WHO reports decline in global TB rates, warns progress is at risk

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(From left) Deborah von Zinkernagel, Deputy Global AIDS Coordinator, Dr. Anthony Fauci, Director of NIAID, Dr. Ariel Pablos-Mendez, Assistant Administrator for Global Health at USAID, Dr. Mario Raviglione, Director of the WHO Stop TB Department, Dr. Harold Jaffe, CDC.

The number of people getting sick from tuberculosis (TB) each year is dropping, and the number of people dying from the disease fell to its lowest level in a decade.

World Health Organization (WHO) representatives made the announcement Tuesday morning at the National Press Club in Washington, DC, along with the launch of the WHO 2011 Global Tuberculosis Control Report. “Finally, we’re seeing a return to the decline in rates after the resurgence of TB in the ’80s and ’90s around the emergence of HIV,” said Dr. Mario Raviglione, Director of the Stop TB Department at the WHO.

Specifically, the new report found:

  • The number of people who fell ill with TB dropped to 8.8 million in 2010, after peaking at 9 million in 2005;
  • TB deaths fell to 1.4 million in 2010, after reaching 1.8 million in 2003;
  • The TB death rate dropped 40 percent between 1990 and 2010, and all regions, except Africa, are on track to achieve a 50 percent decline in mortality by 2015;
  • In 2009, 87 percent of patients treated were cured, with 46 million people successfully treated and 7 million lives saved since 1995.

According to a WHO press release, the progress is due mostly to expanded efforts in large countries, not to mention the result of better control of the HIV epidemics in many high-burden countries in sub-Saharan Africa. But with funding for global health programs likely to take a hit in upcoming budget negotiations on Capitol Hill, global health experts worry the strides seen in combating TB could fall victim to underfunding.

“In the late ‘80s, early ‘90s, the U.S. dropped the ball,” said Howard Jaffe, MD, of the Centers for Disease Control and Prevention, at a WHO press conference Tuesday morning. The U.S. pulled funding from domestic tuberculosis programs, a premature move after witnessing declining disease incidence. “We paid with the resurgence of costly and drug-resistant disease, including multidrug-resistant TB,” Jaffe said.

When asked by David Bryden of RESULTS how the U.S. Agency for International Development (USAID) would respond if the nine percent cut to global health programs for fiscal year 2012 as proposed by the House were to pass – which some estimate would translate into 30,000 fewer persons with TB getting treatment – USAID Assistant Administrator for Global Health Dr. Ariel Pablos-Mendez said that the success to date of global TB programs has been their incredible bipartisan support.

“Global health investment works… but in the end money matters,” Mendez said, adding that these cuts would significantly affect everything USAID does.  The WHO report notes that countries have reported a funding shortfall of $1 billion for TB implementation in 2012. However, domestic health expenditures are doubling in many countries, Mendez said, and the U.S. government will continue to work to make these programs more efficient, work with governments as they grow, and do its best to improve funding going forward.  Worldwide, the share of domestic funding allocated to TB rose to 86 percent for 2012, according to the WHO press release. “But most low income countries still rely heavily on external funding.”

Director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, Dr. Anthony Fauci applauded the WHO report’s inclusion for the first time of a chapter specifically dedicated to TB research and development, and warned that the disparity in financial and scientific resources expended on TB as compared to disease burden was “stunning” and reason for concern.

Raviglione also warned that the problem of stock outs of second-line drugs, needed in the fight against drug resistant TB, could become acute as disease diagnoses increase with increased deployment of the GeneXpert Rapid TB diagnostic.

TB mortality rates are expected to drop by 50 percent by 2015 in all parts of the world except for Africa.

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