The Director’s Corner

The Director’s Corner

Drug resistance threatens TB progress, as delegates prepare for Union World Conference on Lung Health in Liverpool 

A message from José Luis Castro

Today (13 October), the World Health Organization (WHO) published its annual Global Tuberculosis (TB) Report for 2016.  This study provides an up-to-date assessment of TB, the impact and spread of the disease, and the progress made in financing and implementing data and services that contribute to its prevention, care and control, both globally and regionally.

In the 2016 edition, a stark message stands out – that global action and investments fall far short of those needed to end the global TB epidemic for good. 

Reviewing the previous year, the report concludes that the TB epidemic surpasses previous estimates - 10.4 million new TB cases recorded worldwide, of which 10% were in children. The rate of decline in TB incidence remained at only 1.5% from 2014 to 2015. This needs to accelerate to a 4–5% annual decline by 2020 to reach the first milestone of the End TB Strategy.*

Additionally, in 2015 there were an estimated 480,000 new cases of multidrug-resistant TB (MDR-TB) and an additional 100 000 people with rifampicin-resistant TB (RR-TB) who were also eligible for MDR-TB treatment. India, China and the Russian Federation accounted for 45% of the combined total of 580,000 cases.   And the crisis of MDR-TB detection and treatment continues.  Only 125,000 of these new cases were enrolled for treatment.  Five countries accounted for more than 60% of the treatment gap – India, China, the Russian Federation, Indonesia and Nigeria.

We must solve the crisis of drug resistance - both treating it and preventing it - by implementing basic TB programmes effectively, especially in those countries where health services and infrastructure are under-resourced.

The recent WHO recommendation of a new shortened regimen for treating multidrug-resistant TB (MDR-TB) – nine-months rather than the previous 24-month standard and based on critical Union research evidence - is a major step forward.  But the next challenge is to ensure that treatment gets to patients as quickly as possible. If we are to end the TB epidemic by 2035, we need to triple our rate of progress in a short period of time and that means tackling MDR-TB head on. It means investment in low- and middle-income countries has to be stepped up and funding for TB research and development given priority by governments worldwide.

When the world’s TB community comes together at The Union World Conference on Lung Health later this month in Liverpool, the main point of discussion is going to be how we confront resistance in all its forms—resistance from those who have vested interests elsewhere, resistance to drugs that are no longer working, resistance to innovative solutions. In short, anything that stands in the way of ending the TB epidemic. 

What the WHO report tells us is the data are crying out for fresh thinking and approaches.  The TB community must rise to that challenge and provide them.

(Note: *The WHO End TB Strategy calls for a 90% reduction in TB deaths and an 80% decrease in TB incidence by 2030, with a complete eradication of the disease by 2035.)

The 47th Union World Conference on Lung Health takes place in Liverpool, UK, between 26-29 October.  The conference theme is Confronting Resistance – Fundamentals to Innovations.

Registration and information here: www.worldlunghealth.org

Read the WHO Global Tuberculosis Report 2016 here (PDF 6.9MB)