An Enduring Epidemic

“Global actions and investments fall far short of those needed to end the global [tuberculosis] epidemic.”

World news has been full of bacteria lately, most notably in the wake of the United Nations General Assembly’s resolution on antimicrobial resistance. Given the high-profile nature of that meeting and its outcomes, it would be easy to overlook some of the other recent data – such as the World Health Organization’s 2016 Global Tuberculosis Report (1), which highlights a significant gap between the UN’s goal to end the worldwide TB epidemic and the actions currently being taken to achieve it.

The targets involve an 80 percent reduction in the disease’s incidence rate and a 90 percent reduction in deaths by 2030 – but since 2015, when those targets were established, the epidemic has proven to be larger than expected. Multi-drug-resistant TB (MDR-TB), in particular, is causing crisis: only one-fifth of eligible patients are enrolled for treatment, and the treatment success rate is just over 50 percent. The numbers for extensively drug-resistant TB (XDR-TB) are even worse, with only 28 percent of patients successfully treated.

That’s not to say there’s been no improvement – quite the opposite. More countries than ever are testing newly diagnosed TB patients for rifampicin resistance, at least 23 have introduced new, shorter treatment regimens for drug-resistant disease (with success rates up to 90 percent), and at least 70 countries have begun to use new antibiotics like bedaquiline and delamanid against MDR- and XDR-TB. It’s a good start – but it’s not enough. The current funding gap for TB care and prevention is nearly US$2 billion and expected to increase, and an additional $1 billion is needed to develop new vaccines, diagnostics and treatments. And the barriers aren’t just monetary; patients need better education and improved access to care. Will the WHO’s report prompt the necessary actions? That remains to be seen…