17 October 2012

WHO: 20 Million Lives Saved by TB Care and Control

I wrote this originally for the PSI Impact Blog.

Cambodia transformed from a country shouldering a remarkably high TB rate 20 years ago to a nation experiencing rapid declines in the number of TB cases. By implementing WHO-recommended  services such as Directly Observed Therapy – Short Course (DOTS), Cambodia has witnessed clases decline by 45% from 2002 to 2011. Health centers providing DOTS services grew from 60 to 1000 in only five years.  “Cambodia changed a health crisis into an opportunity,” says Dr Ikushi Onozaki, from WHO’s Stop TB Department in WHO article.

The WHO says that the success of Cambodia is a reflection of implementing WHO recommendations for the treatment of TB. The report Global Tuberculosis 2012 released today by the WHO today estimated that some 20 million people are alive today thanks to improved care and control for TB.

“In the space of 17 years, 51 million people have been successfully treated and cared for according to WHO recommendations. Without that treatment, 20 million people would have died,” says Dr Mario Raviglione, Director of the WHO Stop TB Department. “This milestone reflects the commitment of governments to transform the fight against TB.”

A decrease in the TB mortality rate by 41% since 1990 puts the global effort on track to reach the Millennium Development Goal target of a 50% reduction by 2015. Technical advances like the rapid molecular test Xpert MTB/RIF provide further support in the effort to reduce the global burden of TB.This week also saw the promising announcement by Oxford University researchers that they will know whether their MVA85A vaccine is effective against TB by early 2013.  “If the results meet our expectations it will be a turning point,” said Helen McShane, professor of vaccinology at Oxford university, to the Financial Times. “It will transform the field.”TB vaccines offer little opportunity to make money for pharmaceutical companies since TB is largely a disease of poverty. “It’s been hard to make a convincing market argument for TB drugs,” Ann Ginsberg, vice president of scientific affairs at TB vaccine non-profit Aeras, told PlusNews. “The reality is that the vast majority of companies working on TB drugs do not expect to make any profit from it. They are in it because they think it is the right thing to do. They hope not to lose money in the process, but they don’t expect to make any,” she said.

Multidrug-resistant TB (MDR-TB) is an area that the WHO admits needs more work. The number of cases in the 27 countries with the greatest MDR-TB burden is increasing. India announced the discovery of the first cases of 'totally drug-resistant TB" in December of 2011. The WHO responded by working with the Indian government and convening a group of 40 experts to determine how to act.

The report says that the Indian government has implemented several measures to address totally drug-resistant TB.
In Mumbai, laboratory and hospital facilities were improved, contact-tracing stepped up and efforts made to train staff on drug-resistant TB and infection control. Medical staff and funding were increased substantially. Access to second-line drugs was provided to eligible patients. National regulations governing private sales of anti-TB medication were strengthened. By the end of 2012, all 35 states in the country are expected to provide programmatic management of drug-resistant TB. In May 2012, India made TB a notifi able disease and data collection on TB using a webbased system was initiated
In order to ensure that the number of cases of TB continues to decline and problems like MDR-TB are reeled in, the WHO says that $1 billion in donor funding is needed in low and middle-income countries through 2015. That figure represents a doubling of present.

Another $1 billion will be needed to support HIV-positive TB patients. Roughly one out of ever four people with HIV also have TB. By ensuring that countries have the financial ability to implement the WHO guidelines, the WHO believes that the burden of TB can continue to drop.

“Cambodia’s success in providing universal access to TB care and treatment is remarkable but there is still a long way to go,” says Dr Pieter van Maaren, WHO Representative in Cambodia. “Many people are infected and public health work to detect and treat the disease will be needed for a long, long time.”