The following post is by Center staff member David Bryden.
An exciting and important step forward was taken this week by global partners working to stop TB. The Stop TB Partnership issued a revised and ambitious five-year plan to address TB in all its aspects. The plan overview is available on their website.
South Africa Coordinator for the Community Initiative for TB Carol Nawina Nyirenda said victims of TB support the plan because it provides a blueprint for eliminating the disease. “For me and many others out there who live with the reality of TB and TB/HIV, for us this global plan means hope, a hope that countries will take TB seriously, a hope for a future free of TB, a hope for our children and children’s’ children to have a future free of TB.” (From VOA News article)
The Partnership is made up of governments, including the U.S. government, as well as non-profits, companies and international organizations. The Partnership was established in 2000 with the goal of eliminating TB as a public health problem by 2050 and, ultimately, to obtain a world free of TB.
Note: The Lancet has also just published an interesting commentary on the Partnership and future strategy by Keshavjee et al.
The updated Global Plan to Stop TB provides a roadmap for policy makers to move towards TB elimination by driving universal access to diagnostics and treatment.
Did you know? Not only does TB kill about 5000 people each day, it also has a significant, though in some respects hidden, impact on women, as documented by the ACTION Project. TB-positive women are twice as likely to give birth to a premature or low-birth-weight baby and four times more likely to die during childbirth, according to studies from Mexico and India. The risk of infant death also greatly increases. Severe stigma about TB and other factors often lead to a delay in TB screening and treatment for women. Tuberculosis should be an important part of the Obama Administration’s approach to global health, which emphasizes women, girls and gender equality.
The Plan documents an enormous cost of inaction on TB. It states that without dramatic increases in funding and political commitment between 2010 and 2015:
- More than 50 million people will develop active TB disease
- More than 10 million lives will be lost to this preventable, curable disease; 4 million of them will be women and children
- Millions of children will be orphaned needlessly
- More than 2 million cases of multi-drug resistant (MDR)-TB will emerge for want of proper care
The Plan calls for $47 billion, including research and development funding, between 2011 and 2015. The Stop TB Partnership estimates that about half, about $23 billion, will come from the 149 low and middle-income highly burdened countries (including about US$ 11 billion from the large economies of Brazil, China, India, the Russian Federation, and South Africa) and $4 billion is projected to come from European countries. This leaves a $20 billion projected gap in funding.
Only about half of the required funding would have to be provided by relatively wealthy donor countries. The Plan states:
“Overall, high-income countries may have to contribute as much as half of the necessary resources for the Implementation and Research and Development components of the Global Plan to Stop TB 2011-2015. Endemic countries, especially the BRIC countries, South Africa and the middle-income countries of Europe, would be expected to mobilize the rest internally.”
The Stop TB Partnership Plan reports that since the largest gap in funding needs for country-level implementation is in Africa, a particular focus on this region is necessary.
The plan aims to increase services to provide 6.9 million people with diagnosis and treatment according to World Health Organization (WHO) standards by 2015, up from 5.7 million in 2008/09. It calls for the diagnosis and treatment of 1 million patients with MDR-TB. However, according to a statement by the Treatment Action Group , the implementation targets should be treated as a floor and not a ceiling since the plan falls short of universal access to TB care.
A massive increase in laboratory capacity was also included as a major component in the Plan, along with rollout of revolutionary advances in diagnostic technology. This will greatly increase the number of people being accurately and rapidly diagnosed.
Half a million people die each year from HIV-associated TB. The Plan states that screening for TB among HIV-infected people and provision of isoniazid preventive therapy to those without active TB more than doubled between 2007 and 2008. But, it notes:
Despite these improvements, progress falls short of what is needed. The numbers screened were equivalent to about one-third of those on [antiretroviral therapy (ART)] and around 10 percent of the numbers estimated to be in need of ART. The number of people living with HIV who have been started on [isoniazid preventive therapy] is less than 1 percent of the people living with HIV worldwide.
The Plan calls for HIV testing for all TB patients and, if the test is positive, that they receive antiretroviral drugs and other appropriate HIV care. In HIV treatment settings, the plan states that patients must be screened for TB and receive appropriate preventive therapy or treatment as needed. This will mean HIV testing for almost 30 million TB patients and screening for TB of approximately 71 million people living with HIV.
For the first time, the Plan identifies all the research gaps that need to be filled, recommending a major increase in research and development funding, to $2 billion per year, which includes specific funding for basic science and operational research as well as research and development of new diagnostics, drugs and vaccines. However, the Plan notes that a major gap exists in research funding, amounting to $1.4 million per year.
On vaccines, the Plan states that “costs to develop new TB vaccines and ensure their availability to those who need them most will be higher than originally anticipated.” The Plan states that from 2011 to 2015, a total of $1.9 billion is required, increasing from close to $250 million in 2011 to almost $440 million in 2015. Currently nine TB vaccine candidates are in clinical trials, and by 2020 new generation TB vaccines could be available if the funding is secured.