Tuberculosis

An Opportunity to Reach Zero Deaths in our

Lifetime

Dr Lucica Ditiu, Executive Secretary, Stop TB Partnership

27th October 2014, Barcelona

Which disease is
responsible for the most
deaths in the last 200 years

the
burden

1.5

1.3

MILLION

MILLION

Population of
urban Lyon

People who
died of TB
in 2012

the
achievem
ents

56 million

people

22 million

Lives saved

45%

treated for TB since 1995

Since 1995

Reduction in TB mortality
Since 1990

the
burden
TB incidence

target
10 / 100k
year

global
125 / 100k
107
92
79
68
58
50

90 2000 2010 2020 2

the
burden
TB incidence in the European Region

target
10 / 100k

40global
36
32 / 100k
28
24
20
14
12
10

2013 2018 2023 2028 2

the
burden

8.6 MILLION
estimated TB cases
MDR-TB

77,000
MDR-TB cases
diagnosed and on
treatment

1.3
MILLION

5.7 MILLION
new cases
diagnosed
and treated

450,000
estimated new cases

The Missing Cases

TB Incidence Rates (per 100,000 popn)

What is MDR-TB?
A form of TB that is resistant to at least two
key anti-TB medicines
Difficult (terrible side effects) to treat
Expensive to treat 150X more than "normal"
TB (drugs only)
Man made
Clear sign of under investment and poor TB
care

Why is MDR a public health crisis?

Less than 25% of estimated
new MDR cases were
detected in 2012

700

600

500
Thousands

the
burden

400

300

17,000 patients on
waiting list for treatment

200

100

0
Est. number of ALL MDR
TB cases in the World
today

Est. number of NEW MDR

TB cases per year

New cases diagnosed

New cases on treatment

the
burden

27 high MDR-TB burden countries in 2012

55% in Europe (15)

30% in Asia (8)

15% in Africa (4)

WHO 2013 Global Tuberculosis Report;

continuous
transmission
Airborne
everyone is
susceptible
unless we end
the epidemic

0%

2 billion people
infected with TB

200 million
will develop TB

1 MDR case

1 TB case

infects up to

infects up to

10 / year

15 / year

WHO 2012 Global Tuberculosis Report; CDC 2013; Styblo 1985; Basu 2009

The
burden

Estimated TB incidence rates (2012)

Africa - highest in the world

High HIV +
highest TB
incidence in the
world + financing
gaps and GF
dependence =
Significant
challenge

the
lessons
learned

lives saved
due to TB & HIV
integration
(2005-2011)

25 fold increase

doubled

cases detected & treated

due to prioritized
interventions in
vulnerable populations

detection & treatment

through engagement
with TB communities

the
potential
of new
tools

90

minutes to diagnose

12

new vaccine

Rif resistant TB with Gene Xpert

machine

candidates in
the pipeline

months to treat TB
with new drugs and regimens in
development (compared with
current 6-24 months)

What is the Stop TB Partnership?

Vision

A TB-free world.

Zero deaths, disease and suffering due to tuberculosis

Mission

Ensure that every TB patient has access to effective

diagnosis, treatment and cure

Reduce the inequitable social and economic toll of TB

Develop and implement new preventive, diagnostic and

therapeutic tools and strategies to stop TB

Targets

By 2015: the global burden of TB disease (deaths and

prevalence) will be reduced by 50% relative to 1990

By 2035: 95% reduction in tuberculosis deaths (compared

with 2015)

Partners

More than 1200 partners

Governments, communities and civil society , affected

people, NGOs, multilaterals, donors, technical agencies,
private sector.

