Conferences and meetings are critical to share knowledge, engage stakeholders, and bring the community together. I enjoy attending TB conferences (e.g. Union World Conference on Lung Health, American Thoracic Society meetings), as do my students and team members.
But I am convinced we can do better with TB conferences, enhance their reach and impact. I have 5 suggestions for conference & event organizers. These apply to myself!
1. Organize meetings in high TB burden countries: While meetings in The Hague, Liverpool, Berlin, Banff or Seattle are fine, these regions have a low burden of TB. Sitting in fancy hotels and resorts, it is easy to be disconnected from the reality of the TB epidemic which affects the poorest communities in low and middle income countries (LMICs). Every year, the richest people in the world meet at a ski mountain resort in Davos to talk about poverty. TB must avoid this Davos syndrome.
Further, participants from LMICs often struggle to get visas to enter these countries. This was evident at the 2017 Union TB Conference in Liverpool, and replayed again at the recent Global Symposium on Health Systems Research in Liverpool. In fact, WHO has voiced alarm about the impact of the UK government’s immigration policy on international academic cooperation after several foreign scholars were denied visas to attend the Liverpool conference. So, holding meetings in countries which discriminate against participants from high TB burden countries seems antithetical to the very goal of TB conferences.
When conferences have been held in places like Durban, Cape Town, or Guadalajara, the meetings have been more exciting, vibrant, and meaningful. Meetings in high burden countries also allow participants to visit TB projects and communities to get a real-world experience of how TB impacts people and see what is being done to control the epidemic. Needless to say, holding conferences in high burden countries allows local TB control workers (e.g. National TB program staff), experts and policy makers to participate.
Recently, the Union announced India as the venue for their 2019 conference. This announcement was enthusiastically received by the TB community. India has pledged to end the TB epidemic by 2025, and this will require serious cash and commitment. Hopefully, the Union conference organizers in India will use the opportunity well and ensure the participation of the Prime Minister, Health Minister and other key policy makers.
2. Reduce fees for LMIC participants: Registration fees for participants in LMICs must be lower, especially when conferences are held in LMICs. This will enable a much larger number to attend the meetings, and greatly widen the scope and reach.
3. Include TB survivors in all sessions: Unlike the HIV community, the TB community has not done a good job of harnessing the power of survivors and patient advocates. Although this is changing, TB conference organizers can help turn the tide by demanding (or strongly encouraging) that all sessions and panels must include TB survivors and advocates. If we care that our science makes a difference, then we need to listen carefully to those who desperately need science to work for them.
It took me several years to learn the importance of engaging TB survivors. Today, I try hard to include them in every event or course that I organize.
It is not enough to include TB survivors on the agenda, we need to find ways to support their participation. The Union, for example, does a great job of giving registration fee waivers to the affected community. This must become the norm across all TB meetings. Travel scholarships should also be made available to TB survivors, and funding for this can come from sponsors as well as fees paid by other participants.
4. Allow experts from high-burden countries to set the agenda: In most TB meetings, experts from high-income countries set the agenda, chair the sessions, and deliver most of the talks. It is not uncommon at all to see panels composed of only speakers from high income countries.
This is not shocking, since TB research is largely funded by rich countries, and TB has a long history of social inequities and colonialism. But real progress in ending the epidemic will require countries most affected by TB to step up, show leadership, and invest in TB control as well as research.
5. Discourage all-male panels and sessions: In 2018, this requires little explanation, but TB conferences are still dominated by white men. Women make up 70 percent of the global health workforce, yet occupy only 25 percent of leadership positions in global health (including TB). So, conference organizers must actively work to prevent all-male sessions.
In summary, equity is at the center of all global health work, including TB. Our conferences can be one place to demonstrate our commitment to equity.
Photo credits: The Union & Health Systems Global
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Sir One of the best and open suggestion to many in the world TB cannot be discussed in closed doors of 5 star hotels most of the things discussed in high end places are forgotten by many very soon as they not really concerned with the problem and real time situations
Absolutely relevant points mentioned by Dr Madhukar Pai to ponder over by the stakeholders of TB Conference and Events organisers around the Globe, especially the point no. 1. Time has come for them not to appear unreal year after year by discussing things at being far away from the real action ie those places on earth where actually the problem is (high TB burden areas) eg India and others...
Dr Anupam Aggarwal, MD
Editor and Publisher, GP Clinics (www.gpclinics.in)
The Publisher of Let's Talk TB (www.letstalktb.org)
All point a well taken, some comments:
1 - An event like this would for sure involve Ministry of Health and the government at highest level, local media exposure would be considerable.
3 - In LMIC stigma and discrimination are still a reality, this type of exposure help to decrease this behaviour.
4 – In the lasts years the union has done a great job overcoming language as barrier offering courses in other languages besides English, additional effort is needed here to guarantee professionals and patients from countries like Mozambique (High burden) have access to information (Portuguese is the official language).
Celso Khosa, MD
Scientific Director of Centro de Investigação
e Treino em Saúde da Polana Caniço / CISPOC-INS (https://www.ins.gov.mz/)
Thank you for raising awareness and starting this discussion on gender, category and country diversity in TB Conferences. As much as we do share your concerns and wish to increase access to TB conferences of high-burden low-income countries’ activists, healthcare workers, survivors and NTP members, as officers of the TB section of the Union, we would like to highlight a few points related specifically to the Union World Conference. We too would like to increase access to TB conferences for high-burden, low-income countries’ activists, healthcare workers, TB survivors and NTP staff. Along these lines, we would first like to thank the recent CCSA members and chairs- including Stacie Stender, Rajita Bhavaraju, Keren Middelkoop and others – for their efforts to make the selection of all the activities of the Union Conference (abstract driven sessions, symposia, educational programmes, satellite sessions and others) a transparent and high-quality process. Thanks also to all of you and others who volunteer for important tasks such as reviewing the selection criteria, the abstracts and proposed courses, sessions and satellite sessions and even nominations for the annual prizes and awards. The Conference is truly a team effort for which all of us are responsible.
