A new roadmap for curbing the global epidemic of tuberculosis aims to save five million lives between 2011 and 2015 and eliminate TB as a public health problem by 2050 but comes with a price tag of US$47 billion, nearly half of which must still be found.
The Global Plan to Stop TB 2011-2015 developed by the World Health Organization’s (WHO) Stop TB Partnership builds on progress towards goals laid out in a 2006 plan to halve TB prevalence and death rates by 2015 and scale up TB diagnosis, treatment and care, but adds essential research targets including the development of faster methods to test and treat TB and to prevent it through an effective vaccine.
After peaking in 2004, the global incidence of TB is declining, but “far too slowly”, noted Mario Raviglione, director of WHO’s Stop TB Department, at the launch of the plan in Alexandra, a Johannesburg township. The curable disease still affects some nine million people a year and claims nearly two million lives annually.
In southern Africa the death toll from TB is particularly severe, largely as a result of a twin epidemic in HIV - people infected with HIV are between 20 and 37 times more likely to develop TB.
The choice of a primary school in an impoverished South African township to host the launch was significant: South Africa has the world’s third highest burden of TB, a disease that spreads easily in overcrowded, poorly ventilated dwellings like the ones that cram the streets of Alexandra.
The South African government’s Kick TB Campaign, which started in June 2010 during the country’s hosting of the FIFA World Cup, targets school children in high TB-burden areas like Alexandra with information about TB that it is hoped they will pass on to their families and communities. At the launch on 13 October, hundreds of children gathered in a playing field attached to Pholosho primary school to kick around soccer balls emblazoned with illustrations of TB symptoms.
One of the learners pleaded with the international experts, activists and journalists gathered for the event to “stop TB in my lifetime”. Rifat Atun, chair of the Stop TB Partnership Board, responded that this is exactly what the plan aims to do and that, providing funding is made available, it is a realistic goal.
Guidance on TB control
Specifically, the plan provides countries with guidance on how to improve TB control through scaling up existing interventions for its diagnosis and treatment and by making use of new diagnostic tests and drugs that will become available over the next five years. A new test that uses molecular line probe assays to detect multi-drug resistant (MDR-)TB in a few days instead of the weeks needed using older testing methods has already been introduced in some countries. Other tests that will soon be available can detect TB in a matter of hours.
Current TB drug regimens take six months to be effective for drug-susceptible TB and much longer for drug-resistant strains, during which time many patients are lost to follow-up. The pipeline of new TB drugs promises shorter treatment times. Meanwhile, nine TB vaccine candidates are in clinical trials and a new generation of TB vaccines is expected to be available by 2020.
Other major elements of the plan focus on efforts to combat drug-resistant TB and TB in people living with HIV. It calls for a scale-up in access to tests that can detect resistance to first- and second-line TB drugs, identifying limited laboratory capacity as the main reason why only 5 percent of the estimated 440,000 people who had MDR-TB in 2008 were diagnosed. It also recommends testing all TB patients for HIV (by 2008, only about 22 percent of TB patients knew their HIV status) and providing antiretroviral treatment to all those who test positive.
|Hidden toll from TB|
|HIV testing and treatment to prevent TB|
|Too few MDR-TB cases diagnosed|
|New two-hour TB test|
The plan estimates that $10 billion alone is needed to fund further research and development over the next five years, about $7 billion of which still needs to be raised. Out of the estimated $37 billion needed to implement the Global Plan’s TB diagnosis, treatment and care targets, a funding gap of about $14 billion remains.
Atun of the Stop TB campaign said he was encouraged by the record levels of support for the Global Fund to Fight AIDS, Tuberculosis and Malaria at the Fund’s replenishment meeting in New York last week at which donors pledged a total of $11.7 billion over the next three years. He added, however, that part of the shortfall for funding TB programmes and research will need to come from domestic budgets.