Global Tuberculosis Report 2016: An ‘uphill battle’ in the fight against TB

13 October 2016

Progress in halting TB – the world’s leading infectious disease killer – is plagued by a lack of political will and inequalities in healthcare access

A man cured of tuberculosis (TB) speaking with a Red Cross volunteer in India
Ram Assay is a former tuberculosis patient and migrant worker living in India. He accessed treatment through the Red Cross and is now cured of the disease.

Global efforts to fight tuberculosis (TB) saved nearly three million lives in 2015, but progress is slow in combatting TB – which surpassed HIV as the world’s leading infectious disease killer last year. Major inequalities in healthcare access continue to hamper the TB response, with renewed political and financial commitments needed to ensure ambitious targets are met.

Between 2014 and 2015, rates of change in global TB incidence remained static at 1.5%, according to the World Health Organization (WHO) Global Tuberculosis Report 2016, released today.

If targets set out in the WHO End TB Strategy (2015-2035) and the Sustainable Development Goals (SDGs) are to be met, the rate of change needs to reach 4-5% by 2020. The targets call for a 90% reduction in TB deaths and an 80% reduction in TB cases by 2030, from 2015.

WHO Director General, Dr Margaret Chan said: “We face an uphill battle to reach the global targets for tuberculosis […] There must be a massive scale-up of efforts, or countries will continue to run behind this deadly epidemic and these ambitious goals will be missed.”

An estimated 10.4 million new TB cases occurred in 2015, of which 1.2 million (11%) were people also living with HIV. The number is larger than originally thought, largely due to an increase in cases from India due to better reporting. Worryingly, only 6.1 million cases were officially reported, leaving a gap of 4.3 million in people who remain either undiagnosed or underreported.

We face an uphill battle to reach the global targets for tuberculosis […] There must be a massive scale-up of efforts, or countries will continue to run behind this deadly epidemic and these ambitious goals will be missed.

Six countries accounted for 60% of all new cases of TB globally – India, Indonesia, China, Nigeria, Pakistan and South Africa – all of these countries, save Pakistan, are classified as having a high burden of HIV/TB co-infection.

The number of deaths from TB remains unacceptably high for a disease that is essentially treatable and curable. In 2015, there were 1.4 million TB deaths, with a further 0.4 million deaths from TB among HIV-positive people (the underlying cause of death is recorded as HIV, not TB).

TB remains the leading killer of people living with HIV globally, accounting for around a third of all HIV deaths. Sub-Saharan Africa bears the biggest burden of HIV and TB co-infection by far, with southern Africa accounting for 50% of all cases.

Major improvements have been made in Africa to ensure that all TB patients are aware of their HIV status – 81% of all TB patients had a documented HIV test result, compared to 55% globally. The proportion of known HIV-positive TB patients on antiretroviral therapy was 78% globally, and above 90% in India, Kenya, Malawi, Mozambique, Namibia and Swaziland.

To focus efforts on the first milestone of the End TB Strategy in 2020, which calls for a 35% reduction in TB deaths and 20% reduction in TB incidence on 2015, the WHO devised three separate lists of high-burden countries: one for TB, one for multi-drug resistant TB (MDR-TB) and one for HIV/TB co-infection. Of these 48 high-burden countries identified, 30 are highly burdened with HIV/TB and 14 are highly burdened by all three.

MDR-TB remains a ‘public health crisis’, according to the WHO, as only one in five people are able to access second-line treatment. Three countries account for just over half of all the 480,000 cases of drug-resistant TB – Russia, China and India. Major improvements are needed to close the detection and treatment gap for TB.

But in order to reinvigorate the TB response, urgent financing is needed. In 2016, investments in TB care and prevention in low and middle-income countries are a worrying $US 2 billion short.

“The resources deployed against TB, the leading infectious killer in the world, are falling short,” said Dr Ariel Pablos-Méndez, Assistant Administrator for Global Health, of the US Agency for International Development (USAID). “Everyone has a part to play in closing the gap. As the report shows, we need universal health coverage, social protection mechanisms, and public health financing in high burden countries. The development aid community needs to step up more investments now, or we will simply not end one of the world’s oldest and deadliest diseases.”

Photo credit:
Benoist Carpentier/IFRC (CC BY-NC-ND)