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GHN EXCLUSIVE | GLOBAL HEALTH | HEALTH SYSTEMS | INFECTIOUS DISEASES | RESEARCH | WHO

A Roadmap for Ending the Moral Catastrophe of TB

March 20, 2019

MICHAEL REID
GAVIN YAMEY

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Indian TB patient Sonu Verma, 25, poses with his chest x-ray in Sonipat, March 3,
2016. Image: Money Sharma/AFP/Getty

The good news is that tuberculosis deaths are declining steadily. The bad news is that
we are wildly off track to meet the bold targets set for controlling the world’s #1 lethal
infectious disease.

The Sustainable Development Goals call for a 90% reduction in TB deaths by 2030.

And the WHO’s End TB strategy calls for a 90% reduction in TB incidence by 2035. Yet
at current rates of decline, a 90% reduction in TB incidence probably will not be
achieved in in India until 2124 or in Uganda until 2134, for example.

Such slow progress inevitably means an enormous burden of suffering and mortality.
Yet TB is preventable, treatable and curable—making the avoidable burden of TB a
moral catastrophe.

Fortunately, there is a growing momentum to address the lack of progress.

In September 2018, all 193 UN member states adopted a political declaration on TB

committing them “to accelerate national and collective actions, investments and
innovations in fighting the preventable disease.” Translating that declaration into
concrete action requires a roadmap for how high-burden countries and their donor
partners should prioritize investments toward ending the epidemic. The Lancet
Commission on Tuberculosis Report, published this week by an international group of
76 authors, including ourselves, provides that roadmap.

The report, Building a Tuberculosis-Free World, highlights the critical importance of

scaling up proven TB control strategies, such as TB preventive therapy, drug
susceptibility testing (so that patients receive the right treatment), and second-line
drugs to treat drug-resistant TB. Improving the quality of TB care is also essential. The
commission found that in India alone addressing poor quality care, especially in the
private sector, will save more than 8 million lives over the next 25 years. Failing to
implement these proven strategies in high-burden countries has huge economic
consequences: In India alone, failure to achieve the SDG targets costs the economy $32
billion every year.

The report highlights that increased investment in TB control is likely to bring large
economic returns. For example, the commission estimates that the benefit-to-cost
ratio for TB interventions is 7:1. Greater domestic resource mobilization, especially in
middle-income countries, will be key. Countries such as Bangladesh, China, Indonesia,
and Zambia could increase their annual TB expenditures more than 5-fold over the next
5 years through increased revenue generation and allocation of greater budgetary
resources to health.

To accelerate progress, we also need new TB control technologies. While the Stop TB
Partnership estimates that it will take an annual investment of $2 billion to develop
critically needed products, we are only spending around $700 million per year. Closing
the funding gap for TB product innovation will require all countries, especially high- and
middle-income countries, as well as the private sector, to increase their investments.
Finally, the report underscores the importance of accountability to ending the
epidemic. Establishing greater accountability at all levels, from heads of state to the
local TB clinic, is necessary to ensure that promises are kept and targets reached. To
this end, the commission plans to launch a “TB Observatory” to track progress toward
global targets. Meeting annually over the next 5 years, the Observatory will evaluate
country progress towards global targets and ensure that the report’s recommendations
lead to urgent policy changes, helping high-burden countries develop strategies to
address their TB epidemics and also to secure universal health coverage.

Many countries, including China, Cameroon and Ethiopia, have achieved substantial
declines in TB mortality over a 20-year period. Other countries could achieve similar
results. With bold leadership, shared responsibility, and smart investments based on
sound science, we can end TB within a generation.

Michael Reid is an assistant professor of Medicine in the School of Medicine at the

University of California, San Francisco and also works at the UCSF Institute for Global
Health Diplomacy and Delivery. Twitter: @MikeReidMD

Gavin Yamey is a professor of Global Health and Public Policy at Duke University,
where he directs the Center for Policy Impact in Global Health at the Duke Global
Health Institute. Twitter: @gyamey

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TAGGED TUBERCULOSIS TB INFECTIOUS DISEASES TB OBSERVATORY STOP TB PARTNERSHIP

UNIVERSAL HEALTH COVERAGE TREATMENT CHINA INDIA UGANDA INDONESIA CAMEROON ZAMBIA
BANGLADESH ETHIOPIA MICHAEL REID GAVIN YAMEY

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