30 June, 2014 - London / Geneva - A new report on tuberculosis calls for raising the profile of TB, fight apathy and lack of compelling ambition in addressing the disease. The report ‘Ancient enemy, modern imperative: A time for greater action against tuberculosis’ by the Economist Intelligence Unit, supported by Janssen, a pharmaceutical company producing TB drugs, also suggests finding and treating people where they live. The report examines the state of the TB challenge, barriers to further progress, and how efforts need to evolve.
Dr Lucica Ditiu, executive secretary, STOP TB Partnership, explains in the report that TB has been met with apathy; "It is like an orphan. It has been neglected even in countries with a high burden and often forgotten by donors and those investing in health interventions."
Some of the key findings of the report include weaknesses in TB treatment, the inadequacy in responding to the challenge of drug-resistance TB, a lack of interest at national and international levels and a persistent high stigma associated with TB. The report also found that national TB programmes have created vertical self-contained structures rather than integrate with healthcare in general. Lack of coordination between national efforts and private care is also a problem.
Despite successes in TB treatment, the progress has been slow. "Prevalence and, in particular, incidence figures have been slower to come down than mortality, and much of the drop in the former may have resulted indirectly from economic development rather than directly from better TB control," the report says. Prevalence is a measure of how widespread the disease is at a given time, and incidence conveys the risk of the disease in a population over a period of time.
The lack of ambition is reflected in a number of ways, the report says. For example, national TB programme goals sometimes aim to treat only a proportion of those presumed to be ill.
Further, funding for TB programmes globally falls short by more than US$ 1 billion annually and donor fatigue is a growing risk. Research into new drugs and diagnostics has been slow, with funding in this area even declining, according to the report.
On drug-resistant TB, the report says that although it has become a public health crisis it is receiving too little attention. The report is critical of the pursuit of a single, broad strategy that "is increasingly out of step" with distinct regional attributes of the global TB epidemic. "The dynamics of an effort led by an international organisation and funded by global donors can slow reaction to emerging dangers," it said.
It also underscores that TB efforts at various levels have often suffered from a lack of compelling ambition and interest. Dr Neil Schluger, chief scientific officer of the World Lung Foundation and chair of the Tuberculosis Trials Consortium, states, there is "a tendency [among policymakers and the public] to think of TB as background noise. It still kills a lot of people but doesn’t seem to have a sense of urgency around it."
The report calls for changing the way TB treatment is addressed. Rather than have patients visit health providers to seek diagnosis and treatment, the approach should be to find and treat people where they live. The Directly Observed Treatment, Short Course (DOTS) strategy has been based on patients who feel ill coming to clinics for testing and, if found to have the disease, treatment. "Although inexpensive, this approach misses a large number of cases and does not take account of the psychological and social needs of patients that might impede them from beginning or finishing their treatment," the report says. Active case-finding has not been the norm and contributes to higher transmission levels, it says.
Fighting the disease will mean taking TB control out of existing ‘silos’ - the fragmented way in which the disease is addressed. It says common co-infection of TB with HIV/AIDS, and coordinating public and private health provision are some ways to tackle this. Despite funding constraints, efforts should be to harness cost-effective technology that have the potential to transform treatment.
Finally, it calls upon activists and others who care about fighting the disease, to raise the profile of TB. "Find better ways to elevate national and global ambitions to deploy the tools at hand with sufficient intensity to make more rapid progress against this disease," it says.