WHO Warns of Consequences of Underfunding TB Prevention Efforts

The World Health Organization (WHO) reports for the first time that the number of people falling ill with tuberculosis (TB) each year is declining. New data, published today in the WHO 2011 global tuberculosis control report, also show that the number of people dying from the disease fell to its lowest level in a decade. Yet, current progress is at risk from underfunding, especially efforts to combat drug-resistant TB.

The new report finds:

-- the number of people who fell ill with TB dropped to 8.8 million in 2010, after peaking at 9 million in 2005;

-- TB deaths fell to 1.4 million in 2010, after reaching 1.8 million in 2003;

-- the TB death rate dropped 40 percent between 1990 and 2010, and all regions, except Africa, are on track to achieve a 50 percent decline in mortality by 2015;

in 2009, 87 percent of patients treated were cured, with 46 million people successfully treated and seven million lives saved since 1995. However, a third of estimated TB cases worldwide are not notified and therefore it is unknown whether they have been diagnosed and properly treated.

Major progress is no cause for complacency

"Fewer people are dying of tuberculosis, and fewer are falling ill. This is major progress. But it is no cause for complacency," says United Nations secretary-general Ban Ki-moon. "Too many millions still develop TB each year, and too many die. I urge serious and sustained support for TB prevention and care, especially for the world's poorest and most vulnerable people".

Much of the progress reported today is the result of expanded efforts in large countries.

Decline in burden of TB

"In many countries, strong leadership and domestic financing, with robust donor support, has started to make a real difference in the fight against TB," says WHO's director-general, Dr Margaret Chan. "The challenge now is to build on that commitment, to increase the global effort - and to pay particular attention to the growing threat of multidrug-resistant TB."

Among these countries are Kenya and the United Republic of Tanzania. In these African countries, the burden of TB is estimated to have been declining for much of the last decade after a peak linked to the HIV epidemic. Brazil has reported a significant and sustained decline in its TB burden since 1990. In China the progress has been dramatic. Between 1990 and 2010, China's TB death rate fell by almost 80 percent, with deaths falling from 216,000 in 1990, to 55 000 in 2010. In the same period, TB prevalence halved, from 215 to 108 per 100,000 population.

Worldwide, the share of domestic funding allocated to TB rose to 86% for 2012. But most low income countries still rely heavily on external funding. Overall, countries have reported a funding shortfall of US$ 1 billion for TB implementation in 2012.

Treating MDR-TB patients

Treating multidrug-resistant TB (MDR-TB)* remains one of the most underfunded areas. While the number of MDR-TB patients treated increased to 46 000 in 2010 this is just 16 percent of the estimated number of MDR-TB patients that needed treatment. Of the US$ 1 billion gap reported by countries for 2012, US$ 200 million is for the MDR-TB response.

"A new rapid test for MDR-TB is revolutionizing TB diagnosis with 26 countries using the test only six months after its endorsement by WHO last December, with at least ten more countries expected to have it by the end of 2011," says Dr. Mario Raviglione, director of WHOs Stop TB Department. "But the promise of testing more people must be matched with the commitment to treat all detected. It would be a scandal to leave diagnosed patients without treatment".

Africa and TB/HIV

People living with HIV, who are also infected with the bacteria causing TB, are up to 34 times more likely to develop TB disease. In 2010, 1.1 million people living with HIV developed TB -- 82 percent of them (900,000 people) in Africa. Worldwide, 12 percent of TB patients have HIV co-infection.

Progress has been made in addressing the TB/HIV co-epidemic, with coverage of testing for HIV rising to 59 percent of TB patients in Africa. But further commitment is needed if the region is to meet key 2015 TB targets. In 2010, almost half of TB patients testing positive for HIV in Africa were taking antiretrovirals, and about three-quarters began co-trimoxazole preventive therapy, which helps reduce mortality. Both treatments are among the essential elements of TB/HIV care.

New tools to fight TB

The report features promising developments in TB diagnostics, drugs and vaccines. Among these, there are strong prospects for shortened drug regimens. Results from three Phase III drug trials are expected between 2012 and 2013, while results from two Phase II trials of new MDR-TB drugs are expected in 2012.

The data on TB and its prevention, care and control, included in the WHO 2011 global tuberculosis control report, were submitted to WHO by 198 countries. Profiles for these countries are also included in the report.

*MDR-TB is caused by bacteria that are resistant to the most effective anti-TB drugs (isoniazid and rifampicin). This form of TB does not respond to the standard six month treatment with first-line anti-TB drugs and can take two years or more to treat with drugs that are less potent, more toxic and much more expensive.