But TB ranks
alongside HIV as a leading cause of death worldwide
By WHO
The fight
against tuberculosis is paying off, with this year’s death rate nearly half of
what it was in 1990. Nevertheless, 1.5 million people died from TB in 2014.
Most of these deaths could have been prevented, according to WHO’s Global
tuberculosis report 2015, which was released today in Washington.
To reduce TB’s
overall burden, detection and treatment gaps need to be closed, funding
shortfalls filled and new diagnostics, drugs and vaccines developed, according
to the report.
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| A child receiving Tuberculosis medicine in South Sudan under a programme supported by the Global Fund to Fight AIDS, Tuberculosis and Malaria and UNDP. Photo: UNDP South Sudan/Brian Sokol. |
Most of the
improvement has come since 2000, the year the Millennium Development Goals
(MDGs) were established. In all, effective diagnosis and treatment saved 43
million lives between 2000 and 2015, according to the report, the 20th in a
series of annual evaluations produced by WHO.
“The report
shows that TB control has had a tremendous impact in terms of lives saved and
patients cured,” said WHO Director-General Margaret Chan. “These advances are
heartening, but if the world is to end this epidemic, it needs to scale up
services and, critically, invest in research.”
Those advances
include the achievement of the MDG that called for halting and reversing TB
incidence by 2015. The goal was reached globally and in 16 of the 22
high-burden countries that collectively account for 80% of cases.
Worldwide, TB
incidence has fallen 1.5% per year since 2000, for a total reduction of 18%.
“Despite the
gains, the progress made against TB is far from sufficient,” according to Dr
Mario Raviglione, Director of WHO’s Global TB Programme. “We are still facing a
burden of 4 400 people dying every day, which is unacceptable in an era when
you can diagnose and cure nearly every person with TB.”
In 2014, TB
killed 890 000 men, 480 000 women and 140 000 children. The disease ranks
alongside HIV as a leading killer worldwide. Of the 1.5 million people killed
by TB in 2014, 400 000 were HIV-positive. HIV’s total death toll in 2014 was
estimated at 1.2 million, which included the 400 000 TB deaths among
HIV-positive people.
This year’s
report describes higher global totals for new TB cases (9.6. million) than in
previous years. However, these figures reflect increased and improved national
data and in-depth studies rather than any increase in the spread of the
disease. More than half of the world’s TB cases (54%) occurred in China, India,
Indonesia, Nigeria and Pakistan. Among new cases, an estimated 3.3% have
multidrug-resistant TB (MDR-TB), a level that has remained unchanged in recent
years.
Action needed to close diagnostic and treatment gaps
The report
highlights the need to close detection and treatment gaps, fill funding
shortfalls, and develop new diagnostics, drugs and vaccines.
The detection
gap is significant. Of the 9.6 million people who fell ill with TB in 2014, 6
million (62.5%) were reported to national authorities. That means that, worldwide,
more than a third (37.5%) of the cases went undiagnosed or were not reported to
national authorities. The quality of care for people in the latter category is
unknown.
Detection and
treatment gaps are especially serious among people with MDR-TB, which remains a
public health crisis. Of the 480 000 cases estimated to have occurred in 2014,
only about a quarter – 123 000 – were detected and reported to national
authorities. The 3 countries with the largest numbers of cases are China, India
and the Russian Federation.
Treatment
initiation for those diagnosed with MDR-TB substantially increased and almost
all cases detected in 2014 started treatment. Forty-three countries reported
cure rates for MDR-TB patients of more than 75%. Nevertheless, globally, data
shows an average cure rate of only 50% for treated MDR-TB patients.
Treatment is
improving, with 77% of patients known to be co-infected with HIV and TB getting
antiretroviral medicines in 2014.
The number of
people living with HIV who were given TB preventive therapy was nearly 1
million in 2014, an increase of about 60% compared with 2013. More than half
(59%) of these people were in South Africa.
Financing shortfalls stand in way of accelerated progress
“A primary
reason for detection and treatment gaps is a major shortfall in funding,” said
Dr Winnie Mpanju-Shumbusho, WHO Assistant Director-General for HIV, TB, Malaria
and Neglected Tropical Diseases. This shortfall amounted this year to US$ 1.4
billion of the US$ 8 billion needed to fully implement interventions. In
addition, an annual funding gap of at least US$ 1.3 billion must be filled for
research that would include the development of new diagnostics, drugs and vaccines.
From 2016, the
global goal will shift from controlling TB to ending the global TB epidemic.
The End TB Strategy, adopted by all WHO Member States, serves as a blueprint
for countries to reduce TB incidence by 80% and TB deaths by 90% and to
eliminate catastrophic costs for TB-affected households by 2030.
“Ending the TB
epidemic is now part of the Sustainable Development Goal agenda” said Dr Eric
Goosby, UN Special Envoy on Tuberculosis. “If we want to achieve it, we’ll need
far more investment – at a level befitting such a global threat. We’ll also
need progress on universal health coverage and poverty alleviation. We want the
most vulnerable communities worldwide to gain first, not last, in our efforts.”
Source: WHO.
For more information: Global tuberculosis report 2015.
