World Leaders Must Cement Political Commitment to Fight TB
The WHO estimates that a quarter of people in the world have latent tuberculosis – which means they have been infected with the TB bacteria but have not yet developed the disease.
The most important development to come out of this week’s UN High Level Meeting on Tuberculosis (TB) in New York would be a global political commitment to taking the steps needed to wipe the disease off the face of the Earth. Without that support, financing, new technologies and the leadership of experts in the field, will be unable to significantly tip the odds in the fight against TB.
There is some good news. Overall, TB deaths have decreased over the past year. In 2017, there were 1.6 million deaths, including among 300 000 HIV-positive people. Since 2000, a 44 percent reduction in TB deaths occurred among people with HIV compared with a 29 percent decrease among HIV-negative people.
But serious challenges persist. The WHO estimates that a quarter of people in the world have latent tuberculosis – which means they have been infected with the TB bacteria but have not yet developed the disease.
An estimated 10 million people around the world developed TB in 2017. The number of new cases is falling by two percent per year, although faster reductions have occurred in Europe (five percent per year) and Africa (four percent per year) between 2013 and 2017.
That is where political will comes in.
It will take more than just health ministers to solve the fight against TB because there are many economic, political and social determinants of the disease. I have worked in TB for over 30 years and stand by the words of Dr. Tereza Kasaeva, Director of WHO’s Global TB Program as my appeal to the leaders gathered for the UN High Level Meeting on TB: “It is unacceptable that millions lose their lives, and many more suffer daily from this preventable and curable disease. We need to join forces to root out this disease that has a devastating social and economic impact on those who are “left behind,” whose human rights and dignity are limited, and who struggle to access care. The time for action is now.”
A month ago, the WHO issued a Rapid Communication on key changes to the treatment of drug-resistant TB based on the latest scientific evidence. These changes should result in better treatment outcomes and more lives saved. The WHO is already working with countries and partners to roll out these changes.
It is unacceptable that millions lose their lives, and many more suffer daily from this preventable and curable disease.
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. The report flags that 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. A further US$ 1.3 billion per year is required to accelerate the development of new vaccines, diagnostics, and medicine
The fight against TB is uneven throughout the world and therefore could benefit from more co-orindated political leadership.
Some countries are moving faster than others – as evidenced in Southern Africa, with annual declines (in new cases) of four percent to eight percent in countries such as Lesotho, Eswatini, Namibia, South Africa, Zambia, and Zimbabwe, thanks to better TB and HIV prevention and care. In the Russian Federation, high-level political commitment and intensified TB efforts have led to more rapid declines in cases (five percent per year) and deaths (13 percent per year)
Drug-resistant TB remains a global public health crisis: In 2017, 558 000 people were estimated to have developed disease resistant to at least rifampicin– the most effective first-line TB drug. The vast majority of these people had multidrug-resistant TB (MDR-TB), that is, combined resistance to rifampicin and isoniazid (another key first-line TB medicine).
Why is it so difficult to eradicate TB?
Underreporting and under-diagnosis of TB cases remains a major challenge. Of the 10 million people who fell ill with 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 percent of this gap, with India, Indonesia, and Nigeria topping the list.
Less than half of the estimated one million children with TB were reported in 2017, making it a much higher gap in detection than that in adults.
Treatment coverage is currently at 64 percent and must increase to at least 90 percent by 2025 to meet the TB targets. Another issue is that only around half of the estimated 920,000 people with HIV-associated TB were reported in 2017. Of these, 84 percent were on antiretroviral therapy. Most of the gaps in detection and treatment were in the WHO African Region, where the burden of HIV-associated TB is highest. Only one in four people with MDR-TB were reported to have received treatment with a second-line regimen. China and India alone were home to 40 percent of patients requiring treatment for MDR-TB, but not reported to be receiving it. Globally, MDR-TB treatment success remains low at 55 percent, often due to drug toxicity making it impossible for patients to stay on treatment.
At Project HOPE, our most effective work to tackle TB has been facilitating linkages between urban TB service organizations and social support, reaching priority at risk populations, strengthening labs, human resource development and building the skills of health workers. Project HOPE received an A1 rating from the Global Fund for some of our work in TB, and we are determined not to allow another generation to die from this preventable and curable disease.