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- Tuberculosis can be treated, prevented and cured, but it kills 1.6 million people a year, more than any other infectious disease.
- The savings from preventing TB deaths are estimated at three times the cost and could be much higher in many countries.
- Despite existing treatments, global investment in research must be quadrupled to transform TB control outcomes, says major report released prior to World TB Day
- Authors Emphasize Accountability for Tuberculosis – Assess Progress in 10 Highly Affected Countries and Announce Launch The lancet Tuberculosis Observatory – an independent annual report badessing progress towards the goals of the UN High-level Meeting in 2022
A TB-free world is possible by 2045 if increased political will and financial resources are devoted to priority areas, including providing evidence-based interventions for all, especially for high-risk groups, and intensifying research to develop new methods of diagnosis, treatment and treatment. and prevent tuberculosis. Funding for this response will require substantial investment and accountability mechanisms will be needed to ensure that promises are fulfilled and goals are achieved.
Released before World TB Day (March 24, 2019), The lancet The Tuberculosis Commission estimates that the reduction in TB-related mortality has considerable financial benefits: the savings made to prevent TB deaths are estimated at three times the costs and could be much higher in the future. many countries.
"This report is optimistic about the possibility of ending TB – a preventable, treatable and curable disease, but our work leaves no room for complacency and we need to move quickly and strategically to save the next generation of TB. Tuberculosis, "said Senior Commissioner Eric Goosby, UN Special Envoy on Tuberculosis, University of California, San Francisco, USA. "In the wake of the UN High Level Meeting on Tuberculosis, the Commission sees this report as a roadmap to help keep countries with high fiscal burdens responsible for the fight against this deadly disease."
Tuberculosis remains the leading cause of infectious mortality of our time, causing 1.6 million deaths worldwide in 2017, with drug-resistant forms of TB threatening control efforts in many parts of the world. In addition, in 2017, about a quarter of the world's population was living with tuberculosis.
The World Health Organization (WHO) first declared that tuberculosis was a public health crisis in 1993. In 2018, the first-ever United Nations high-level meeting on tuberculosis the fight against tuberculosis is a global priority. This included ambitious goals of treating 40 million people and preventing 30 million new cases between 2018 and 2022.
The lancet The TB Commission makes policy and investment recommendations for TB-affected countries and their development partners. The report is the work of 37 Commissioners from 13 countries and includes economic badyzes and modeling of interventions to address treatment issues (drug-resistant TB, HIV co-infection and treatment in private health systems), which are published in detail in an accompanying research paper in The lancet World Health Journal. The report is published with related comments from former UN Secretary General, Ban Ki-moon, and the Indian Minister of Health and Family, Jagat Prakash Nadda, as well as a profile from Nandita Venkatesan, journalist, TB survivor and human rights activist patient and co-author of the report.
Expand existing interventions and reach high-risk groups
The first priority for most hard-hit countries is to ensure that high-quality diagnostic tests and treatments are available for all people with active TB.
Many people with TB, especially the poorest, can not access or pay for services, and health systems are often slow to identify and investigate cases, which means that patients do not complete treatment. nor do they recover. Currently, more than one-third of TB cases (35%) are neither diagnosed nor treated. Authors call for universal access to drug susceptibility testing [2] at the time of diagnosis to ensure that all patients receive appropriate treatment, including access to second-line treatment for drug-resistant TB. The estimates in this report suggest that the increase of these interventions (drug susceptibility testing to 90% of people diagnosed and second-line treatment to 85% of people with drug-resistant TB) in Moldova, where TB rates drug-resistant, could result in a 73% reduction in TB deaths and 43% in new cases between 2018 and 2045.
However, private health care is often the primary means of diagnosing and treating patients in hard-hit countries, which means that countries and donors need to work with the sector to improve care. The modeling shows that subsidize testing and help patients complete their treatment in India, the country where the burden of TB is the heaviest [3] and, mainly in private health care, more than a quarter (28%) of deaths due to TB could be prevented over the next 30 years (8 million additional lives). That would cost an additional $ 290 million each year, which is significantly lower than the $ 32 billion in Indian losses badociated with TB mortality each year.
Identify groups at high risk of TB infection (including people living with HIV, people living in the same house as a person with TB, migrants, prisoners, health professionals). health and minors) and their care will be vital, including providing TB prevention, such as treatment for latent TB. This is particularly important for people living with HIV, where the risk of co-infection is high and where TB is the leading cause of death. By making TB prevention accessible to 90% of people living with HIV in Kenya, the authors estimate that TB mortality could be reduced by 17% (equivalent to 3 million lives saved) between 2020 and 2045, would cost $ 66 million per year between 2018 and 2045. This would be relatively modest compared to the economic costs of preventable deaths due to non-compliance ($ 2.7 billion per year).
Once high-risk populations and those already receiving care have access to affordable, high-quality services, universal health coverage is needed to help countries detect the latest TB cases.
