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The World Remains Off Target to End TB by 2035

OCT 31, 2017 | CONTAGION® EDITORIAL STAFF
According to the latest Global Tuberculosis (TB) Report from the World Health Organization (WHO), we remain off target to cut deaths from the disease by 95% and reduce new cases by 90% between 2015 and 2035. In addition, TB remains the #1 infectious killer, worldwide, surpassing HIV / AIDS.

Each year, the WHO provides a comprehensive report detailing the current state of TB around the world. The report includes current statistics on rates of infection, as well as the progress that has been made in terms of care and prevention. Approximately 201 countries and territories that account for over 99% of the world’s population and TB cases reported data for the report. The data in this latest report indicate that approximately 1.3 million HIV-negative individuals around the world died from TB in 2016. (The number of HIV-positive individuals who succumbed to the infection was 374,000.)

Of the approximately 10.4 million individuals who became infected with TB in 2016, 90% were adults. Of those adults, 65% were male and 10% were individuals living with HIV (74% in Africa), according to the report. Five countries represented 56% of the cases: India, Indonesia, China, the Philippines, and Pakistan.

Perhaps more alarming is the fact that WHO reports there were a total of 600,000 new cases of TB resistant to rifampicin, “the most effective first-line drug.” Of these cases, almost 500,000 (490,000) had multidrug-resistant TB (MDR-TB). Forty-seven percent of the MDR-TB cases were seen in India, China, and the Russian Federation.

Although the 2016 mortality figures are down from those seen in 2000 (at 1.7 million), and are falling at a rate of about 3% per year, the WHO stresses that the decrease is not enough “to reach the first (2020) milestones of the End TB Strategy,” which are to reduce TB deaths by 35% and the incidence of TB infections by 20%.  

This is not the first time that the WHO has stressed that the world would be able to reach its targets. The organization stated similar sentiments this time last year when it released its 2016 report. Like last year, the WHO affirms that “most deaths from TB could be prevented with early diagnosis and appropriate treatment.” The global treatment success rate for the disease remains around 83%. A small success was seen in the number of individuals who were started on treatment for drug-resistant TB (up to 129,689 from 125,629 in 2015); however, the global treatment success rate remains low at 54%.

Although access to preventive treatment has expanded for individuals living with HIV and children under 5, those individuals who are eligible for preventive treatment are not accessing it. Poverty, HIV infection, undernutrition, and smoking are still the broader influences on the epidemic around the world. And, although WHO cites that research for “new diagnostics, drugs, treatment regimens and vaccines are progressing,” the organization feels that, “increased investment in research and development is needed for there to be any chance of achieving the technological breakthroughs needed by 2025.”

According to the report, “there are 17 drugs in Phase 1, 2, or 3 trials, including 8 new compounds, 2 drugs that have received accelerated or conditional regulatory approval based on Phase 2b results, and 7 repurposed drugs. Various new combination regimens are in Phase 2 or Phase 3 trials. There are 12 vaccine candidates in clinical trials: 3 in Phase 1, and 9 in Phase 2 or Phase 3.”
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