Taking action against TB-diabetes

A message from Executive Director Jose Luis Castro

Last week the World Health Organization released new data showing that TB has become the world’s most deadly infectious disease, measured by numbers of people who die from the illness. TB killed 1.5 million people in 2014, including people with TB-HIV co-infection. That’s 890,000 men, 480,000 women and 140,000 children.

The report is a wake-up call.

It tells us that even as the world has made substantial progress against major diseases such as HIV/AIDS and malaria in recent years, progress against TB continues at a crawl.

It tells us that there remains a large gap between vision and action. Last year the World Health Assembly endorsed the End TB Strategy, which aims to reduce TB deaths by 95 per cent, to cut new cases by 90 per cent, and to ensure that no family is burdened with catastrophic costs due to TB—all by 2035. Yet the 2015 Global TB Report documents this campaign is stymied by a $1.4 billion gap in funding needed to deliver basic TB services on the front lines. TB efforts suffer from a dramatic shortage of human resources needed to deliver care. As a consequence, TB incidence is falling at a mere 1.5 per cent per year.

What this means is that ‘business as usual’ will not End TB; it will cost millions more lives. The people and communities affected by TB cannot afford business as usual.  

To achieve the End TB Strategy, we need to aggressively pursue more funding and human resources to expand the delivery of quality basic services, while we doggedly pursue innovative approaches that anticipate how the epidemic is changing with time.

Today, I’m proud to be among the public health experts, researchers, business and technology leaders and civil society from six continents who are convening at the world’s first summit on TB-diabetes in Bali, Indonesia. The summit is hosted by The Union, the World Diabetes Foundation and the Ministry of Health of the Government of Indonesia, with support from Becton Dickinson, Eli Lilly and Qiagen. Summit participants will sign onto the Bali Declaration on the Looming TB-Diabetes Co-Epidemic, a landmark document that lays out the rationale and priorities for action. I hope the summit will be a catalyst for a global response to TB-diabetes.

Diabetes increases the risk of developing TB two to three times. With diabetes escalating worldwide, unless we act, this trend will increasingly drive the TB epidemic. Recent studies conducted in places as diverse as India, the United States and the Pacific Islands countries have already shown rates of diabetes between 16 and 46 per cent among people diagnosed with TB. We’re witnessing an alarming trend: high-TB-burden countries make up six of the 10 countries expected to have the highest numbers of people living with diabetes by 2035.

A key solution is to implement bidirectional screening for TB and diabetes, where people diagnosed with TB are screened for diabetes, and, in certain contexts, people with diabetes are screened for TB. Getting this done will require closer and more thoughtful collaboration between stakeholders in infectious diseases and non-communicable diseases.

We must not ignore the wake up call contained within the WHO report. The power to end TB is in our hands. To be successful, we must be better at quickly adapting our own actions to the realities of a changing epidemic.