Tuberculosis remains leading infectious killer

According to the new Global TB Report 201716 released by the World Health Organization (WHO) in October 2017, global efforts to combat Tuberculosis (TB) have saved an estimated 53 million lives since 2000 and reduced the TB mortality rate by 37%.

However, despite these achievements, the latest picture is grim. TB remained the top infectious killer in 2016. TB is also the main cause of deaths related to antimicrobial resistance and the leading killer of people with HIV. Progress in most countries is not fast enough to reach global targets or even close persistent gaps in TB care and prevention.

TB is an infectious disease caused by the bacillus Mycobacterium tuberculosis. It typically affects the lungs (pulmonary TB) but can also affect other sites (extrapulmonary TB). The disease spreads when people who are sick with pulmonary TB expel bacteria into the air, for example by coughing.

High global burden of disease and death in 2016

Overall, the latest picture emerges as one of a still high burden of disease, and progress that is not fast enough to reach neither targets nor making a major headway in closing persistent gaps. TB is the ninth leading cause of death worldwide and the leading cause from a single infectious agent, ranking above HIV/AIDS. In 2016, there were an estimated 10.4 million new TB cases worldwide; 10% of which were people living with HIV. Seven countries accounted for 64% of the total burden - with India bearing the brunt, followed by Indonesia, China, Philippines, Pakistan, Nigeria and South Africa. An estimated 1.7 million people died from TB, including nearly 400 000 people who were co-infected with HIV. There is a drop in numbers by 4% compared to 201517. Multidrug-resistant TB (MDR-TB) remains a public health crisis and a health security threat. WHO estimates that there were 600 000 new cases with resistance to Rifampicin – the most effective first-line drug, of which 490 000 had MDR-TB. Almost half (47%) of these cases were in India, China and the Russian Federation.

Persistent gaps in care and financing

Tackling the epidemic requires action to close gaps in care and financing. It also requires progress in a particular subset of high TB burden countries such as India, Indonesia, Nigeria, the Philippines, South Africa, Pakistan, Bangladesh, the Democratic Republic of the Congo, China and the United Republic of Tanzania.

Underreporting and under diagnosis of TB cases continues to be a challenge, especially in countries with large unregulated private sectors and weak health systems. Of the estimated 10.4 million new cases, only 6.3 million were detected and officially notified in 2016, leaving a gap of 4.1 million. India, Indonesia and Nigeria accounted for almost half of this global gap.

Only one in five MDR-TB cases was started on treatment. India and China accounted for 39% of the global gap. Treatment success remains low, at 54% globally.

Of the almost half a million reported cases of HIV-associated TB, 15% were not on antiretroviral therapy (ART) as recommended by WHO. Most of the gaps related to HIV-associated TB were in the WHO African Region.

Preventive treatment for TB is expanding in two priority risk groups - people living with HIV and children under 5 years. However, most people eligible for TB preventive treatment are not accessing it.

For TB care and prevention, investments in low- and middle-income countries fell almost US$ 2.3 billion short of the US$ 9.2 billion needed in 2017. In addition, at least an extra US$ 1.2 billion per year is required to accelerate the development of new vaccines, diagnostics, and medicines.

Shortfalls in TB funding are one of the main reasons why progress is not fast enough to be on track to reach the end TB targets. More domestic funding is needed in middle-income countries, and more international donor support is needed to support low-income countries.

Political commitment and multi-sectoral action

Ending the TB epidemic requires actions beyond the health sector so as to address the risk factors and determinants of the disease. For the first time, the Global TB Report presents results from a new multi-sectoral monitoring framework that identifies linkages with the TB epidemic across seven Sustainable Development Goals (SDGs). Analysis of the latest status of the indicators for the 30 high TB burden countries show that most will be challenged to reach SDG targets.

In order to increase multi-sectoral action, plans to galvanize all sectors and secure attention at the highest levels, the WHO Global Ministerial Conference on Ending TB in the Sustainable Development Era is scheduled to be held in Moscow on 16 and 17 November 2017. This will be followed by the very first UN General Assembly High-Level Meeting on TB in 2018, which will seek commitment from heads of state.

Footnotes

16. http://www.who.int/mediacentre/news/releases/2017/political-commitment-tb/en/

17. http://apps.who.int/iris/bitstream/10665/259366/1/9789241565516-eng.pdf

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