Secondly, as with everything in life, the balance between desirability and feasibility has been a challenge for the Union. The LMIC officers (Nina and Anete) feel it very deeply: this year, they paid half a month’s salary to attend the World Conference in The Hague. While we agree that travel and conference registration costs are very high for those working in countries with weak currencies, many of the activities of the Union, including the publication of the International Journal of Tuberculosis and Lung Diseases, are supported by Conference fees and membership dues. The Union granted 72 scholarships to the Conference this year. This is insufficient, of course, but most were granted to Southeast Asian and African registrants. Thus, as a group, we need to find other financing opportunities to expand the scholarship program (with selection continuing to be based on peer review). We will also continue to promote high-quality research in LMIC, led by local researchers, so that their abstracts are selected and they are invited to speak and present, as has been progressively seen with the BRICS countries, especially South Africa and the former Soviet Union countries. Finally, countries themselves need to commit further to build capacity and support the TB programs to such an extent that representatives can attend the meeting.
With regards to the geographic location of the conference, balance is also a problem. To hold it in a high burden country is not a guarantee that people from other LMICs will attend. India is much less accessible to Latin America and Africa, for example, than is the Netherlands, because of distance and the visa process. At the Malaysia conference, there were very few attending from India despite relative proximity, because of religious holidays. Finally, financial issues are a consideration, however much we might prefer otherwise. The selection of the conference venue is partly based on a bidding process, whereby cities that offer more in-kind contributions are preferred. This frees up funds for scholarships. It would be highly relevant to review attendance by country, according to the conference site. The Hague set an attendance record (also reflecting efforts and support by KNCV, and increased attention to TB after the UN HLM), and it will be important to document where the participants came from.
This committee – which includes two women and two men, two from HIC and two from LMIC - is committed to all necessary efforts to maintain the transparency of the peer review process and to ensure diverse country and gender representation. As the Programme Secretary, Anete Trajman will represent the TB Section—by far the Union’s largest—in the planning and programming process for the Hyderabad (2019) and 2020 World Conferences.
Anete Trajman, incoming Programme Secretary [Rio de Janeiro, Brazil], for the TB Section officers:
Paul Nunn, Chair [London, United Kingdom]
Kevin Schwartzman, Vice-Chair [Montreal, Canada]
Rovina Ruslami, incoming Secretary [Bandung, Indonesia]
Wendy Wobeser, outgoing Programme Secretary [Kingston, Canada]
Madhukar Pai’s advocacy brings to mind (at least it is felt as such) the current widespread socio-political paradigm dear to populists, nationalists, identity politicians and others: the partial exclusion of “the other”. His blog pleads for more inclusion of LMICs as conference organisers and agenda setters, of candidates without means to participate in conferences, of TB survivors as conference participants and of women in conference panels. Nobody will entertain the absurd statement that the UNION willingly excludes others from participating in UNION conferences. Nevertheless, the reaction of the TB-Section on this issue is only partially satisfactory.
Firstly, the form: does an “authoritative” mail from the TB-Section addressed to members referring them to Pai’s blog with an I-link, barely taking into account the mostly very poor I-net connections in low income countries (access to additional links! forced enrolment in social networks!), really allow for a “start of a discussion” with equal means?
Then, the content of the note: a series of justifications, proofs of good will, some non-committed promises or engagements and pious hopes for a better future, all summarised in commonplaces like “everything will be done to find a balance between desirability and feasibility” and “financial issues are a consideration” does not really address the issues raised by Pai.
Pai’s blog as a matter of fact is not asking for justified balance carried out until now nor for expressions of good will. It is rather asking for fathoming out feasibilities and perhaps, too, for more transparency. For example, in what time-line will attendance by country with respect to the conference site (venue) be evaluated and made public in a bid to get more evidence-based answers than the anecdotal one that Indian participation at the Malaysian conference was lower than expected due to religious holidays in India? If regional and gender criteria play a role in the acceptance of abstracts how is this made transparent?
Financial issues do of course matter as nobody ignores the fact that market economy dominates world affairs. If it is right to say that “(a)s a group, we need to find other financing opportunities to expand the scholarship program…”, how can this be done within the available resources? Exhorting countries to commit further to such an extent that representatives can attend the meeting is no short term solution. It does not take into account the scandalous and structural inequality of wealth distribution worldwide. It should be remembered that BRICS are not LMICs. Other solutions can be looked into. For example, the journal of the UNION cited as an expense item can be converted to an e-version; technical assistance (TA) based on physical assistance can be transformed into assistance via electronic media (teleconference); more local TA in LMIC can replace expatriate TA on a time bound contract basis (assuring the UNION identity, if an issue, by means of electronic communication). - By the way, how many more scholarships were given to participants for The Hague Conference (HIC) as compared to the ones in Cape Town or Kuala Lumpur (LMICs) as this seems to be an argument. And when will a survey evaluate the amount of financial and time resources wasted in vain by candidates for conference participation during futile visa applications?
The Ghanaian NTP in the last African Region Union Conference succeeded in an exemplary way to follow-up e-visa demands with the issuing border authorities. What is being planned for facilitating the predictable considerable number of e-visa demands for India from participants of LMIC to attend the next conference (taking into account the possible restrictions that could arise given the Hindu-nationalistic and Muslim-hostile atmosphere in today’s Modi-India)?