Global Tuberculosis Report 2017: A push for multi-sectoral action
As progress continues to fall short of the fast approaching 2030 targets, the World Health Organisation (WHO) calls for accelerated, multi-sectoral action against tuberculosis – the leading killer of people living with HIV.
The picture painted in the 2017 Global Tuberculosis Report is grim. Progress in treatment and prevention of tuberculosis (TB) is stalling, such that achieving the first set of milestones in the push to end the TB epidemic by 2030 is becoming increasingly unlikely.
Ending TB by 2030 would require a 90% reduction in TB deaths and an 80% reduction in annual TB cases, yet since 2000 the mortality rate has only declined by 37%. TB remains the leading infectious killer in 2016, responsible for 1.3 million deaths among HIV-negative individuals (down from 1.7 million in 2000). A further 374,000 deaths were reported among people living with HIV, for whom the disease is still the leading killer.
People living with HIV have an estimated 26 to 31-fold greater risk of contracting TB, particularly when they are not on antiretroviral treatment (ART) as their immune systems are weakened making them more susceptible to co-infection. Yet thankfully, ART can reduce the risk of TB infection in people living with HIV by 65%.
But efforts to provide preventative TB treatment have so far been uneven and insufficient. In 2016, 18 of the 30 countries with the highest burden of HIV-associated TB offered no preventative TB treatment for patients diagnosed with HIV, despite WHO recommendations. As such, cases of HIV-associated TB have continued to rise, with 10% of the 10.4 million new TB cases among those living with HIV in 2016.
Positively, in the last six years to 2016, TB treatment has prevented an estimated 44 million deaths among HIV-negative people and an additional 9 million deaths when supported by ART in those living with HIV.
However, multi-drug resistant TB (MDR-TB) remains a serious threat. In 2016, there were 600,000 new cases with resistance to Rifampicin, the most effective first-line drug, and of these 490,000 cases were multi-drug resistant.
As it stands, new infections are falling by 2% each year while mortality rates are declining by 3%. To reach the 2030 targets these would each need to improve by 4% to 5%, effectively doubling the current rate of decline.
Recognising the need to accelerate the response, the WHO is calling for a radical new approach to tackle TB. The social and economic drivers of the epidemic mean that TB cannot be beaten by the health sector alone, instead “a dynamic, global, multisectoral approach” is needed. Tedros Adhanom, Director-General of the WHO, argues that “actions and investment don’t match the global rhetoric.”
To reflect this multisectoral approach, the 2017 Global TB Report presents its findings for the first time using a 'multisectoral monitoring framework', which connects the TB response with wider development goals.
They have created 14 indicators to review countries’ TB epidemics in the context of the 2015-2030 Sustainable Development Goals. They look at factors such as: coverage of essential health services and expenditure; percentage of population living below the poverty line; prevalence of undernourishment and GDP per capita. They hope that highlighting the way risk factors such as these influence the rise of TB will encourage nations to implement the needed structural changes to properly combat the epidemic – introducing policies such as Universal Health Coverage or measures to alleviate poverty.
To kick-start these new initiatives, the WHO has planned two conferences in the upcoming year. The first is a global ministerial conference taking place in Moscow from the 16th to the 17th of November. It will host leaders of UN organisations, NGOs, civil society, academia and corporate sectors, hoping to gather commitment from across different sectors for the End TB strategy. In addition to this the United Nations will hold the first ever General Assembly on Tuberculosis in 2018. It will be the fifth general assembly to be held on a specific health issue, and will aim to build on the outcomes of the Moscow meeting, developing a coordinated global response to TB.
These events mark “a tremendous and unprecedented step forward by governments and all partners engaged in the fight against TB," said Dr Mario Raviglione, Director of the WHO Global TB Programme. The WHO hopes that this new approach will provide the push needed to get the fight against TB back on track.