Despite gains against tuberculosis, better research funding required – UN report

The Global Tuberculosis Report 2014, published by the World Health Organization (WHO), has confirmed almost half a million more cases of the disease than previously estimated, noting that some 9 million people developed TB in 2013 while 1.5 million died, including 360,000 people who were HIV positive.

The report stresses, however, that the mortality rate from TB continues to fall and has dropped by 45 per cent since 1990, keeping the world on track to meet the Millennium Development Goals (MDGs) target of reversing TB incidence, along with the target of a 50 per cent reduction in the mortality rate by 2015.

At the same time, the number of people developing the disease is declining by an average 1.5 per cent per year while an estimated 37 million lives have been saved through effective diagnosis and treatment of TB since 2000.

In a message marking the report’s launch, Dr. Mario Raviglione, WHO Director of the Global TB Programme, applauded the data collection efforts by Member States, noting that it was helping the UN agency draw a broader and clearer picture of the global epidemic.

“Following a concerted effort by countries, by WHO and by multiple partners, investment in national surveys and routine surveillance efforts has substantially increased,” observed Dr. Raviglione.

“This is providing us with much more and better data, bringing us closer and closer to understanding the true burden of tuberculosis,” he added.

Although higher than expected, the overall figures fall within “the upper limit of previous WHO estimates,” the UN agency said in a press release. Despite this, the report nevertheless underlines that a “staggering” number of lives are being lost to what is effectively the “second biggest killer disease from a single infectious agent” and that “insufficient funding is hampering efforts to combat the global epidemic.”

An estimated $8 billion is needed each year for a full response, but there is currently an annual shortfall of $2 billion.

Against that backdrop, the multidrug-resistant TB (MDR-TB) crisis continues to wreak havoc through “severe epidemics” affecting developing countries, particularly in Eastern Europe and Central Asia. According to WHO, 2013 saw an estimated 480,000 new cases of the difficult-to-treat strain while extensively drug-resistant TB (XDR-TB), an even more antibiotic resistant strain of the disease, has spread to 100 countries.

“The progress that has been made in combatting MDR-TB has been hard won and must be intensified. Containing and reversing the epidemic requires immediate and sustained efforts by all stakeholders,” commented Dr. Karin Weyer, WHO Coordinator for Laboratories, Diagnostics and Drug Resistance.

Dr. Weyer noted that improved diagnostic tools and access to patients meant greater detection and treatment of cases, adding that in countries such as Estonia and Latvia, where there is universal access to rapid diagnostics and treatment, the number of MDR-TB cases has fallen “significantly.”

“But,” she warned, “the gap between detecting and actually getting people started on treatment is widening and we urgently need increased commitment and funding to test and treat every case.”

The report also spotlights the ongoing challenge posed by the HIV and TB “co-epidemic” which affected an estimated 1.1 million people in in 2013. While the overall number of TB deaths among HIV-positive people has been falling for almost a decade, the report notes, antiretroviral treatment, preventive therapy and other “key interventions” still need to be scaled up.

Amid the swarm of data and figures, the report issues a critical warning regarding the state of funding for the development of new tools to combat the global TB epidemic.

Katherine Floyd, WHO Coordinator for TB Monitoring and Evaluation, lamented the “serious underfunding for research,” adding that an annual allotment of $8 billion would be required for TB and MDR-TB prevention, diagnosis and treatment. According to WHO estimates, there is currently an annual shortfall of $2 billion.

“Domestic and international financing needs to step up to prevent millions of unnecessary deaths,” she said.