Another year - same trends: why change is essential in TB now more than ever before

Statement by Dr Lucica Ditiu, Executive Secretary of the Stop TB Partnership on the WHO Global Tuberculosis Report 2014

23 October 2014 - Geneva - The battle against tuberculosis is losing strength according to the new data published in this year’s WHO Global Tuberculosis Report. The WHO report is the important tool that gives us all the best indication on whether we have made progress and how far or close we are in reaching our targets. This year is a reminder that if we want to see a real bend in the TB curve, we need to get out of our comfort zone, push the boundaries and really challenge ourselves and our entire TB community.

We all made a huge effort and worked hard in 2013 at every single level - but why is it that in spite of all these efforts, there are still 9 million new TB cases and 1.5 million deaths (more than the 1.3 million reported last year) from this curable disease. The report confirms the decline in new cases continues - which is good news - but at an unacceptably low rate of 1.5%. If we continue at this rhythm, we will be waiting another 200 years before we eliminate TB as a pandemic (at the global TB incidence rate of 10/100 000)

WHO estimates that in 2013, identical with previous years, about 3.3 million people were still missed by health systems escaping diagnosis or notification by healthcare facilities and not getting the treatment they need.

This year’s WHO Global TB Report also contains a special Drug-Resistant TB supplement, highlighting the progress made in surveillance of anti-TB drug resistance between 1994 and 2013 as well as a profile on the global status of the response to the drug-resistant TB epidemic. The conclusion: it remains a monumental challenge.

In 2013, approximately 480,000 people developed drug-resistant TB worldwide and nearly a tenth of these (9%) are expected to be XDR-TB patients. There is a three-fold increase between 2009-2013 in the number of patients that were put on drug-resistant treatment in 2013 - that should be highlighted, and appreciated. But what does it really mean? It means that only 97,000 individuals globally were lucky enough to be diagnosed and receive appropriate treatment for MDR-TB. This means that 380,000 people did not receive the MDR-TB treatment - they probably received either no treatment or some form of treatment, which means they suffered, infected many others, developed further resistance and, probably eventually died. Sadly enough, with the current treatment success rate of MDR-TB, only 45, 000 of the 97,000 enrolled in treatment are likely to be cured.

An estimated 1.1 million (13%) of the 9 million people who developed TB in 2013 were HIV-positive, with 4 out of 5 cases and deaths occurring in the African Region. While the number of TB deaths among HIV-positive people has been falling for almost a decade, from 540,000 in 2004 to 360,000 in 2013, progress in HIV testing of TB patients is slowing down and ART coverage of TB patients at 70% is far from good as this falls well short of the 100% target set for 2015.

Global TB figures are on the right course to meet the Millennium Development Goal target of halving prevalence of TB by 2015 compared to 1990. This is when you look at the global figures. If you unpack it, the figures show that in Eastern Europe and Central Asia, Africa and the Eastern Mediterranean regions, new TB cases are not decreasing and targets will not be met.

Our current tools use technology that is old and outdated, with treatment regimens that are long, complicated and with huge side effects, and with a vaccine that is 90 years old and not very effective, and no point-of-care diagnosis. In 2013, a miniscule amount of US$ 676.6 million was spent on TB research as clearly outlined and explained in the new annual R&D report by Treatment Action Group (TAG) also released today. The report also shows one of the lowest ever annual R&D spending by pharmaceutical companies - the industry spent US$ 99.6 million in 2013, lower than what it spent at the peak of the financial crises in 2009.

In terms of funding needed for implementation, there is a serious gap of US$ 2 billion per year compared with the required US$ 8 billion needed annually to ensure a full response to the global TB epidemic. To make things difficult, TB progress depends mainly on domestic resources and - in all countries with a lower income - TB programmes are almost fully funded by external donors, of which Global Fund provides the biggest share.

We need to face these numbers in all their ugliness, understand their meaning and the cruel reality. Behind them are people, families, children, women suffering day by day, coughing their lungs out, dying from a perfectly curable diseases. This is unacceptable.

TB is a difficult disease to fight - it is old, and has been with us for thousands of years. It has learned our weaknesses, and is exploiting any sign that we relax and enjoy our comfort zone.

To address TB we need to address weaknesses in countries’ health systems, we need sustained and predictable funding, political engagement and support, and we need countries to step up their domestic investments in TB in a cost efficient manner - in interventions that work and show impact. We need communities, people affected and civil society in the driving seat.

The post 2015 WHO strategy aims to end the TB pandemic by 2035. We need a dramatic change to take place over the very next few years in how we fight TB, otherwise, we risk losing the battle before we have even started. If we manage to bend the curve of reduction in TB cases downwards, we can bring TB elimination forward to 2035. But to do that, we need to think in new ways, and out of the box - radical, innovative ways of delivering services, new tools, new boundaries.

We aim to follow this line during the development of the next Stop TB Partnership Global Plan 2016-2020 which will outline what it takes - in terms of efforts and funding - to set the world on the right track to reach the goals set in the post-2015 Global TB Strategy and we hope to have everyone taking part in this effort.

We all hate suffering, we all want to have zero TB deaths, and we all want to see dramatic progress. I believe that if we step out of our comfort zone, press for change and smartly use the coming years to craft our path in fighting TB - we will be successful!