TB deaths climbing up, not declining: "Governments need to get their heads out of the sand..." says MSF

Ashok Ramsarup, CNS, South Africa
WHO's latest Global Tuberculosis Report reveals some shocking statistics: Tuberculosis (TB) deaths jumped to 1.8 million in 2015 from 1.5 million in 2014, with 41% of people estimated to have fallen sick with the disease being left undiagnosed and untreated. The treatment gap for people with drug-resistant TB remains morbidly high – in 2015, just 20% of people sick with drug-resistant forms of TB received the treatment they needed. The WHO Global TB Report is a wake-up call to break the status quo in how TB, and its drug-resistant forms, are being diagnosed and treated.

Governments have agreed on targets to end the tuberculosis (TB) epidemic both at the World Health Assembly and at the United Nations General Assembly within the context of the Sustainable Development Goals. They include a 90% reduction in TB deaths and an 80% reduction in TB cases by 2030 compared with 2015.

"We face an uphill battle to reach the global targets for tuberculosis," said Dr Margaret Chan, WHO Director General. "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."

How can a curable disease be among top causes of deaths globally?

While efforts to respond to TB saved more than 3 million lives in 2015, the report shows that the TB burden is actually higher than previously estimated, reflecting new surveillance and survey data from India.

An estimated 1.8 million people died from TB in 2015, of whom 0.4 million were co-infected with HIV. Although global TB deaths fell by 22% between 2000 and 2015, a curable disease like TB was one of the top 10 causes of death worldwide in 2015, responsible for more deaths than HIV and malaria.

Gaps in testing for TB and reporting new cases remain major challenges. Of the estimated 10.4 million new cases, only 6.1 million were detected and officially notified in 2015, leaving a gap of 4.3 million. This gap is due to underreporting of TB cases especially in countries with large unregulated private sectors, and under-diagnosis in countries with major barriers to accessing care.

Rate of TB decline is static: needs to increase manifold!

In addition, the rate of reduction in TB cases remained static at 1.5% from 2014 to 2015. This needs to accelerate to 4–5% by 2020 to reach the first milestones of the World Health Assembly-approved "End TB Strategy".

Multidrug-resistant TB (MDR-TB) remains a public health crisis. WHO estimates that 480,000 people fell ill with MDR-TB in 2015. Three countries carry the major burden of MDR-TB – India, China, and the Russian Federation – which together account for nearly half of all cases globally.

Detection and treatment gaps continue to plague the MDR-TB response. In 2015, only 1in 5 of the people newly eligible for MDR-TB treatment were able to access it. Cure rates continue to remain low globally at 52%.

"The dismal progress in the TB response is a tragedy for the millions of people suffering from this disease. To save more lives now, we must get newly recommended rapid tests, drugs and regimens to those who need them. Current actions and investments fall far short of what is needed," said Dr Mario Raviglione, Director of the WHO Global TB Programme. "The world is finally waking up to the threat of antimicrobial resistance – now is the time to accelerate the MDR-TB response."

Let evidence drive policy and practice

"Governments need to get their heads out of the sand and realise that TB is not a disease consigned to the 1800s; we see and treat TB in our clinics everyday, and it’s a deadly threat to all of us unless governments wake up and start diagnosing and treating everyone with TB. WHO's report reveals that more people are dying of TB and more people are left undiagnosed and untreated than last year, creating a cycle of TB transmission and death. Only a third of the countries carrying the highest TB burdens are using the recommended rapid test to detect TB and drug-resistance as the initial diagnostic test for all people with TB – this represents an unacceptably low take up of a critically important, lifesaving tool. Governments of countries with high TB burdens and donors must urgently support implementation of the most effective tools and strategies to get more people with TB diagnosed and on the right treatment, and must fund research and development of rapid, simple and affordable diagnostic tests that can be used at the point of care, so that we can close this deadly gap as quickly as possible" said Dr Greg Elder, Medical Coordinator, MSF Access Campaign.

Ashok Ramsarup, CNS, South Africa
13 October 2016