WHO Report Indicates Progress, Highlights Gaps Toward TB Elimination

Thanks to improved detection and diagnosis, more than 7 million individuals worldwide received treatment for tuberculosis (TB) in 2018. This marks the greatest number of individuals treated in a single year, according to the World Health Organization (WHO’s) latest Global TB Report.

Additionally, the report notes a reduction in the number of TB-related deaths, which fell from 1.6 million in 2017 to 1.5 million in 2018.

Although increasing linkage to care and a reduction in deaths are considerable milestones in the fight to end TB, the report indicates that an estimated 3 million individuals living with TB are not getting the care they need. As such, the WHO calls for accelerating progress to reach the goal of ending TB by 2030.

The World Health Assembly approved a Global TB Strategy with a goal of reducing TB deaths by 90% and TB incidence by 80% by 2030, compared with 2015 levels. By 2020, the strategy seeks a 35% reduction in TB deaths and a 20% reduction TB incidence from 2015 levels.

The overall incidence of new TB cases has been on the decline, but the burden of the disease is particularly high among low-income countries and marginalized populations, the agency explains. There are a number of reasons for this including fragile health infrastructures and shortage of health care workers which can delay diagnosis and appropriate treatments.

Subpar surveillance systems in these nations also present a problem as they do not fully identify the disease landscape, or the resources required to solve the problem. Additionally, TB treatment in high burden countries is expensive, with approximately 80% of patients spending more than 20% of their annual income on TB treatment.

In addition to the Global TB Strategy, the UN Political Declaration on TB in 2018 seeks to treat 40 million individuals for TB between 2018-22, reach at least 30 million individuals with preventive treatment for latent TB during the same period, mobilize $13 billion annually for access to testing, treatment and care, and mobilize at least $2 billion annually for TB research.

However, the WHO reports that TB remains underfunded, estimating the shortfall for prevention in care in 2019 to be $3.3 billion. There are also gaps in the funding of research and development, with an annual shortfall of $1.2 billion. Funding is urgently needed for the development of a new vaccine or effective preventive drug treatment along with rapid diagnostic tests and improved drug regimens.

“WHO is working closely with countries, partners, and civil society to accelerate the TB response,” Tereza Kasaeva, MD, PhD, director of WHO’s Global TB Program, said in a statement issued by WHO. “Working across different sectors is key if we are to finally get the better of this terrible disease and save lives.”

In addition to gaps in funding, efforts must focus on reaching children who are at-risk or have TB already. Current estimates indicate that half of children with TB do not access quality care and only 25% of children under 5 years of age who are living in TB-affected households receive preventive care.

Another serious barrier to the fight against TB is drug-resistance. In 2018, there were approximately 500,000 new cases of drug-resistant TB. However, only 1 in 3 of these individuals were enrolled in treatment. In response to this, WHO has issued new guidance which aims to improve treatment of resistant cases by shifting to completely oral treatment regimens that are safer and more effective.

According to the WHO, countries are expected to submit a report on goal progress in September 2020.