The global burden of tuberculosis

Progress, challenges, strategy

and opportunities beyond 2015
Dr Mario RAVIGLIONE
Director

Barcelona
27 October 2014

This talk will deal with

TB Basics
Burden, Progress, Challenges
Way Forward

Tuberculosis: basics
Tuberculosis (TB) is one of
the oldest diseases of
humans
Second greatest infectious
killer after HIV/AIDS
TB is also one of the top
killers of women worldwide
TB is curable, if properly
treated
If untreated, TB may be
fatal
One third of world has
latent TB infection

TB is airborne

Text

Bacterium Mycobacterium

TB usually affects the lungs, although other

organs are involved in 15-30% of cases

Who carries the burden of tuberculosis?

mostly, the most vulnerable

TB spreads in poor, crowded & poorly
ventilated settings

510,000 women and 80,000

children die of TB each
Migrants, prisoners, minorities,
year; 10 million TB
refugees face risks, discrimination
orphans
& barriers to care

TB linked to HIV infection, malnutrition,

alcohol, drug and tobacco use, diabetes

The Global Burden of TB - 2013

Estimated number
of cases

All forms of TB

9 million
126 per 100,000

550,000 in children
3.3 m in women

Estimated number
of deaths

1.5 million*
80.000 in children
510.000 in women

HIV-associated TB

1.1 million (13%)

360,000

Multidrug-resistant TB

480,000

210,000

Source: WHO Global TB Report 2014

* Including deaths attributed to HIV/TB

Estimated TB incidence rate, 2013

4%

Americas
3%

E. Mediterranean
8%

South-East Asia
37%

Africa
29%

35% in India + China

24% in India

Western Pacific
18%

Ref: Global TB Control Report 2014

Europe

TB cases and deaths in slow decline, 1990-2013

Incidence peaked at 9.5 million in 2004

9 million in 2013

Total mortality peaked in 2002 at 1.7 million

1.5 million in 2013

Global progress on impact - 2013

37 million lives saved since 2000
Reduction in TB mortality rate
45% since 1990
Incidence falling
slowly (1.5%/yr):
2015 MDG on track

4.8 million lives saved

since 2005 through
TB/HIV collaborative
activities
86% cure rate
61 million patients cured,
1995-2013

Challenges: Priorities for action 2014

5 PRIORITIES FOR ACTION
Reaching the missed cases
(3 million not in the system)
Address MDR-TB as crisis
Accelerate response to TB/HIV
Increase financing to close
resource gaps
Intensify research and ensure
rapid uptake of innovations

Reaching the "missed" cases

(nearly 3 million not diagnosed or reported)

Share of total missed cases

9 million estimated

6 million notified

10 countries account for 74% (2.4 million) of the

estimated missed cases globally
Estimated incidence
Global notifications

Ref: Global TB Control Report 2013

Accelerate response to TB/HIV

Estimated HIV prevalence in new TB cases, 2013

Ref: Global TB Control Report 2014

Address MDR-TB as a crisis:

Percentage of new TB cases with MDR-TB

Ref: Global TB Control Report 2014

India, China, Russia, Pakistan and Ukraine

have 60% of all MDR-TB cases

The status of the MDR-TB response

THERE IS SIGNIFICANT PROGRESS IN MDR-TB DETECTION BUT
TREATMENT CHALLENGES COMPROMISE GAINS

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Five priority actions to address the global MDR-TB crisis

ACTIONS NEEDED ON ALL FRONTS FROM PREVENTION TO CURE

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67th World Health Assembly, Geneva, May 2014

based on a call from member states in 2012

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The End TB Strategy: Vision, goal, targets 2035

Vision: A world free of TB
Zero TB deaths, Zero TB disease, and Zero TB suffering
Goal: End the Global TB epidemic (<10 cases per 100,000)
Target 1

95% reduction in
deaths due to TB
(compared with
2015)
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Target 2

90% reduction in TB
incidence rate
(compared with
2015)

Target 3

No affected
families face
catastrophic
costs due to TB

The End TB Strategy: 3 pillars and 4 Principles

Integrated,
patientcentered
TB care
and
prevention

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Bold
policies and
supportive
systems

Intensified
research
and
innovation

Adapting the End-TB Strategy for

low TB incidence countries
Ref: Global TB Control Report 2013

Countries with < 10/100,000 TB cases/year, notified all forms cases & > 300k population
Other countries progressing rapidly or with potential to consider elimination in the future

Estimated incidence, new TB cases/year: 155,000

Notified cases/year: 131,000 (among women: 50,000; among children: 5,000)
TB deaths/year: 10,000 (30 deaths a day)
Estimated new TB/HIV cases/year: 4,000
Notified MDR-TB cases/year: 567
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Targets

<1 case per million

<10 cases per million
<100 cases per million

Pre-elimination: 2035

Current TB burden-2012
in low-incidence countries

in low-incidence countries

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Elimination: 2050

Challenges for TB elimination

in low-incidence countries
TB concentrated in vulnerable and high-risk groups
Recent transmission vs. reactivation
Cross-border migration
Dwindling political commitment and visibility

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ACTION FRAMEWORK
8 priorities for elimination in low-incidence countries

Ensure political
commitment, funding
and stewardship for
planning and
essential services
of high quality

Address the most

vulnerable and hardto-reach groups

Undertake
screening for active
TB and latent TB infection
in TB contacts and
selected high-risk groups,
and provide appropriate
treatment

Support global
TB prevention, care
and control

Invest in
research
and new tools

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Address special
needs of migrants
and cross-border
issues

Ensure continued
surveillance,
programme
monitoring &
evaluation, and casebased data
management

Optimize the
prevention and care
of drug-resistant TB

Reaching the targets:

Research and development crucial

Current global trend: -2%/year

Optimize current tools,

pursue universal health
coverage and social
protection

Average
-10%/year
by 2025

Introduce new tools: a vaccine,

a new prophylaxis & treatment Average
regimen, a PoC test
-17%/year

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-5%/year

Political commitment needs to be

backed by financing to end the TB epidemic
$2 billion
Funding gap

$8 billion funding required for TB prevention,

diagnosis and treatment

$1.32 billion
Funding gap

$2 billion funding required research

and development
TAG TB R&D report 2014

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Role of Members of Parliament to support the

global and national vision to END TB
Create national parliamentary groups, fora and caucus to promote the cause in
your country
Ensure support to Ministers of Health in the adoption and adaptation of the new
End TB Strategy and related elimination targets
Advocate for inclusion of TB support and resources in the main national and
international agendas of your country; prioritize high-quality TB care, social
protection and UHC initiatives that are TB-sensitive, and research investments
Establish links with those responsible for the post-2015 global development
agenda and promote specific wording, targets, indicators for TB as part of the
future "sustainable development" goals
Advocate for much increased investments on TB control and elimination by
financial institutions (e.g., World Bank, Global Fund, UNITAID) to ensure sufficient
international funding in support of the poorest countries

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Many thanks
to all!

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PROGRAMME