“It is extremely concerning that the World Health Organisation’s (WHO) 2019 Global Tuberculosis Report confirms that tuberculosis (TB) remains the single most lethal infectious disease globally, surpassing HIV/Aids, killing some 1.6m people annually, and that the end of TB will remain out of reach until national leaders step up,” said Dr Paula I Fujiwara, scientific director of the International Union Against Tuberculosis and Lung Disease (The Union).
“This, despite the world’s heads of state coming together last year at the UN General Assembly and for the first time unanimously promising to end TB by 2030 based on the Sustainable Development Goals. According to these new WHO data for 2019, that well-meaning goal will remain a fantasy unless there is a dramatic shift in the way we do business. It is not rocket science – TB is a disease that is preventable, treatable and curable.
“One of the most concerning parts of the new report is the global failure to prevent adequate numbers of new infections. We have the medications to prevent TB and we know prevention remains one of the most effective ways to slow the global pandemic and bring the global target into reach, and yet indicators show new cases are failing to decline in significant numbers. If we are to have a realistic chance of eliminating TB then we need to begin preventing the disease wherever we are treating it. This is an emergency: it is both long overdue and timely that we will see some significant announcements on prevention trials at the upcoming 50th Union World Conference on Lung Health in Hyderabad in India in a few weeks’ time.”
India has the highest TB burden in the world with one in four of all global cases reported in that country. The Indian government has made the fight against TB a central priority and boldly pledged to end TB by 2025, five years before the globally agreed target.
“According to the WHO’s report, the number of people with TB in India is falling and that is good news,” said Fujiwara. “This demonstrates that making serious gains against TB in a short time frame is possible even in the world’s largest and most geographically diverse countries if political leaders prioritise the disease. But let’s be honest – TB is not still not falling nearly fast enough in India, progress is still too slow to meet the targets – and if we don’t end TB in India we can’t hope to end TB globally.
“This is an even bigger challenge given that nearly every other TB high-burden country except Indonesia remains far behind the pace needed to meet the global elimination target by 2030.”
The WHO says more people received life-saving treatment for TB in 2018 than ever before, largely due to improved detection and diagnosis. Globally, 7m people were diagnosed and treated for TB – up from 6.4m in 2017 – enabling the world to meet one of the milestones towards the UN political declaration targets on TB.
WHO’s latest Global TB Report says that 2018 also saw a reduction in the number of TB deaths: 1.5m people died from TB in 2018, down from 1.6m in 2017. The number of new cases of TB has been declining steadily in recent years. However, the burden remains high among low-income and marginalised populations: around 10m people developed TB in 2018.
“Today we mark the passing of the first milestone in the effort to reach people who’ve been missing out on services to prevent and treat TB,” said Dr Tedros Adhanom Ghebreyesus, WHO director-general. “This is proof that we can reach global targets if we join forces together, as we have done through the Find.Treat.All.EndTB joint initiative of WHO, Stop TB Partnership and the Global Fund to Fight AIDS, TB and Malaria”.
WHO’s latest Global TB Report, highlights that the world must accelerate progress if it is to reach the Sustainable Development Goal of ending TB by 2030. The report also notes that an estimated 3m of those with TB still are not getting the care they need.
In many countries today, fragile health infrastructure and workforce shortages make it difficult to provide timely diagnosis and the right treatments for TB. Weak reporting systems are another problem: health providers may treat people but fail to report cases to national authorities, leaving an incomplete picture of national epidemics and service needs. Further, up to 80% of TB patients in high burden countries spend more than 20% of their annual household income on treating the disease.
Tedros added: “Sustained progress on TB will require strong health systems and better access to services. That means a renewed investment in primary health care and a commitment to universal health coverage.”
Last month heads of state agreed a political declaration on Universal Health Coverage at the UN in New York, highlighting the importance of expanding service coverage and committing specifically to strengthen efforts to address communicable diseases like HIV, TB, and malaria.
One way to improve coverage is to adopt more people-centred comprehensive approaches. Better integrated HIV and TB programmes already mean that two thirds of people diagnosed with TB now know their HIV status. In addition, more people living with HIV are taking treatment.
But child health programmes still do not always focus adequately on TB: half of children with TB do not access quality care and only a quarter of children under the age of 5 in TB-affected households currently receive preventive treatment.
Drug resistance remains another impediment to ending TB. In 2018, there were an estimated half a million new cases of drug-resistant TB. Only one in three of these people was enrolled in treatment.
New WHO guidance aims to improve treatment of multidrug resistant TB, by shifting to fully oral regimens that are safer and more effective. The guidance is part of a larger package of steps released on 24 March 2019 – World TB Day – to help countries speed up efforts to end the disease. “WHO is working closely with countries, partners and civil society to accelerate the TB response,” said Dr Tereza Kasaeva, director of WHO’s Global TB Programme. “Working across different sectors is key if we are to finally get the better of this terrible disease and save lives.”
The fight against TB remains chronically underfunded. WHO estimates the shortfall for TB prevention and care in 2019 at $3.3bn. International funding (which is critical for many low- and middle-income countries) amounts to $0.9bn in 2019, with 73% coming through the Global Fund. The recent successful replenishment of the Global Fund will be critical to strengthen international financing.
The largest bilateral donor is the US government, which provides almost 50% of total international donor funding for TB when combined with funds channelled through and allocated by the Global Fund. There is an urgent need for funding of TB research and development, with an annual shortfall of $1.2bn. Priority needs include a new vaccine or effective preventive drug treatment; rapid point-of-care diagnostic tests; and safer, simpler, shorter drug regimens to treat TB.
“To accelerate TB research and innovation, WHO is developing a global strategy,” adds Kasaeva. “We are collaborating with academia, research networks such as the BRICS TB Research network, and partners including the Bill & Melinda Gates Foundation, UNITAID and others in a quest to bring innovations into practice to break the trajectory of the TB epidemic”.WHO material World Health Organisation report