

Efforts have been made, and we’ve been helped over the years by the Global Fund [to Fight AIDS, Tuberculosis and Malaria]. There’s a network of civil society organizations here who are very active on the topic and have done much work, but more needs to be done.

This year, we’re planning to revamp the TB law, following some expert advice. The law has to do with things including the rights of patients and the support provided in terms of quality and volume. There are also some financial allocations that have not been revised for a long time now.

Some of the challenges are around identification and screening of people with TB. Efforts have been made in recent years to bring in the newest technology for identifying TB and make sure people get support, but still, more is needed.

There is also an issue of stigma with regard to TB patients, and it will take time and probably more communication efforts to explain that they’re not to be discriminated against.

How have both COVID-19 and an influx of refugees from the war in Ukraine affected the situation?

During COVID-19, the percentage of people that discontinued treatment went up, while there has been a significant decrease in the number of people identified with TB. [Moldova saw a 40%-50% decrease in TB diagnoses in 2020].

It’s unlikely that this is because the number [of] infected fell, but most likely because they were not screened and identified in time given the disruptions in the health system.

Now with the war, we are also seeing some TB patients arrive from Ukraine. We probably have up to 90,000 refugees in Moldova from Ukraine permanently staying here, and half a million have passed through over the last few months.

The number of people with TB from Ukraine that we know of now is in the tens, though, so I wouldn't necessarily say it's a massive issue yet. I’m aware of some different national and World Health Organization statistics on Ukrainian TB refugees in Moldova. [WHO predicted “more than 50 people” with TB would arrive in the first month alone]. But for now, national Moldovan authorities are prepared for additional refugees who have TB.

What's good to know is that we have very close collaboration with colleagues from Ukraine and there is clear information flow on the patients that come here. We are also allowing refugees to benefit from medical services in the country free of charge.

What lessons have such crises provided in terms of how to tackle TB?

A challenge any crisis brings for chronic problems like TB is that it diverts resources. One lesson is therefore that if you want an issue to stay on the agenda, it's good to have friends and networks in place that can continue to advocate for it. Having things like a National TB Caucus and someone in a relevant ministry who is concerned with the topic helps.

What COVID-19 also taught us all is that access, access, access is important, and ease for people to reach services. Making efforts to reach out during a crisis is important, ensuring TB [treatment] is not missed out.

What is key to putting TB firmly on the agenda in Moldova and beyond?

I think awareness is important among people who have decision-making power, like parliamentarians, ministers, and secretaries of state, not only people who understand the topic from a technical point of view.

[We need to make it] something that the entire society cares about. That takes time, and it takes effort to make people aware of what needs to be done.

It’s one of those problems that if not addressed will snowball. It’s much smarter to invest to prevent things from getting out of control than to not make those reasonable investments in time and then face a huge increase that will take a much bigger toll on the budget.

TB is an infectious disease at the end of the day, so it will spread if not addressed, be more costly to treat, and lives will be lost or ruined.

Visit the Talking TB series for more coverage on how we can eliminate tuberculosis by 2030. The time for a paradigm shift and a renewed focus on funding, research, and global solutions is now. Join the conversation by using the hashtag #TalkingTB.