Skip to content

Fighting TB in Kids: A Discussion with Doctors without Borders

2025-11-13 · collab / interview · John, Ani Herna Sari, Natalia, Mariama, Cathy Hewison · 1 h 0 min · watch on YouTube

Topic: Global development · mode: Q&A & conversation · tags: guest or collab, heavy topic, timely hook, civic or action cta

In a livestream panel on tuberculosis in children, John and guests from Doctors Without Borders (survivor Ani Herna Sari, Mozambique pediatrician Dr. Natalia, Sierra Leone TB program manager Dr. Mariama and MSF adviser Cathy Hewison) discuss misdiagnosis, missing child-specific tests and formulations, weak health systems and aid cuts; John concludes that protecting kids from TB is a question of prioritization and political will.

What is said

The parts of the video and what is said in each (★ — how much it matters to the video).

00:00:00 — John opens: TB in kids, poor tests and pediatric treatment, the World TB Report

  • ★★ John says the cause of tuberculosis has been known for about 140 years, yet there is still no great test for kids. — 00:00:00 · tuberculosis
  • ★★ John says kids are often misdiagnosed by microscopy and by GeneXpert tests because they cannot produce enough sputum, so chest x-ray is essential but has shortcomings in kids. — 00:00:00
  • ★★ John says we don't invest much of our research money in kids. — 00:00:47
  • ★★ John recently met someone whose child got TB and who had to crush the pills, divide them into thirds and give them in sugar water daily for months; this is starting to change. — 00:00:47
  • ★★ John says a man in the US who got TB in the 1940s was treated the same way by his mother, an 85-year gap that John finds damning for how we treat TB in kids. — 00:01:17 · United States
  • ★★★ Citing the World TB Report released the day before, John says TB, the deadliest infectious disease, kills 1.2 million people a year, a slight reduction: progress, but slow. — 00:01:17 · tuberculosis
  • ★★ John says progress against TB in kids is even slower. — 00:01:46 · tuberculosis

00:02:20 — Ani Herna Sari's story as a two-time TB survivor and mother of a child with TB, and the role of survivors

  • ★★ Ani Herna Sari: Ani introduces herself as a TB survivor in Indonesia who now leads the TB survivor organization Rekat Peduli Indonesia Foundation. — 00:02:49
  • ★★ Ani Herna Sari: Ani says in 2011 an x-ray indicated TB though two sputum tests were negative; the doctor still gave TB medicine she thinks was inadequate, and she kept coughing blood for months. — 00:03:17
  • ★★★ Ani Herna Sari: Ani says another doctor tested her sputum over three months and found her resistant to three medicines; she started MDR-TB treatment on 11 November 2011. — 00:04:23
  • ★★ Ani Herna Sari: Ani found herself pregnant in February 2012; pregnancy plus drug side effects meant daily vomiting, and she wanted to give up but kept fighting for her baby. — 00:04:48
  • ★★★ Ani Herna Sari: Ani says when her water broke early and she needed surgery, she was put in glass isolation and asked to change hospitals, which she calls stigma, and was separated from her baby for five days. — 00:05:17
  • ★★ Ani Herna Sari: Ani says her baby was healthy, took TB preventive therapy and later got the BCG vaccine; she recovered in 2013. — 00:06:33
  • ★★ Ani Herna Sari: Ani says in 2015 she cared for her brother with drug-sensitive TB, and afterwards she and her son were infected, her second struggle with TB. — 00:06:33
  • ★★ Ani Herna Sari: Ani says her nine-month-old, still breastfeeding, kept spitting out the crushed medicine; she was depressed, and her family's support gave her courage. — 00:07:36
  • ★★ John says reinfection with TB, as Ani experienced, is common when community spread is not solved. — 00:09:46 · tuberculosis
  • ★★ John says preventive therapy can prevent reinfection, but there is not nearly enough of it available. — 00:10:19
  • ★★ John says the most recent study showed maybe 20% of people who should get TPT are getting it. (hedged) — 00:10:19
  • ★★ John thinks the 20% figure is misleading and the real share is probably more like 10%. (hedged) — 00:10:49
  • ★★★ John says in the US he would be offered TPT without problem if a relative got TB, but not in many high-burden countries like Indonesia, which reveals problems we face as a world. — 00:10:49 · United States
  • ★★ Ani Herna Sari: Ani says giving her child bitter pills he vomited up was painful; she felt she had failed as a mother, since he got TB despite TPT and BCG. — 00:12:43
  • ★★★ Ani Herna Sari: Ani says survivors can be role models for families who may not know they have TB, giving education and awareness about infection, masks and nutrition. — 00:13:58
  • ★★ Ani Herna Sari: Ani says survivors also advocate with stakeholders so people on treatment get their right to the best service. — 00:14:45

