The world is losing its battle with tuberculosis (TB), which is now the biggest infectious killer globally, causing 1.5 million deaths every year. Without a clear investment plan and a complete overhaul in how this disease is tackled, TB is unlikely to be eliminated until the end of the 22nd century, and the world will miss the recently announced Sustainable Development Goal to end TB by 2030.
This will require a US$ 56 billion investment package from 2016-20, which will see 29 million people with TB receive treatment; save more than 10 million lives and prevent 45 million people from getting ill with TB. This investment will offer a huge return for affected individuals, their families, and their communities, and one of the highest returns on investment of any health intervention -- an estimated US$ 85 for each dollar invested. This is clearly outlined in the new Global Plan to End TB 2016 -2020 launched today by Stop TB Partnership.
The Global Plan to End TB is aiming to reach the following targets, called 90-(90)-90:
- i) To have 90% of all people with tuberculosis diagnosed and treated
ii) As part of part (i), ensure 90% of the most vulnerable populations in all countries are diagnosed and treated. Vulnerable populations include mining communities, children, people living with HIV, injecting drug users, prisoners, homeless people, Indigenous populations and migrants among others. Vulnerable populations exist in all countries, from the poorest to the richest.
iii) Ensure 90% of people diagnosed successfully complete treatment with services to ensure adherence and social support.
South Africa, a country with one of the highest TB rates in the world, has already put into action its plan to reach the 90-(90)-90 targets by 2020. "The Global Plan makes it clear that what is needed to end TB is a paradigm shift - a change in the way we fight TB at every level, in every community, in every health facility, in every country," says Dr Aaron Motsoaledi, Chair of the Stop TB Partnership Coordinating Board and Minister of Health of the Republic of South Africa.
He adds: "TB has always been a disease of poverty, and a litmus test for our commitment to social equality and health for all. Unfortunately, its longevity has created a sense of acceptance that it is here to stay and a sense of complacency. The Global Plan to End TB 2016-2020 sets out to smash this status quo, and provides a way to address these challenges though scaling up and integrating TB care into a wider health and community system approach, to eliminate poverty, and build healthy, sustainable societies." The initial phases of South Africa's plan will see vulnerable mining communities and their families tested, as well as 90% of the prison population, where TB has always thrived, and also where the late Nelson Mandela became infected with TB in the 1980s.
A complete overhaul of the 'business-as-usual' methods of dealing with TB will be needed to achieve these ambitious targets. But it is the only way that the very small decline in TB incidence in recent years (around 1.5% per year) can be accelerated to the 10% annual decline needed globally to reach the recently announced WHO End TB targets--which aim to reduce TB incidence to a global average of 10 new cases per 100,000 population or less by 2035, effectively ending the disease as a public health threat. If the woefully inadequate 1.5% annual decline continues, TB is unlikely to be eliminated for another 150 years.
"It is a global disgrace and human tragedy that TB--a curable disease --is killing around 1.5 million people per year and nobody speaks about ending it," says Dr Lucica Ditiu, Executive Director of the Stop TB Partnership. "We know it can be done, we know how it can be done, we know how much it will cost us - we need to have the desire to do it and energy to move on. Ours can be the generation remembered as the one that turned the tide on this enormous yet treatable epidemic," she adds.
To implement the actions proposed in the Global Plan to End TB first and foremost, a change in mindset is required-- with a combination of existing tools and new ones in development, the disease can and will be defeated. The new strategy is centred on a human rights and gender approach, stronger political leadership and a community and patient-based focus. And the plan also highlights we must also have new and innovative TB programmes, integrated interventions within country health systems, and improvements to the poor socioeconomic conditions in which TB can thrive (including overcrowded housing and undernutrition).
This battle with TB cannot be won without new tools. For this, the Global Plan calls for an additional US $9 billion, needed for vital research and development to create a vaccine that protects people of all ages against TB, highly sensitively rapid diagnostic tests that can be implemented at the point of care, and drug regimens (including for drug-resistant TB) that are highly effective and non-toxic.
Funding for the plan would be expected to come from domestic sources for high-income countries and BRICS (Brazil, Russia, India, China, and South Africa).
The Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria alone currently provides nearly 80% of external funding for TB programmes to low-income and low middle-income countries that require significant external support. With a joint effort to have a fully replenished Global Fund beginning with a major meeting in December this year in Japan, Dr Ditiu says that "increased funding to turn the tide on the world's enormous TB problem must be at the top of the agenda."
Dr Mark Dybul, Executive Director of the Global Fund, welcomed the plan by saying: "We applaud the launch of the Global Plan 2016-2020: The Paradigm Shift - we know that it creates the path towards an accelerated impact on TB epidemics and, ultimately towards ending TB. If we are serious about ending TB - considering that it is curable in just six months - we really need a shift in thinking, ambition and action at every level to scale up, increase coverage and reach everyone with the right package of TB interventions. We are ensuring that our Global Fund Strategy 2017-2022 is fully coordinated and aligned with the Global Plan and we will work together to implement it. "
Later this month, at the 46th Union World Conference on Lung Health in Cape Town, South Africa, the Stop TB Partnership's Global Plan will be endorsed by high level politicians from around the world, at a special high-level event led by Dr Motsoaledi.
"There is no doubt that we are facing serious barriers in the fight against TB. The Global Plan provides a roadmap that builds on the End TB Strategy and tackles the challenges the barriers present," says Dr Eric Goosby, UN Special Envoy for TB. "It's a forward-looking, ambitious document that calls upon all parties to do their share in helping to reach the SDG 2030 goal."