End TB by 2030!

Strong efforts have reduced TB prevalence by 750% and TB deaths by nearly 75%

THE World Health Organization (WHO) in the Western Pacific Region urges governments and partners to strongly support calls to action to end the burden of tuberculosis (TB) in the Region, especially in this day and age of treatment-resistant TB.

“Sadly, tuberculosis continues to be an agonizing chapter in the public health history of the Region,” said Dr Shin Young-soo, WHO Regional Director for the Western Pacific. “We must strengthen efforts to close the book on TB for the Region’s 1.8 billion people.” The world observed World TB Day last March 24.

In a press statement, WHO said that there has been remarkable progress in decreasing the burden of TB in the Western Pacific Region. The direct observed treatment, short course, or DOTS, strategy, along with the 2016 Stop TB Strategy, have resulted in substantial health benefits across the Region.

Since 1990, concerted efforts have reduced TB prevalence by more than half and TB deaths by nearly three quarters. An estimated 9 million lives have been saved since 2000. Today, 1.35 million patients are treated annually, and the Western Pacific Region has achieved the TB-related targets of the Millennium Development Goals.

Despite big reductions in deaths, however, TB remains a leading killer, claiming more than 100,000 lives every year in the Region. In 2013, 1.6 million people fell ill with TB, shattering lives and livelihoods. The disease particularly affects low-income and disadvantaged groups, highlighting the need for innovative and multisectoral responses to effectively address the problem.

Challenge

While TB can affect anyone, migrants, prisoners, children, and older and poor people are more vulnerable to the disease. Detecting TB cases can be more difficult among these groups, which often have the lowest capacity to cope with the TB burden.

Although basic TB services are available for free in nearly all countries, many patients still suffer heavy financial burden. Loss of income and direct expenses can trigger a downward spiral, whereby patients are unable to complete treatment, which could place them at risk of developing drug-resistant TB.

The problem of drug resistance is a great threat to TB control and a major concern for regional health security. Every year, an estimated 71,000 new cases of multidrug-resistant TB (MDR-TB) occur in the Region. However, only 11,412 cases were notified in 2013, with only 6,926 patients placed on treatment. In other words, less than 10 percent of all new MDR-TB cases received treatment. Even for those who received treatment, the cure rate was only 52 percent in 2011.

Weak health systems and regulatory mechanisms result in limited services, inadequate treatment, irrational drug use and discrimination against people with TB. Weak health systems also prevent the establishment of links across social sectors to address poverty, undernutrition and other risk factors that greatly influence people’s vulnerability to TB and health outcomes of people with TB. Strengthening health systems is fundamental to TB responses across the Region.

WHO response

During the session of the WHO Regional Committee for the Western Pacific held in Guam in 2015, Member States approved the Regional Framework for Action on Implementation of the End TB Strategy in the Western Pacific 2016–2020. WHO developed the framework in consultation with Member States, national TB programs and regional experts and partners engaged in TB control.

The regional framework aims to adapt WHO’s new global TB strategy, or the End TB Strategy to the particular circumstances of countries and areas in the Western Pacific Region.

Implementation of the strategy requires quality, people-centered TB services for all patients and families, addressing the looming burden of drug-resistant TB, social and financial risk protection, effective regulatory policies to support TB control efforts, and new tools and capacity for rapid adoption of new technologies.

Ending the TB epidemic by 2030 is among the health targets of the recently adopted Sustainable Development Goals. WHO has gone further to set a 2035 target of 95 percent reduction in deaths and a 90-percent decline in TB incidence — similar to current levels in low TB incidence countries. This ambitious target is achievable, but only if we work together to strengthen our efforts to combat this disease.

Vital Signs Issue 87 Vol. 4, May 1-31 2016