The Global Drug Facility

Provides access to life saving quality assured TB medicines

and diagnostics

Finding The Missing Cases

Mobile
outreach

Community
resources

Innovative
transport

Innovative
Lab reports

Business
models

Digital Xray
screening

Slum
outreach

New
diagnostics

Incentives

Indigenous
people

TB
financing
trends

Funding gaps in 125 countries

96%and
of global
burden,
2013funding
Domestic
international
donor
(excluding research and development for new tools)
International
Asia:International
Lowbillion
income,$0.8
high
13%
burden
7%

Rest of
World
15%
Funding gap
$2 billion

Asia: Other
30%

WHO 2013 Global Tuberculosis Report;

Africa
Domestic
48%

$5.3
billion
Domestic
87%

TB
financing
trends

International
funding gaps
per region per
International
funding
year
South-East
Asia
$150 million
WesternPacific
$150 million

Americas
$30 million
Africa
$930 million

EasternMediterranean
$160 million

Europe
$200 million

WHO and Global Fund to Fight AIDS, TB and Malaria March 2013 news release - Urgent need for US$ 1.6 billion a year in
international financing to prevent spread of disease

TB
financing
trends

Total
international
funding
per
Percentage
of total donor
international
donor
funding from the year
Global Fund per year
HIV
TB
International donor funding $8.2
accounts
for 50% or more of total funding
82%
billion
in 17 of the 22 High TB Burden Countries (excludes BRICS, which
make up the other 5)

Malaria
Malaria
$1.8
50% billion
TB
HIV
$0.8

21%
billion
WHO, 2013Global Tuberculosis Report
The Global Fund to Fight AIDS, Tuberculosis and Malaria website

Funding for R&D new tools

2012

TB
financing
trends

Diagnostics
7%
Infrastructure
8%

R&D funding
$0.6 billon
Drugs
38%

Funding gap
Operational
$1.4
billion
research
12%

$0.6 billion total

Vaccines
14%

Treatment Action Group 2013 Report on Tuberculosis Research Funding Trends, 20052012

Basic Science
21%

TB is not just a health issue

But a global economic and security risk

economic
challenge

microeconomic
impact of TB on
households

Up to

75%
must take out a
loan

50% 15

yrs

decrease in
yearly income

of income lost
with TB death

11%
of school
children quit
school when
parent has TB

Rajeswari R, Balasubramanian R, Muniyandi M, Geetharamani S, Thresa X, Venkatesan P, 1999. Socio-economic impact of

tuberculosis on patients and family in India. Int J Tuberc Lung Dis 3: 869877.
Stop TB Partnership. (2000). Tuberculosis and Sustainable Development.

economic
challenge

US$ 8
billion

75 %

Source: www.tballiance.org/why/economic-impact.php
http://www.who.int/tb/careproviders/ppm/workplaces/en/index.html

Estimated
economic
burden of TB per
year in the EU
alone

of TB patients
are in their most
productive years

Economic

opportunity
heart attacks

Tuberculosis
case finding
& treatment
US$ 30

acute low-cost management

US$ 25
expanded
immunization
US$ 20
local surgical
capacity
US$ 10

malaria
prevention & treatment

US$ 20
HIV
combination prevention

US$ 12

Return on investment for every one dollar

spent on the most cost-effective health interventions
Report of the High-Level Panel of Eminent Persons on the Post-2015 Development Agenda, 2013

What we Attention and support to TB

need By world leaders, country governments and YOU

In the post-2015 agenda

For development of the next Global Plan to stop TB 20162020

Increased domestic funding

Particularly for high burden and middle income countries

Increased external funding

Increased funding for high-impact programs in addition to

Global Fund
Set up an additional channel of funding
e.g. for innovations in care delivery
Funding for research on new tools

Integration within countries systems

Walk away from vertical interventions

Cross cutting areas procurement and supply, health
information systems, service delivery peripheral level

How we
can help

Connect to relevant in country partners

Support on prioritization of areas in need for
support
Engagement of "non traditional" partners
communities, civil society, private sector
Global Fund
- NFM related events, activities
- TA
TB REACH
Challenge Facility for Civil Society
GDF
Email us: ditiul@stoptb.who.int

Photo of GA with IDF?

We can
Make history
on the Road to Zero TB Deaths