WHO report shows TB, treatable and curable, surpassing HIV as No. 1 infectious disease killer

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While tuberculosis deaths have dropped by nearly half since 1990, an estimated 4400 people die daily from TB, a disease “that often strikes the voiceless . . .”

As World Health Organization report is released, USAID official says White House “is close to” releasing plan for multidrug-resistant tuberculosis . . .

Dr. Eric Goosby, Dr. Ariel Pablos-Mendez, and Dr. Mario Raviglione

Dr. Eric Goosby, Dr. Ariel Pablos-Mendez, and Dr. Mario Raviglione

With the deaths of 1.5 million people caused by tuberculosis in the last year, a disease that has been treatable and curable since the middle of the last century became the leading infectious cause of death worldwide, according to the World Health Organization’s 2015 Global Tuberculosis Report. Its toll now exceeds that of HIV, a disease that remains incurable, from which 1.2 million people died last year, but for which large scale investments have led to large scale drops in mortality in recent years, World Health Organization Global TB Program Director Dr. Mario Raviglione noted. Data released in the report today included deaths caused by tuberculosis among 400,000 people co-infected with HIV.

WHOTBreport3Former U.S. Global AIDS Coordinator Dr. Eric Goosby, now United Nations Special Envoy on Tuberculosis called the report “a wake-up call to the global community,” adding “Tuberculosis cannot continue to be the stepchild” of global health responses.

“The tragedy of tuberculosis, and the response to it, has not been a  story of resources that have been inappropriately applied,” he said, adding that a steady decline in deaths shows responses have been appropriate, but inadequate. “TB often strikes the voiceless,” he said. “We need to speak for them.”

The report,  the 20th since WHO began global surveillance of the disease, reflects progress against tuberculosis, but also continued failures at every stage of response to the disease: surveillance, prevention, treatment, and research.

Of an estimated 9.6 cases of tuberculosis that emerged in 2014, only six million were reported, Raviglione noted, leaving more than a third unnoted, according to the report

“And we don’t know, of course, what is happening to them,” Raviglione said, at an event today releasing the report. Some, he added, are treated in the private sector, and some are dying.

Only one in four of an estimated 480,000 people in 2014 who were sick with tuberculosis resistant to multiple drugs — requiring longer, more toxic, less effective treatments — were diagnosed, and reported to national tuberculosis programs. While treatment for multidrug-resistant tuberculosis increased, about 25,000 of those who were diagnosed with the disease were not treated, leaving them infectious, and sick with a deadly disease. “The ethical issue of those diagnosed but not put on treatment,” Raviglione said, was caused by “system problems” — drugs that were either unavailable, or too expensive to provide. Of those treated for multidrug resistant tuberculosis, only about half are cured. In the process, they face a brutal obstacle course of toxic treatments, and loss of income.

“If I had MDR-TB,” Raviglione said, “I would have a hard time making my monthly salary.”

More than half the burden of multidrug-resistant tuberuculosis cases last year were in five countries: India, China, Russia, Pakistan and the Ukraine.

In the meantime, investment in research to develop new drugs, to more efficiently fight tuberculosis that is not drug resistant, and to provide effective treatment for drug-resistant strains, continues to lag, Raviglione noted. Funding for tuberculosis research and investment, he said, falls short by more than half of the $2 billion needed. Funding to put interventions into action, he said, falls short of the $8 billion needed by 1.4 billion.

Raviglione  said that he is happy to see interest in addressing anti-microbial resistant infections gaining ground, “although they tend to exclude tuberculosis,” explaining that attention to drug-resistant infections often cite the disease as an example, but without proportionate action.

“You need a national plan that is funded,” Raviglione said.

The White House last March released a national plan to confront the growing threat of antibiotic-resistant bacteria in  which it listed multidrug-resistant tuberculosis as one of five serious threats, and promised a specific plan to address the disease, to be completed this fall. The plan was due to be submitted to the White House in September, but no date has been set for its release, raising concerns that the Obama administration, which has proposed a series of funding cuts to tuberculosis programming in recent years, is unwilling to request the money needed to support it.

The plan, has been developed and cleared by agencies that would be involved in putting it into action, said USAID Assistant Administrator for Global Health Dr. Ariel Pablos-Mendez, adding “the White House is close to releasing it.”

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