On Sunday 17th May, InterSurgeon had the privilege of co-sponsoring The Global Coalition for TBI Side Event which seeks to make TBI (traumatic brain injury) a chronic and notifiable condition. An estimated 69 million TBI events occur annually which has a huge economic impact. By making the condition notifiable and chronic, data can be collected more accurately over a long period of time (i.e. post discharge) to inform services, advocate for funding and save lives. In 2019, 60% of TBI events occurred in LMICs. If TBI is not considered a chronic condition, there is an absence of surveillance on patients and an inability strengthen prevention said Bernice Gulek, Acute Care Nurse Practitioner. Long term surveillance can also help build systems to offer support whilst “leader, public/private partnership, national polices and WHO resolutions can help provide comprehensive care.” Global registries might be one answer, suggested Dr Alexis Joannides, consultant neurosurgeon at the University of Cambridge. This would help to document cases but would require collaboration across systems and countries.
Why make a resolution?
Every 1.5 seconds, a traumatic brain injury occurs but this is largely invisible in international statistics. Technical Advisor to the World Health Organisation Maryam Mallick says ;“burden is highest where systems are weakest. TBI shows fault lines in our health systems”. Dr Gail Rousseau, G4 alliance board chair and consultant neurosurgeon, adds that TBI contributes to 6 million deaths a year (scope), it affects individuals, families and communities (shock) and the brain is a sensitive organ that is personalised to the individual (soul). Data is required to correctly adjust where resources are allocated; “prevent, protect and rehabilitate the brain who makes us who we are.” 30 years ago, TBI treatment was considered impossible and neurosurgery was a luxury. There are still inequities in care says Dr Franco Servadei (WFNS) but all neurosurgeons can take care of brain injury. TBI has put in both the WHO neurology action plan and rehabilitation.
Keynote
The keynote speech was given by Dr Hanan Balkhy, Regional Director, WHO EMRO. She reiterated the panel discussions adding the TBI is a public health challenge. There is a gap where we need data (after the acute care phase) so we should increase surveillance to strengthen and improve the continuity of care and prevention.
National Leadership and Global Commitment on TBI
The current state of TBI data means that we cannot quantify its true numbers and the economic burden to countries. TBIs can occur due to conflicts, falls, sports injuries, road injuries and interpersonal violence. In Guatemala, the minister of health (MoH) says the main issues are what data to collect, who should collect it and then how is the data used. This is not just a ministry of health issue this is a state issue as it can lead back to infrastructure planning, finance and many more sectors. The MoH then said the Guatemala would be happy to co-sponsor the TBI WHO resolution. In Pakistan, 79% of the population is under 40 and TBI is currently representing 6% of the burden of disease. Despite those numbers the MoH says that TBI represents 50% of the out-of-pocket expenditure. The Pakistani government has been working towards providing a social protection net, but earthquake and flood challenges have contributed to a deficiency in rehabilitation services. It is a similar picture in Tanzania where 73% of TBI is people aged 15-45. In both areas, TBI is disproportionately affecting the working population. The MoH in Tanzania has identified several areas that need strengthening including infrastructure, public-private partnerships, capacity building, equipment support and a health4all initiative (which is a government subsidised service). As the youngest country at the table, South Sudan MoH said that there is a public responsibility to enforcing road safety regulation, enforcement, TBI awareness and education.
From Recognition to Action
WHO encourages member states to put TBI on the national action plan and increase visibility. In Qatar, the MoH stated that; “we have encouraged deliberate investment not passive management” which has been possible through political will and cross-sector investment. This has been difficult since there is not a single document source for TBI data. To move forward and improve treatment and care for TBI, the MoH says you need evidence, a multisectoral involvement/solution (since it is a multisectoral problem) and political support.
The coalition is currently developing a resolution to put forward to the WHA80. There has been academic and civil society consultation and multisectoral involvement, even though the highest burden is to health. Dr Hanan Balkhy, Regional Director of WHO Eastern Mediterranean Region says the political will is there. The engaged member states will bring the resolution to the WHA80 in 2027.
