A new report on tuberculosis (TB) published by The Economist Intelligence Unit (EIU) investigates the increasing health challenges posed by TB and calls for new ways to improve the effectiveness of the global response to this pandemic.1 The report supported by Janssen and titled 'Ancient enemy, modern imperative: A time for greater action against tuberculosis', highlights the evolving TB crisis. It emphasises the urgent need for integrated care, harnessing innovative yet cost-effective strategies and raising the profile of TB to overcome this highly infectious, yet treatable killer.
Dr Lucica Ditiu, Executive Secretary at the STOP TB Partnership explains 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."
As a result of the need for critical change to enable more effective TB control, the report calls for new TB strategies that address current weaknesses, while leveraging successes to date. These changes include:1
Finding and treating people where they live: To identify the nearly 3 million new cases of TB every year, health systems in countries with a high TB burden need to look across the entire population. Even those countries with a lower prevalence have to find better ways of going into and working with marginalised populations.
Taking TB control out of existing silos: TB needs to treat the whole person, including addressing common co-morbidities such as HIV/AIDS, and co-ordinating public and private health provision.
Harnessing cost-effective technology: Although progress in TB remains frustratingly slow, new tools available today - both medical and non-medical such as mobile technologies and integrated databases - have the potential to transform treatment.
Raising the profile of TB: Perhaps most important, activists and other stakeholders must translate new global ambitions into national ones - that deploy the tools at hand with sufficient energy to make more rapid progress against this disease.
"The report calls for more attention to the basics in the battle against TB and the drug-resistant form of the disease; current efforts are insufficient and resistance is out of control. The vast majority of people with multi drug resistant (MDR) TB are not properly diagnosed or treated appropriately, and we have to recognise that MDR-TB is a real global public health emergency. Not only is the growth of drug resistance making TB control more difficult, but it is also revealing failures in basic TB control," said Dr Neil Schluger, Chief Scientific Officer of the World Lung Foundation and chair of the Tuberculosis Trials Consortium.
If these required changes are urgently implemented this will play a key role in helping achieve the new "Post 2015 Global Strategy and Targets for Tuberculosis Prevention, Care and Control", approved by The World Health Organization (WHO).2 These latest targets call for reducing the incidence of TB to below 10 cases per 100,000 population and cutting the number of deaths by 95% by 2035 - however this will require healthcare systems to make dramatic progress and for the apathy associated with TB to be extinguished.
"While efforts in the fight against TB have saved millions of lives, to control this disease effectively, fundamental changes are required. With the development of new treatments and cost-effective technologies, now is the time to make these changes so that they can be introduced responsibly and sustainably through structured health systems," said Wim Parys, M.D., R&D Head, Global Public Health, Janssen. "We are committed to driving better health outcomes, improving the lives of TB patients worldwide and continuing to work towards a coordinated global TB control strategy that ensures treatments are available and used appropriately."
Tuberculosis is responsible for the second greatest number of deaths from a single infectious disease, after HIV/AIDS, causing 1.3 million deaths in 2012 (2% of global mortality).1 Someone with active, pulmonary TB on average infects around one new person per month and in two thirds of active cases, if left untreated, TB is fatal.1 For pulmonary TB this is usually as a result of degrading the lungs to an extent the person affected eventually suffocates to death.
Despite treatments for TB existing for nearly 70 years3 and the WHO estimating that 22 million lives have been saved due to ongoing successful efforts since 19952 the report emphasises that progress has been too slow and significant weaknesses still remain. The report highlights that MDR-TB, defined as being resistant to the most powerful first-line treatments4 have received too little attention with rates of MDR-TB continuing to make up an increasing percentage of all new TB cases across the globe, especially in central Asia and Eastern Europe.
About Multi-Drug Resistant Tuberculosis (MDR-TB)
MDR-TB is a particularly complicated form of TB characterised by resistance to at least two of the standard four-drug, anti-TB drugs.4 Inadequate treatment allows resistant bacteria to thrive and poses a significant transmission risk to the general population.4 Without significant public health intervention, it is estimated that more than two million people will be infected with MDR TB strains of TB, between 2011 and 2015.5