00:15:14 — Dr. Natalia on diagnosing and treating TB in children in Mozambique: atypical symptoms, delays, pediatric formulations, stigma, information

  • ★★ In the Philippines John saw Doctors Without Borders work in an impoverished Manila community and met a young man diagnosed with TB hours earlier. — 00:15:14
  • ★★ John says hearing from a survivor who has been through TB is entirely different from hearing from him or a nurse that medicine will make you stronger. — 00:15:14
  • ★★ Natalia: Dr. Natalia says children often lack classic TB symptoms: a nine-year-old patient, Francisco, first showed only less playing and eating, so loss of playfulness, appetite and weight must join fever, cough and night sweats. — 00:16:39
  • ★★ Natalia: Dr. Natalia says delayed diagnosis delays treatment; GeneXpert sensitivity in children is not the best, but they always request it because a negative result is also information. — 00:18:28
  • ★★★ Natalia: Dr. Natalia describes Regina, a one-year-old whose mother has resistant TB; using the treatment decision algorithm she could have been treated the day her mother was diagnosed, but three months were lost. — 00:21:27
  • ★★ Natalia: Dr. Natalia says stockouts of pediatric formulations are a major struggle: other formulations risk toxicity, resistance and refusal, so pediatric formulations must be pushed. — 00:21:51
  • ★★ Natalia: Dr. Natalia says pediatric formulations exist, but pharmacy supply chains in Mozambique are difficult. — 00:22:48
  • ★ John says colleagues elsewhere report frequent stockouts and shortages from supply chain problems. — 00:23:16
  • ★★ Natalia: Dr. Natalia says in Mozambique, with high HIV incidence, TB stigma is worst when a child has HIV co-infection. — 00:23:38
  • ★★ Natalia: Dr. Natalia says the lack of information in communities and among health staff about new diagnostics and treatments is sometimes a bigger problem than stigma; information is power. — 00:24:16
  • ★★ Natalia: Dr. Natalia says most people still think TB treatment takes six months, but a large group of eligible children can get four months. — 00:25:12

00:25:58 — Dr. Mariama on Sierra Leone: missed child cases, broken x-ray machines, TPT coverage and the impact of global health funding cuts

  • ★★ John says it is important to address the psychosocial and not just the biomedical side of TB, or we miss why people struggle to finish treatment, are diagnosed late, or fear TB. — 00:25:58
  • ★ John calls Dr. Mariama one of his personal TB heroes for her work in Sierra Leone, a place that matters to him and the community. — 00:26:42 · Sierra Leone
  • ★★★ Mariama: Dr. Mariama says Sierra Leone reported over 22,000 TB cases in 2024; 15% should be children but only 9% were, so about 3,000 children with TB are missed every year. — 00:27:45 · Sierra Leone
  • ★★ Mariama: Dr. Mariama says health workers have low confidence in diagnosing childhood TB, which is mostly clinical and subjective. — 00:28:21
  • ★★ Mariama: Dr. Mariama says diagnostics are scarce: samples must travel to machines, and x-ray machines are sparse and often broken, so children must be moved to them. — 00:28:50
  • ★★ Mariama: Dr. Mariama says Sierra Leone diagnosed less than 1% of its MDR-TB cases last year (2024). — 00:29:22 · Sierra Leone
  • ★★★ Mariama: Dr. Mariama says the target is TPT for 90% of child contacts under five, but only 2.8% has been reached. — 00:29:45
  • ★★ Mariama: Dr. Mariama says the four-month regimen requires excluding severe TB, hard with limited diagnostics and staff, so clinicians are unsure whom to put on four or six months. — 00:30:12
  • ★★ Mariama: Dr. Mariama says TB screening is not yet embedded in child and maternal health services, so many children who come to hospital go undiagnosed. — 00:30:39
  • ★★ Mariama: Dr. Mariama says contact tracing is poor and the system relies on passive case finding, with caregivers bringing children in, rather than actively finding cases. — 00:31:01
  • ★★ Mariama: Dr. Mariama says under-five care is free but financial barriers persist: no enablers for drug-sensitive TB and no social protection, and catastrophic costs impede adherence. — 00:31:53

  • ★★★ Mariama: Dr. Mariama sums up: new guidelines, drugs and diagnostics are filters, but the health system itself is a weak sieve with large holes through which the sickest children slip undiagnosed. — 00:32:22

    “The current system looks like a sieve. It could be seen as a sieve with large filters or large holes.”

