Tuberculosis (TB) treatment has saved the lives of more than 22 million people since 1995, according to the World Health Organization (WHO) Global Tuberculosis Report 2013, published today.
TB incidence is falling at a rate of 2% per year and global TB deaths decreased from 1.4 million in 2011 to 1.3 million deaths in 2012, the report says. However further gains are under serious threat due to two urgent challenges.
First, efforts must be intensified to reach the three million people—a third of all new TB cases—who are “missed” every year by health systems. Seventy-five percent of these missed cases are in 12 countries, WHO estimates.
“Quality TB care for millions worldwide has driven down TB deaths,” says Dr Mario Raviglione, WHO Director of the Global TB Programme. “But far too many people are still missing out on such care and are suffering as a result. They are not diagnosed, or not treated, or information on the quality of care they receive is unknown.”
Second, multidrug-resistant TB (MDR-TB) must be addressed as a public health crisis, the report says. There is a huge gap between the number of people who are getting ill with MDR-TB and the number of people who are diagnosed and enrolled on treatment.
WHO estimates that 450 000 people fell ill with MDR-TB in 2012 alone. Despite the number of people detected with rapid diagnostic tests increasing dramatically in 2012, three out of four people estimated to have MDR-TB worldwide were not detected in 2012.
Worryingly, at least 16 000 MDR-TB cases reported to WHO in 2012 were not put on treatment, with long waiting lists increasingly becoming a problem. Furthermore, due to a lack of service capacity, clear approaches and human resources, the global cure rate for MDR-TB is very low. Only 48% of those enrolled in treatment are cured at the end of the two year treatment period.
“We are sitting and watching a ticking bomb,” said Dr Lucica Ditiu, Executive Secretary of the Stop TB Partnership, in response to the report’s findings. “The WHO report shows that quality TB care can save millions of lives, but we are advancing far too slowly. Let me be clear about what we are facing. At the current rate of progress, we will not eliminate TB as a public health threat until 2170. In addition, we are not on track to meet the TB prevalence target by the time the Millennium Development Goals expire in 2015 and two regions are not on track to reach the mortality target in the same period.”
“The fact that more than 16 000 people with MDR-TB are on waiting lists for treatment is cause for global alarm,” she said. “These people are not only suffering, but dying unnecessarily, transmitting disease and very likely being subject to stigma. It is also of great concern that 10% of people with MDR-TB have extensively drug-resistant TB, for which treatment options and hope are severely limited.”
In light of the report’s findings, Dr Ditiu urged the global community to urgently scale up efforts to fight TB. “Leaving aside targets, we are talking here about people’s lives. Complacency is unacceptable," she said.
She highlighted a number of ways in which the Stop TB Partnership and its partners are tackling the challenges highlighted in the report.
“In the TB community, we have been aware of the missing three million for a few years now. This is why, supported by the Canadian government, we launched TB REACH in 2010. This initiative provides partners with funding to innovate and reach undetected TB cases in some of the most poorly-served and vulnerable communities. The innovative models emerging from TB REACH projects have the potential to reach a large number of the missing TB cases. We just need to go ahead and scale up.
“Our Global Drug Facility (GDF) is also standing by to facilitate the scale up of treatment for MDR-TB. GDF’s current capacity to supply medicines for MDR-TB far exceeds the current demand from countries,” Dr Ditiu said.
Finally, a steep increase in funding for TB research and development is needed, Dr Ditiu said. “We must advocate for desperately needed new diagnostics, drugs and vaccines if we are to accelerate the fight against TB.”
The WHO report is based primarily on data provided by WHO’s Member States. In 2013 data were reported by 178 Members States and a total of 197 countries and territories that collectively have more than 99% of the world’s TB cases.
This year’s report contains a Countdown to 2015 supplement, providing information on progress towards international TB targets. It includes details of whether the world and countries with a high burden of TB are “on-track” or “off-track” on various TB targets and what can be done to accelerate impact as the 2015 deadline approaches.