WHO: Global Efforts to End TB 'Off Track'

Megan Brooks

September 19, 2018

Global efforts to combat tuberculosis (TB) have averted an estimated 54 million TB deaths since 2000, but TB remains the world’s deadliest infectious disease and countries are still not doing enough to end TB by 2030, the World Health Organization (WHO) said on September 18.

To meet the global target of ending TB by 2030, countries need to "urgently" accelerate their response, including by increasing domestic and international funding to fight the disease, WHO said.

Progress has been made against TB, "but overall we are still off track," Tereza Kasaeva, MD, PhD, director of the WHO Global TB Programme, said in a press briefing in New York, marking release of the  WHO Global TB Report 2018 .

"We must seize the moment. It's high time for urgent definitive action and investments to drive down the suffering and death caused by this disease. It's unacceptable that in the 21st century millions lose their lives from this preventable and curable disease. This must end. The time for action is now," Kasaeva said.

10 Million Infected in 2017

The new report provides the latest data on the TB epidemic and analysis of the status of global response. It was released ahead of the first-ever United Nations high-level meeting on TB taking place in New York next week. Nearly 50 heads of state and government are expected to attend.

"We must make sure that this report and the commitments we hear next week from country leaders at the High-Level Meeting on TB translate into action," said Eric Goosby, MD, UN Special Envoy on TB. "Equally important, we must ensure that we hold our leaders accountable for the actions they promise to take. And we must hold ourselves accountable for keeping the pressure on."

According to the new report, the number people who died from TB in 2017 fell, but there were still 1.6 million TB deaths, including among 300,000 HIV-positive people. Since 2000, TB deaths are down 44% among people with HIV compared with a 29% decrease among the general population.

WHO estimates that a quarter of the world's population has TB infection, with an estimated 10 million people developing TB in 2017.

However, the number of new cases is falling by 2% per year, although faster declines occurred in Europe (5% per year) and Africa (4% per year) between 2013 and 2017.

Some countries are moving faster than others, including in Southern Africa, which has seen annual declines (in new cases) of 4% to 8% in countries such as Lesotho, eSwatini, Namibia, South Africa, Zambia, and Zimbabwe. In the Russian Federation, "high level" political commitment and intensified TB efforts have led to more rapid declines in cases (5% per year) and deaths (13% per year), Kasaeva noted.

Drug-resistant TB remains a "global public health crisis," Kasaeva said. In 2017, an estimated 558,000 people developed TB resistant to at least rifampicin, the most effective first-line TB drug, and the vast majority had multidrug-resistant TB, which is a combined resistance to rifampicin and isoniazid (another key first-line TB medicine).

Challenges and Opportunities

Underreporting and underdiagnosis of TB continue to be major challenges, the report notes. Of the 10 million people who developed TB in 2017, only 6.4 million were officially recorded by national reporting systems, leaving 3.6 million people undiagnosed, or detected but not reported. Ten countries accounted for 80% of this gap, with India, Indonesia, and Nigeria at the top.

Treatment coverage lags behind at 64% and must increase to at least 90% by 2025 to meet the TB targets, Kasaeva said.

To improve detection, diagnosis, and treatment rates, this year WHO, the Stop TB Partnership, and the Global Fund launched a new initiative known as Find. Treat. All. #EndTB ( https://www.who.int/tb/joint-initiative/en/ ) , which aims to provide quality care to 40 million people with TB from 2018 to 2022.

Kasaeva said that one of the most urgent challenges is to scale up funding. In 2018, investments in TB prevention and care in low- and middle-income countries fell US$ 3.5 billion short of what is needed.

Without an increase in funding, the annual gap will widen to US$ 5.4 billion in 2020 and to at least US$ 6.1 billion in 2022, she said. An additional US$ 1.3 billion per year is required to accelerate the development of new vaccines, diagnostics, and medicines.

WHO Global TB Report 2018. Published September 18, 2018. Full text

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