  • ★★★ Mariama: Dr. Mariama says TB care is mostly donor funded, so broken machines wait on donors; batteries for x-ray machines took almost three years to fix, forcing patients at Lakka to other facilities. — 00:33:32

  • ★★ Mariama: Dr. Mariama says other facilities prioritize their own patients and do not want TB patients, and moving very sick patients needs oxygen and a nurse. — 00:34:31
  • ★★ John calls two years without chest x-rays at the TB hospital a real indictment of how donor-supported aid works, with so many hoops to jump through. — 00:35:12

  • ★★★ John says that in high-level talk about the future of aid, we must remember that if it doesn't include batteries, something is deeply wrong with it. — 00:36:02

    “if the future of aid doesn't include batteries, then there's something deeply wrong with the future of aid”

  • ★★ Mariama: Dr. Mariama says giving TPT first requires finding every patient's contacts and then excluding active TB, which strains diagnostics and expertise. — 00:36:54

  • ★★ Mariama: Dr. Mariama says rifapentine, which shortens TPT to about three months instead of six, has no child-friendly formulation for kids under two, who mostly get six months. — 00:37:42
  • ★★ Mariama: Dr. Mariama says it is hard to get caregivers to give a potentially toxic drug with side effects to a child who is not sick. — 00:38:10
  • ★★ John says six months of medication for a child who isn't sick would confuse him too; survivors like Ani can help by sharing their experience. — 00:38:38
  • ★★★ Mariama: Dr. Mariama says the Global Fund, which supports over 90% of TB services in Sierra Leone, has cut back 12% for the current allocation. — 00:39:56 · Sierra Leone
  • ★★ Mariama: Dr. Mariama says only life-saving activities are kept, so outreach, training, patient enablers and community sensitization with survivor testimony have been cut. — 00:40:46
  • ★★ Mariama: Dr. Mariama thinks those cut activities are also life-saving, because prevention and community engagement curtail TB in the long run. — 00:41:12
  • ★★ Mariama: Dr. Mariama says planned drug resistance, stigma and catastrophic cost surveys were cancelled or postponed, weakening sustainability and increasing donor dependency. — 00:41:12
  • ★★ John repeats a chat point from Benedict: imagine stopping funding traffic lights because they are only indirectly life-saving; the cuts hit obviously essential work like outreach and survivor advocacy. — 00:42:19

00:42:54 — Dr. Cathy Hewison on why TB is hard to diagnose in kids, new tongue-swab tests, vaccines, preventive therapy and nutrition

  • ★★★ Cathy Hewison: Dr. Hewison says children get sick with very few bacteria, which adult-designed tests can't detect, so most never test positive and clinicians must dare to treat without confirmation. — 00:43:17
  • ★★ Cathy Hewison: Dr. Hewison says tests rely on coughing up sputum, but small children swallow it and can't be made to cough into a pot. — 00:43:46

  • ★★ Cathy Hewison: Dr. Hewison says TB in young children is atypical, so clinicians have to think TB or they will never find it. — 00:44:15

    “If you don't think TB, you'll never find it in children.”

  • ★★★ Cathy Hewison: Dr. Hewison says children are the most vulnerable yet always the last thought about and never prioritised; no test has ever been developed for TB in children, and it takes political will. — 00:44:44

