TB overtakes HIV/AIDS as leading infectious disease killer

An Indian doctor examines a tuberculosis patient. (AP Photo/Rajesh Kumar Singh)

Tuberculosis killed 1.5 million people in 2014 – moving ahead of HIV/AIDS, which was responsible for 1.2 million deaths in the same year. The rise of tuberculosis  (TB) is evidence of both the gains made against HIV/AIDS in the past two decades and the silent growth of one of the world’s oldest killers. Making matters worse is the spread of multidrug-resistant forms of the disease.

“It is unacceptable that 4,400 people continue to die from TB each day when we can diagnose and cure nearly every person with TB,” Eric Goosby, United Nations special envoy on TB, wrote in a column for CNN.

Overall, TB death rates are falling. A report by the World Health Organization on the infectious disease shows that TB death rates decreased by nearly half since 1990. The problem is concentrated in China, India, Indonesia, Nigeria and Pakistan, where more than half of all TB deaths occurred in 2014. An accompanying release from the WHO about the report takes an optimistic tone.

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“The report shows that TB control has had a tremendous impact in terms of lives saved and patients cured,” said WHO Director-General Margaret Chan, in the news release. “These advances are heartening, but if the world is to end this epidemic, it needs to scale up services and, critically, invest in research.”

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But advocates and health workers are more concerned. TB is by far the least-funded arm of the Global Fund, compared to malaria and HIV/AIDS. The $6.6 billion spent globally to fight TB pales in comparison to the $20.2 billion for HIV/AIDS. It in part reflects the fact that the WHO estimates only $8 billion is needed annually for TB, leaving a $1.4 billion gap. But the trend for funding TB in the U.S. is cause for concern.

“Unfortunately, the Obama administration has proposed a cut to USAID’s TB program for the last four years. If enacted, these cuts would devastate U.S. capacity to respond to the epidemic,” said Joanne Carter, head of the advocacy group RESULTS, in response to the report. “Fortunately, Congress, whether led by Republicans or Democrats, has seen fit to reject these cuts. But we’re left playing defense, and funding has stagnated at 2012 levels, even as our understanding of the severity of the challenge has grown.”

MDR TB

There were 9.6 million cases of TB last year – higher that the previous year due to improved estimates, according to WHO. While TB has overtaken HIV/AIDS, the two remain a deadly combination. Roughly 400,000 people died from an HIV-TB co-infection

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The report says that resistance “poses a major threat to control of TB worldwide.” It is estimated drug resistance is found in 3.3 percent of new cases and 20 percent of previously treated cases. Those numbers are essentially unchanged in recent years. The overall problem facing the global TB response is accented in the challenge of drug resistance – gaps remain in detection and prevention.

Only about one out of every four of the 480,000 new TB cases last year were detected and reported to national authorities, WHO estimates. And while there is a lack of new drugs in the pipeline for resistant forms, the existing treatments and detection methods are extremely effective. It is a matter of reaching people everywhere. Closing the gap gets back to the issue of funding.

“A primary reason for detection and treatment gaps is a major shortfall in funding,” said Winnie Mpanju-Shumbusho, WHO Assistant Director-General for HIV, TB, Malaria and Neglected Tropical Diseases.

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Tom Murphy

Tom Murphy is a New Hampshire-based reporter for Humanosphere. Before joining Humanosphere, Tom founded and edited the aid blog A View From the Cave. His work has appeared in Foreign Policy, the Huffington Post, the Guardian, GlobalPost and Christian Science Monitor. He tweets at @viewfromthecave. Contact him at tmurphy[at]humanosphere.org.