WHO 2012 Global Tuberculosis Report shows uneven progress

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New cases of TB have been falling for several years, while access to care has expanded,  and deaths from tuberculosis have dropped by forty percent since the mid-1990s.  That’s some of the progress highlighted in the World Health Organization’s Global Tuberculosis Report released last week, and it means the target of halving the death rate from tuberculosis from the 1990s by 2015 is in sight. By those numbers, the goal of halting and reversing the tuberculosis epidemic by 2015 has, the report says, already been reached.

That’s how the report begins, but as global health leaders unveiling the report emphasized Wednesday, the impact of tuberculosis remains huge, responses to drug-resistant strains remains slow, funding gaps endanger diagnosis, treatment and research, and the risks of stalling, once again, are real.

In fact, the progress is not universal with African and European regions unlikely to reach the goal of cutting deaths from tuberculosis in half.

With an estimated 8.7 million new cases of TB and 1.4 million deaths in 2011, TB remains the second leading cause of death from an infectious disease worldwide.  It also remains one of the top killers of women, with 300,000 deaths among HIV-negative women and 200,000 deaths among women infected with HIV.  This latest WHO TB report is the first to include estimates on TB burden among children, and indicates that there was an estimated 490,000 infections among children and 64,000 deaths last year.

Bad tools undermine efforts to control multidrug-resistant TB, according to Dr. Kenneth Castro, Director of the Division of Tuberculosis Elimination at the CDC, who spoke at the report’s unveiling and compared the 1960s-era diagnostics still widely used, and the treatments that have not been augmented in half a century to using a hammer and chisel instead of power tools.

From left to right: Dr. Caroline Ryan, Dr. Ken Castro, Dr. Elizabeth Fox, Dr. Mario Raviglione, Dr. Tony Fauci

WHO Stop TB Department Director Mario Raviglione, who also spoke, said recent technological advancements may finally make an impact on drug-resistant TB.  Sixty-seven resource-limited countries are implementing the diagnostic GeneXpert to identify drug resistance, thanks to a 41 percent reduction in test prices due to negotiations by the Bill and Melinda Gates Foundation and UNITAID.  Two new drugs that will specifically treat MDR-TB are expected to be available to patients in the next few months, he said.  The WHO is currently working on a policy package for member countries, to facilitate access to these drugs.

But the report also outlines funding gaps in care and control, and research and development.  Between 2013 and 2015, $8 billion per year is needed to combat TB in middle and low income countries, but funding falls $3 billion per year short of that.  In 2010 funding for research and devlopment fell $1.4 billion short of the $2 billion needed. Raviglione noted that history already has demonstrated the human toll that results from inadequate attention to tuberculosis.

Even with developments in technology, we don’t understand the fundamentals of the pathology of the ancient disease, Dr. Anthony Fauci, director of the National Institute of Allergies and Infectious Diseases, said at the unveiling.  The “nefarious marriage of TB and HIV,” has made tuberculosis treatment research a priority at the National Institutes of Health, he said.

With  80 percent of patients co-infected with TB and HIV  in Africa — 50 percent  concentrated in nine countries there — the President’s Emergency Plan For AIDS Relief has a chance to address treatment gaps in Africa, Dr. Caroline Ryan, Director of technical leadership at the Office of U.S. Global AIDS Coordinator said at the report’s release. The report notes that up to $1 billion more than is presently available is needed for TB/HIV responses — mostly for the provision of antiretroviral treatment.

Not addressing tuberculosis is not an option, the speakers agreed — with Castro adding that the choice comes down to paying now, or — more —  later.

You can download the report here.

Science Speaks’ Blueprint series, on the plan to reach an AIDS-free generation called for by Secretary of State Hillary Clinton, continues today with a post from Dr. Lucica Ditiu, executive secretary of the Stop TB Partnership.

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