Some 9 million people developed tuberculosis in 2013, according to the World Health Organization in a report released today. It is a significant increase in the estimated number of people infected, thanks to new numbers coming out of Nigeria. The WHO’s Global Tuberculosis Report 2014 also found that TB killed 1.5 million people last year.
Overall, things are getting better. The TB mortality rate is down by 45 percent since 1990. While long-term progress is laudable, TB incidence fell by only 0.6 percent from 2012. Obstacles to progress remain. Multidrug-resistant (MDR) TB infected 480,000 people in 2013. Extremely resistant forms of TB that were detected in Eastern Europe remain a big fear. And, the connection between AIDS and TB remains strong and deadly.
“With a global epidemic that is bigger than we knew, and the growing threat of drug resistance where we aren’t keeping pace with treatment needs, it is clear that we need to invest significantly more in TB diagnosis, treatment and prevention,” said Joanne Carter, Executive Director, RESULTS, and Vice-Chair, Stop TB Partnership Coordinating Board, on a press call today.
“The world faces at least a $2 billion financing gap. Countries with high burdens of TB continue to cover the majority of the cost, and there is far more that donors can do and must do to support the fight.”
There is also uncertainty about the estimates. The case increase in this year’s report is likely to be replicated next year, after the publication of Indonesia’s more comprehensive TB numbers. The WHO says the improved statistics are a good thing and try to downplay the large overall number by saying that the figures “fall within the upper limit of previous WHO estimates.”
“Following a concerted effort by countries, by WHO and by multiple partners, investment in national surveys and routine surveillance efforts has substantially increased. This is providing us with much more and better data, bringing us closer and closer to understanding the true burden of tuberculosis,” says Dr. Mario Raviglione, director of the WHO global TB programme.
Amid the changing numbers and high TB burden is the same top-line message: more will be required to control the spread of TB in the coming years. That means more money and more resources, say advocates.
“While we have focused a lot on Ebola in Africa, for good reason, that fact is that TB is having a major impact in Africa,” David Brayden, TB Advocacy Officer for RESULTS, told Humanosphere. “And the Nigeria case shows that even if we could wave a magic wand and eradicate the HIV virus today, the TB problem there would still be massive, since it is not primarily driven by HIV.”
Better data on TB in Nigeria reveals a doubling of prevalence and a tripling of incidence, compared to previous estimates. The increase means that Nigeria and India are responsible for about one out of every three global TB deaths. Nearly 600,000 adults and children will fall ill with TB in 2014. Current projections show that more than 4 million cases of TB will occur by 2020. Of those cases, nearly 200,00 will be multidrug-resistant TB.
The government is taking its TB problem more seriously, but it might not be enough. A proposed National Strategic Plan for Tuberculosis Control serves as a call to action, said the minister of health. It lays out a plan for achieving “universal access to high-quality, patient-centred prevention, diagnosis, and treatment services for TB, TB/HIV, and drug-resistant TB by 2020.”
All that stands in the way is $505.2 million. That represents the financial gap for the TB response from 2015 to 2017. There is no indication that the funding gap will be filled. Nigeria is waiting for the Global Fund for AIDS, TB and Malaria to reply to their request. It is possible the Global Fund provides a generous amount of money for TB, it is possible it will not. The country cannot wait.
“A massive scale-up of effort is required to meet the overwhelming needs of people with all forms of TB,” says the Nigerian plan. “[W]hile treatment sites have been expanded, facilities and trained personnel are inadequate to match the rapid scale-up in diagnosis that is envisioned under this Plan to address the low case detection issues.”
The investments necessary to improve TB treatment and control will help support overall health in Nigeria and elsewhere. Existing innovations from Nigeria’s polio vaccine work helped keep Ebola from spreading. The same kind of crossover benefits would be seen through investing in TB. It is a fact not lost on the United States, whose TB investments focus on routine and early warning surveillance, laboratory and drug management networks, and infection control measures. Improvements in all three areas will help for problems like malaria and even Ebola.
And it comes down to having enough money.
“In addition to the serious underfunding for research, $8 billion a year is required for TB and MDR-TB prevention, diagnosis and treatment. Domestic and international financing needs to step up to prevent millions of unnecessary deaths,” said Katherine Floyd, WHO Coordinator for TB Monitoring and Evaluation.
