It’s Time to End Tuberculosis

In 2017, 9,105 cases of tuberculosis (incidence 2.8 cases per 100,000 persons) were reported to U.S. Centers for Disease Control and Prevention. Since TB surveillance began in the U.S. in 1993, case rates have steadily declined and reflect the effect of strong and well-resourced TB control programs. However, a slowing rate of decline has raised concern about the difficulty of the final steps of disease elimination.

Globally, the news is not so promising. The World Health Organization (WHO) estimates that in 2017, there were 10 million new cases of tuberculosis worldwide, two-thirds arising in just eight countries (India, China, Indonesia, Philippines, Pakistan, Nigeria, Bangladesh, and South Africa). In 2017, TB claimed over 4,500 lives a day with an estimated 1.3 million deaths caused by TB alone and an additional 300,000 deaths from TB in persons with HIV infection. Therefore, TB is one of the top 10 causes of death worldwide and the leading cause of death from a single infectious agent.

Kenya, where I live, is much more reflective of the global TB situation than the U.S. Kenya is one of the top 30 countries with highest burden of TB, where TB is at an epidemic level. There were 85,000 estimated cases in Kenya in 2017, with an incidence of 319 per 100,000 adult population, a rate that is over 100 times higher than the U.S. The concurrent epidemic of HIV, over half of the country’s urban population living in slums, and only half of TB cases detected and treated all add fuel to Kenya’s rampant TB firestorm. To increase case finding, some outpatient clinics screen sputum for TB in every person reporting cough of any duration. The first promising signals are present, case finding has increased, which suggests that some of the large proportion of missed cases are finally being identified.

The news is not all bad. Important new and powerful tools for TB control have been developed. Tests including Xpert MTB/RIF and Xpert ULTRA allow the diagnosis of TB within two hours and inform drug resistance. Late last year, the New England Journal of Medicine published a landmark study showing that a new TB vaccine may be possible (Van Der Meeren et al. 2018).

With increasing understanding of the global toll of TB, WHO and the United Nations (UN) have committed to end the global TB epidemic with targets to reduce TB deaths by 90% and TB incidence by 80% by 2030. In the first High-Level Meeting of the UN General Assembly on TB in New York in September 2018, a historic Political Declaration with specific, measurable milestones was made, and an additional $41 million was appropriated for the United States Agency for International Development (USAID) global TB program to support these commitments. By adopting this declaration, national leaders have recognized TB as a challenge and have committed to taking specific actions.

Worldwide, TB incidence is falling at about two percent per year but incidence and mortality rates are not declining fast enough to meet these ambitious goals. Achieving the targets will require the efforts of many stakeholders, including country leaders, government ministries, civil society, TB-affected communities, the private sector and global agencies.

STOP TB is an UN-affiliated organization committed to TB control and works with over 1,700 partners including international and technical organizations, government programs, research and funding agencies, foundations, civil society and community groups and the private sector. TB is a disease that disproportionally affects poor and underserved communities and needs the voices of strong advocates, including healthcare providers to keep attention directed at its control and eventual elimination. This year for World TB day, STOP TB is building public awareness with their “It’s TIME” campaign, encouraging partners to plan events and post social media messages around this theme.