WHO: TB burden not shrinking fast enough

Tuberculosis remains the top infectious disease killer in the world, killing more than 4,000 people daily. According to a new WHO report, the global TB burden is shrinking but not fast enough to reach milestones set by the End TB Strategy.

“TB is an old disease that was once a death sentence,” wrote the authors of WHO’s 2018 Global Tuberculosis Report, released today. “Effective drug treatments first became available in the 1940s, and in combination with social and economic development they allowed countries in western Europe, North America and some other parts of the world to reduce their burdens of TB disease to very low levels.

“For most countries, however, the ‘end’ of TB as an epidemic and major public health problem remains an aspiration rather than a reality.”

The World Health Assembly has adopted WHO’s End TB Strategy, which aims to reduce TB deaths by 90% and new cases by 80% by 2030. According to the new report, however, the world is unlikely to reach the first milestones of the End TB Strategy set for 2020, including a 4% to 5% decrease in new cases per year and a reduction of the case fatality rate to 10%.

So far, the TB incidence rate is falling about 2% each year, WHO reported.

Global estimates show nearly 10 million people developed TB in 2017. The disease caused an estimated 1.3 million deaths among people without HIV and an additional 300,000 deaths among patients with HIV.

“What is needed to get on track?” Tereza Kasaeva, MD, PhD, director of WHO’s Global TB Program, asked during a news conference announcing the report. “We need to close gaps and reach all people with TB and provide care.”

Kasaeva said there are three things causing gaps in treatment and care: underreporting of TB cases, underdiagnosis in low- and middle-income countries and a need for updates in TB preventive treatment.

“We must seize the moment,” Kasaeva said. “It’s high time for urgent and decisive actions. It is unacceptable that in the21st century, millions lose their lives to this curable and preventable disease.”

Additionally, drug-resistant TB “continues to be a public health crisis,” the authors of the report wrote, with an estimated 558,000 people having developed TB in 2017 that was resistant to rifampicin, the most effective first-line TB treatment. Of these cases, WHO estimated that 82% have multidrug-resistant TB. Globally, 3.6% of new cases and 17% of previously treated cases had drug-resistant or multidrug-resistant TB, with 160,684 cases detected in 2017 — an increase from 153,119 in 2016.

WHO reported that only about 25% of patients with resistant infections were treated with second-line regimens, with just a 55% treatment success rate globally.

“There are still far too many people not accessing the treatments necessary,” Irene Koek, PhD, deputy administrator in the Global Health Bureau at the U.S. Agency for International Development, said during the conference. “Countries need to urgently evaluate and revamp their efforts.”

TB — including issues of resistant TB — will be the focus of a United Nations General Assembly high-level meeting on Sept. 26 titled “United to End TB: An Urgent Global Response to a Global Epidemic.” The meeting will highlight the need for immediate action to accelerate progress toward the goal of ending the TB epidemic by 2030. It will be only the fifth time in the history of the U.N. that a global health topic will be discussed at the General Assembly.

“While there is a significant step forward, this is not the time for a victory dance,” Ambassador Eric Goosby, MD, U.S. special envoy for TB, said during the conference. “We must make sure that the words that we hear next week lead to action. We must ensure that we hold our leaders accountable for the actions they promise to take. Accountability is key to unlocking the strong hold that TB has had on global health since the time if the Egyptians.”

Koro Bessho , permanent representative of Japan to the U.N., and active participant in making the high-level meeting happen, said a political declaration will be adopted. The declaration will address treating more people and providing preventive treatments to those at risk for TB. The declaration will also ensure the success or downfalls of TB treatment and prevention are addressed at a second scheduled meeting in 2023, according to Bessho.

“We don’t just want words, we want action,” he said during the conference. “We hope that by getting these people together and talking, that we can get a higher level of awareness around the world.”

“Next week the world will say ‘no more, no longer,’” Goosby added. – by Caitlyn Stulpin

Reference:

WHO. Global tuberculosis report 2018. http://www.who.int/tb/publications/global_report/en/. Accessed September 18, 2018.

Disclosures: Bessho, Goosby, Kasaeva and Koek report no relevant financial disclosures.