Global Elimination of Tuberculosis: How close are we?
By: Christopher C. Whalen, Director of Global Health Institute, Ernest Corn Professor of Infectious Disease Epidemiology, College of Public Health, University of Georgia
In the US, we do not often consider tuberculosis as a major public health problem. It is, indeed, true that rates of tuberculosis are at historic lows in the country, and the prospect of eliminating tuberculosis is just around the corner. In fact, in 2017, a total of 9,093 cases of tuberculosis were reported which represents a 1.8% reduction in the number of cases from 2016 and a 44% reduction in cases in the US since 2000.
From a global perspective, there is also evidence for improvement. According to the World Health Organization (WHO), the global burden of tuberculosis peaked in 2000 and has since declined by 1.5% per year. The number of deaths from tuberculosis has also dropped by 37% since 2000 due to improved diagnosis and better access to standard anti-tuberculosis therapy.
Although encouraging, the modest progress in tuberculosis control falls short of the Millennial Development Goals set for tuberculosis elimination by 2030. Indeed, there are unambiguous signs that global control of tuberculosis is not yet achieved. For example, tuberculosis is the ninth leading cause of death worldwide and the leading cause of death from an infectious disease, as over 1.7 million people die per year of the disease. Moreover, the average global decline in tuberculosis incidence hides an inconvenient truth about tuberculosis: some parts of the world experience steady declines in incidence, whereas other regions, such as sub-Saharan Africa, continue to face high burden of disease.
The HIV pandemic continues to disrupt global efforts to control tuberculosis. People living with HIV are 20 times more likely to develop tuberculosis than people without HIV. The advent of antiretroviral treatment for HIV has made a measurable impact on reducing tuberculosis in HIV-infected people, but tuberculosis still remains a common opportunistic infection and leading cause of death among those with HIV infection.
The control of tuberculosis is further compounded by the wide-spread emergence of multidrug resistant strains, which may be found in nearly every country around the world. Because of the complexity of diagnosis and the long duration of treatment with expensive medications, this form of tuberculosis imposes additional financial costs to underfunded programs.
Like many health conditions, tuberculosis affects children. In any year, over 1 million children become ill with tuberculosis and about 20% of these children die from the disease. Because of how tuberculosis is spread, most children are infected by a parent or adult family member, so the disease seems to run in families.
Despite the remarkable success we have had in controlling tuberculosis in the US, the disease still exacts its toll, as it does elsewhere in the world. Although the number of cases has dropped, there are still between 450 and 500 deaths per year from tuberculosis. Moreover, drug-resistant disease threatens our ability to treat and control tuberculosis in the US, as nearly 100 new drug-resistant cases were diagnosed last year.
One may ask why we have not made greater progress toward the elimination of a disease that is both treatable and preventable. Our standard treatment is effective against most cases of tuberculosis, yet millions die each year and drug-resistant disease grows. We have a vaccine that protects children from disease, yet many children still contract the disease and die. We have medication to prevent tuberculosis, but it is not widely used in settings of greatest risk for disease.
The answer may be as straightforward as commitment. That is commitment on the part of all governments to unite in a coordinated strategy to eliminate tuberculosis. This approach has been articulated in the Sustainable Development Goals, which call for a 90% reduction in tuberculosis deaths and an 80% reduction in tuberculosis disease by 2030.
2018 holds a truly unique opportunity since the United Nations General Assembly will hold its first high-level meeting on tuberculosis in September. This meeting promises to build and fortify the global commitment to end tuberculosis. If previous such meetings prove instructive, the coming months and years will see a heightened awareness about tuberculosis and a greater allocation of resources toward tuberculosis control. So looking ahead, governments, ministries of health, disease control programs, non-governmental organizations, and other interested parties should heed the upcoming UN resolutions and stand poised and committed to respond to the calls to end tuberculosis.
Featured photo: Team at the Lubaga Hospital TB Clinic. UGA is a partner with Makerere University in Kampala, Uganda.