The Global Plan to End TB

The STOP TB Partnership recently released a document entitled Global Plan to End TB: http://www.stoptb.org/assets/documents/global/plan/GlobalPlanToEndTB_TheParadigmShift_2016-2020_StopTBPartnership.pdf

It’s a forward looking document that recommends a “paradigm shift” in the way we approach the TB epidemic with a heavy focus on Key Affected Populations. The Global Plan to End TB delivers a very blunt message to the world – without an immediate and large increase in investment to fight TB, the global fight to eliminate the disease as a public health threat by 2035 (as spelt out in the World Health Organization’s End TB Strategy) will be missed. And if the glacial global decrease in TB incidence of 1.5 per cent per year continues, the disease will remain a public health threat for another two centuries. 

The Global Plan to End TB is aiming to reach the following targets, called 90-(90)-90:

i.        To have 90% of all people with tuberculosis diagnosed and treated

ii.        As part of part (i), ensure 90% of the most vulnerable populations in all countries are diagnosed and treated. Vulnerable populations include mining communities, children, people living with HIV, injecting drug users, prisoners, homeless people, Indigenous populations and migrants among others. Vulnerable populations exist in all countries, from the poorest to the richest.

iii.        Ensure 90% of people diagnosed successfully complete treatment with services to ensure adherence and social support.

A complete overhaul of the ‘business-as-usual’ methods of dealing with TB will be needed to achieve these ambitious targets. But it is the only way that the very small decline in TB incidence in recent years (around 1.5% per year) can be accelerated to the 10% annual decline needed globally to reach the recently announced WHO End TB targets – which aim to reduce TB incidence to a global average of 10 new cases per 100,000 population or less by 2035, effectively ending the disease as a public health threat. If the woefully inadequate 1.5% annual decline continues, TB is unlikely to be eliminated for another 150 years.

“It is a global disgrace and human tragedy that TB – a curable disease – is killing around 1.5 million people per year and nobody speaks about ending it,” says Dr Lucica Ditiu, Executive Director of the Stop TB Partnership. “We know it can be done, we know how it can be done, we know how much it will cost us – we need to have the desire to do it and energy to move on. Ours can be the generation remembered as the one that turned the tide on this enormous yet treatable epidemic,” she adds.

To implement the actions proposed in the Global Plan to End TB first and foremost, a change in mindset is required – with a combination of existing tools and new ones in development, the disease can and will be defeated. The new strategy is centred on a human rights and gender approach, stronger political leadership and a community and patient-based focus. And the plan also highlights we must also have new and innovative TB programmes, integrated interventions within country health systems, and improvements to the poor socioeconomic conditions in which TB can thrive (including overcrowded housing and undernutrition).

This battle with TB cannot be won without new tools. For this, the Global Plan calls for an additional US $9 billion, needed for vital research and development to create a vaccine that protects people of all ages against TB, highly sensitively rapid diagnostic tests that can be implemented at the point of care, and drug regimens (including for drug-resistant TB) that are highly effective and non-toxic.