Invest in TB
However, even if current treatments were extended to 90% of people with TB and 90% were successfully cured, ongoing efforts would not have prevented 800,000 deaths in 2017. Investments in research must be multiplied by four (compared to US $ 726). million in 2016) to develop treatments and prevention tools that can transform the results of TB.
Affected countries, donor countries, the private sector and philanthropists also need to develop effective financing strategies to end the TB epidemic. The initial overall costs of reducing tuberculosis deaths by 90% (from 1.7 million per year to less than 200,000 per year) could be in the order of $ 10 billion per year. [4]and investments are expected to increase by about $ 5 billion a year in the beginning. However, this would reduce costs (to $ 1 billion to $ 2 billion a year in the early 2040s) as the number of new cases decreases.
Investing in TB has a significant return on investment, with an estimated return of US $ 16-82 for every dollar spent on TB research and development. Similarly, TB control could generate considerable economic benefits for hard-hit countries, with savings of three to seven times greater for each death averted by TB.
More public finances need to be allocated to TB (by raising GDP levels, taxing tobacco and alcohol, and strengthening health insurance), in addition to increasing investment in TB. skills and local infrastructure. Estimates suggest that Bangladesh, Zambia, China and Indonesia could multiply by five their annual spending on TB over the next five years.
Global donors also need to invest more wisely. Currently, only 24% of global health aid is allocated to global functions (in relation to country-specific functions) that could help several countries, such as research and development, price negotiation lowest for anti-TB drugs, leadership and advocacy. This funding should be expanded to include a focus on reducing drug-resistant TB to prevent cross-border spread and ensure that high-risk groups are identified and eventually supported through insurance systems. social.
"Although the fight against TB poses many challenges, we have the potential to solve it now, we have fast and sensitive diagnostic tools, and we promise powerful TB treatment strategies." Tuberculosis control, new technologies, sustained global economic growth, increased commitment to universal health coverage, and growing political momentum could all make tuberculosis elimination a generation more achievable than ever before. with shared political will and responsibility, TB is a problem that can be solved, "says co-author Dr. Michael Reid of the University of California, San Francisco, USA. [1]
Speaking on the role of the report in India, the co-author, Dr. Nalini Krishnan, of the Resource Group for Education and Advocacy for Community Health in India, said: "L & # 39; India has shown a strong political commitment to eradicating TB, pledging to eliminate it by 2025. Tuberculosis The program has moved up a gear , giving priority to person-centered care, involving the private sector and prevention, but India now needs to accelerate on three fronts: involving TB survivors and affected communities as key factors in tuberculosis control, improving the quality of care The Commission's recommendations on accountability, rapid development of proven technologies and investment in research are important strategic guidelines to be adopted. " [1]
Accountability: a shared responsibility for TB
Increased accountability for TB at the local, national and global levels is needed. Heads of Government should be held accountable for their achievements in tuberculosis control and report twice a year to the United Nations; donors must be responsible for drug-resistant TB and for research and development. To meet this need, the authors launch The lancet Tuberculosis Watch – an independent annual report badessing progress in achieving UNHLM goals for 2022 and monitoring national and global funding. The authors also created individual fact sheets to monitor progress in tuberculosis, political will and funding for tuberculosis in the ten most affected countries.
Ban Ki-moon, former UN Secretary-General and Vice-President of The Elders, stresses the importance of the responsibility and role of TB control in seeking universal coverage in the field of tuberculosis. health. He said: "CSU may seem like a broad goal to hold countries accountable in the fight against TB, but with a focus on rights, equity, and the services provided to them. needs, it is the ideal framework for combating this life-threatening disease, TB kills more than any other infectious disease, disproportionately affects the poor and the vulnerable, and drug-resistant strains threaten the whole of humanity. this justifies the need to prioritize the elimination of tuberculosis in the CSU reforms. "
The Indian Minister of Health and Family Welfare, Jagat Prakash Nadda, highlighted the policies implemented in India to eliminate TB by 2025, in a related commentary: "The lancet According to the Commission, the loss from tuberculosis mortality is estimated at $ 32 billion a year in India. New tools resulting from further research and development of TB are essential to prevent projected economic losses. With at least 30% of the Indian population infected with TB, we need accurate point-of-care diagnoses to detect TB infection and effective person-centered treatment. We need an effective vaccine to prevent tuberculosis. Ensuring strong advocacy, in close coordination with the Ministry of Science and Technology and research-based pharmaceutical companies, as well as global commitment and collaboration in TB R & D are essential for Achieving our goals … To end TB, governments in the most affected countries will have to come up with bold plans to tackle TB rather than just moderate extra gains. "
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NOTES TO EDITORS
This commission has received financial support from the United States Agency for International Development (USAID) through the University Research Society and the Stop TB Partnership. The Stop TB Partnership and the University Research Society provided administrative support to the Commission.
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