4% annual decrease too slow to end TB by 2030 – call for Europe’s commitment to increase investment to end TB
A new report published by the European Centre for Disease Prevention and Control (ECDC) and the WHO Regional Office for Europe indicates that the number of new tuberculosis (TB) patients has been decreasing at an average rate of 4.3% yearly in the last decade in the WHO European Region. Despite being the fastest decline in the world, this trend is insufficient to achieve the target of ending the TB epidemic by 2030, as envisioned in the End TB Strategy and the Sustainable Development Goals. The new report is released ahead of World Tuberculosis Day, which this year calls on global leaders to accelerate efforts to end TB once and for all.
“It is not enough to ‘walk’ towards ending TB, as this way we would arrive too late for too many people. We need to ‘leap forward’ and invest now for individual benefits and societal returns. The Tuberculosis action plan for the WHO European Region 2016–2020 shows that bold actions will save over 3 million lives and US$ 48 billion in 5 years in the Region,” says Dr Zsuzsanna Jakab, WHO Regional Director for Europe. “We need to revamp political commitment at all levels to achieve tangible and immediate results that change and save the lives of all those people suffering from TB today and ensure a TB-free world for our children tomorrow.”
Recalling the 2030 Agenda for Sustainable Development, Dr Vytenis Andriukaitis, European Commissioner for Health and Food Safety, adds, “The European Commission is fully committed to helping Member States reach the goal of ending TB by 2030. I urge leaders in Europe and beyond to take a multisectoral approach to TB, mobilizing the necessary funds for research, ensuring access to preventative and curative health care for all, and addressing the social conditions that encourage its spread.”
Dr Andrea Ammon, ECDC Director, says, “Remaining vigilant about TB even in low-incidence settings is important due to the potential resurgence of this airborne disease, especially in light of increased population mobility and of multidrug-resistant TB.” She adds, “New technologies to aid investigations of cross-border outbreaks of multidrug-resistant TB, such as whole genome sequencing, are key in curbing transmission in the European Union/European Economic Area.”
Despite progress, TB, especially in its drug-resistant forms, remains a major public health concern in the WHO European Region. Latest data from the TB surveillance and monitoring report indicate that 1 in 4 MDR-TB cases is not detected in the WHO European Region. While diagnosis of MDR-TB patients increased from 33% in 2011 to 73% in 2016, it remains below the regional target of 85% defined in the European TB action plan.
Treating cases with drug resistance is another challenge: the observed increase in treatment success from 46% in 2013 to 55% in 2016 is still insufficient for European countries to reach the 75% target for 2020 they committed to in the action plan.
The spread of extensively drug-resistant TB (XDR-TB) is an additional threat to ending TB in the WHO European Region. With the rapid rollout of drug-susceptibility testing and improved surveillance, countries detected 5000 XDR-TB cases in 2016 in the WHO European Region, but on average only 1 in 3 patients with XDR-TB is cured.
In the European Union/European Economic Area (EU/EEA), the rate of notified MDR-TB cases has remained unchanged since 2012, at 0.3 per 100 000 population. However, the proportion of XDR-TB cases among MDR-TB cases increased from 13.9% to 20.6% in the same period. Treatment success rates for both MDR-TB and XDR-TB remain low.
To address this threat, the ECDC launched a pilot project in 2017 on the use of whole genome sequencing (WGS) technology to improve the detection and investigation of Mycobacterium tuberculosis in the EU/EEA. The project will establish common standards for WGS in investigating MDR-TB bacteria strains and tracing outbreaks. It will also enable all EU/EEA countries without WGS capacity to utilize the technology by connecting them with institutes with robust experience in WGS.
While 2018 marks the 10th anniversary of the Berlin Declaration “All Against Tuberculosis”, and as the world prepares for the first-ever United Nations General Assembly on tuberculosis in September this year, there is a dire need for further commitment to accelerate the pace of TB elimination.
This entails using existing modern and rapid diagnostic technologies; enhancing research for new tools; developing and implementing regulations to scale up access to new medicines and shorter treatment regimens; and working together with all sectors, including civil society, patients and communities, with a whole-of-society approach.
Increased collaboration and intensified allocation of resources are crucial to ensure that every TB-affected person has access to quality health services for early detection, successful treatment and people-centred care.