  • ★★ Cathy Hewison: Dr. Hewison says children's formulations exist for all drugs but cost more, so programs buy adult ones, and underdiagnosis leads to expired stock and no reordering: a vicious circle. — 00:45:46
  • ★★★ Cathy Hewison: Dr. Hewison says nutrition is the number one determinant of TB, children are the most affected, so nutrition is prevention. — 00:45:46
  • ★★ Cathy Hewison: Dr. Hewison says improving access to tools and developing new ones is a question of prioritisation and thinking TB, so decision-makers and families must treat children as a priority. — 00:46:36
  • ★★ John says his friend Henry, an MDR-TB survivor in Sierra Leone, credits Dr. Girum Tefera and also his mother, who brought him extra food when many are abandoned by families. — 00:47:09 · Sierra Leone
  • ★★ John recalls a young MSF doctor in Manila urging him to treat the person, not the lab: especially in kids, a negative GeneXpert test may not tell much. — 00:47:51
  • ★★ Cathy Hewison: Dr. Hewison says a new generation of tongue-swab tests is mobile, palm-sized and battery-run, so testing can happen on the spot in community screening. — 00:48:58
  • ★★ Cathy Hewison: Dr. Hewison says the current test takes about two hours while the new one takes 10 to 30 minutes. — 00:49:39
  • ★★ Cathy Hewison: Dr. Hewison says the new machine costs 1% of the current one and the test half as much. — 00:50:08
  • ★★★ Cathy Hewison: Dr. Hewison says the swab tests are not better at finding bacteria, so they won't fix the problem in kids; tests made for kids, perhaps detecting biomarkers, are needed. — 00:50:37
  • ★★ Cathy Hewison: Dr. Hewison says BCG at birth protects children under two well against the severest TB, including meningitis, but not later in life; new vaccines are in the pipeline. — 00:51:30
  • ★★ Cathy Hewison: Dr. Hewison says preventive therapy is a great tool and formulations now exist for even the smallest kids. — 00:52:58
  • ★★★ Cathy Hewison: Dr. Hewison says WHO recently recommended food support for all household members of a TB patient in food-insecure settings, malnourished or not. — 00:52:58
  • ★★ Cathy Hewison: Dr. Hewison says TB is often a disease of poverty, spreading where people live close together; the tools exist but political will is lacking. — 00:53:27

00:54:10 — John's takeaway: prioritization and political will, and advocacy to governments makes a difference

  • ★★★ John's takeaway: protecting kids from TB is a question of prioritization and political will, decided by all our governments together. — 00:54:10
  • ★★ John says TB fighters impress him because they have made a big difference in getting TB care prioritized. — 00:54:39
  • ★★★ John says those lucky enough to have a say in their governance should use it by talking to their leaders, which really makes a difference. — 00:55:08
  • ★★ John says advocacy has shown it can make a difference, in initial drafts of the US aid budget for 2026 and in Canada's pledge to the Global Fund. — 00:55:08 · United States, Canada

00:55:49 — Where each panelist finds hope; John's closing and sign-off

  • ★★ Cathy Hewison: Dr. Hewison finds hope in seeing a sick child recover and in the buy-in for MSF's TACTiC initiative. — 00:56:34
  • ★★ Mariama: Dr. Mariama finds hope in the community movement around TB: once neglected and stigmatized, it is now discussed openly. — 00:57:07
  • ★★ Natalia: Dr. Natalia finds hope in people speaking out about TB, which is curable, with new diagnostics, better treatments and vaccines coming. — 00:58:15
  • ★★ Ani Herna Sari: Ani finds hope when every mother has clear TB information, every child is diagnosed and treated, and families see patients as human beings, not cases. — 00:58:43
  • ★★★ John says it is important to see people not as patients or statistics but as people whose lives matter as much as any of ours. — 00:59:28

In the description and comments

  • ★★ The description announces a TB Ed Talk stream on December 2 about TB in children. — video description
  • ★★ The description invites viewers to submit questions for the TB Ed Talk via a form. — video description

Threads in this video

Where the stories that moved here went next

Mentioned

Central: Ani Herna Sari · Cathy Hewison · Mariama · Mozambique · Médecins Sans Frontières · Natalia · Sierra Leone · tuberculosis · tuberculosis preventive therapy

Also: People: Henry Reider

Projects: TBFighters

Works: Global Tuberculosis Report

Organizations: European Union · Global Fund to Fight AIDS, Tuberculosis and Malaria · Lakka TB Hospital · World Health Organization

Concepts: active case finding · contact tracing · Development aid · global health · HIV/AIDS · malnutrition · multidrug-resistant tuberculosis · social determinants of health · social stigma · vicious circle · X-ray

Places: Canada · Indonesia · Manila · Paris · Philippines · United Kingdom · United States · United States Capitol

Products: BCG vaccine · GeneXpert · Rifapentine

Policies: Test, Avoid, Cure TB in Children

Only in the description or credits: Girum Tefera · Ministry of Health and Sanitation (Sierra Leone) · Rekat Peduli Indonesia

← Previous: John's Annual Psychophysical Decline · Next → The End of The Penny (and of Congress??)