Targets are realistic, but projected shortfall of US$ 4.2 billion (about R28.5 billion) per year for TB care and crucial research must be filled
The world could be on its way towards eliminating tuberculosis (TB) if governments and donors fully invest in a plan released today by the Stop TB Partnership.
The Global Plan to stop TB 2011-2015: Transforming the Fight-Towards Elimination of Tuberculosis for the first time, identifies all the research gaps that need to be filled to bring rapid TB tests, faster treatment regimens and a fully effective vaccine to market.
It also shows public health programmes how to drive universal access to TB care, including how to modernize diagnostic laboratories and adopt revolutionary TB tests that have recently become available.
"There is an urgent need to scale up action against TB - 10 million people, including 4 million women and children, will lose their lives unnecessarily between now and 2015 if we fail," says Dr Margaret Chan, Director-General of the World Health Organisation (WHO), which hosts the Stop TB Partnership.
"TB control works, with global incidence of the disease declining since 2004, although much too slowly."
A big burden
Twenty-two countries, including South Africa, bear 80% of the burden of TB worldwide.
Some 9 million people become ill with active TB and nearly 2 million die each year. The new Global Plan sets out to provide diagnosis and treatment approaches recommended by the World Health Organization (WHO) for 32 million people over the next five years.
"The Global Plan to Stop TB provides an urgently needed blueprint to cut global TB deaths by half," says Dr Aaron Motsoaledi, Minister of Health of South Africa.
"In South Africa we have embarked on an ambitious agenda for reducing the toll of TB on our people, and we are committed to meeting the Global Plan's targets. We call on world leaders to invest in the plan, which can help move us towards ridding the world of TB."
Six month treatment
Although TB is curable, the treatment requires taking a combination of drugs for at least six months. Laboratories in most countries are still using a century-old diagnostic method that involves searching for TB bacteria derived from a person's sputum under a microscope.
There is still no vaccine able to prevent pulmonary TB, the most common form of the disease.
In addition to helping public health programmes adopt already existing modern diagnostic tests, the Global Plan sets a research agenda aimed at engendering two new "while-you-wait" rapid tests that trained staff at even the most basic health outposts can use to diagnose TB accurately.
Three new drug regimens by 2015
By 2015, the aim is for three new drug regimens - one for drug-sensitive TB and two for drug-resistant TB - to be going through Phase III clinical trials, the final step before drugs are released to market. Four vaccine candidates should be at the same stage of testing.
The Global Plan provides a clear roadmap for addressing drug-resistant TB. It calls for 7 million people to be tested for multidrug-resistant TB (MDR-TB) and one million confirmed cases treated according to international standards over the next five years.
Half a million people die each year from HIV-associated TB. Provided the plan's targets are met, by the end of 2015, all TB patients will be tested for HIV and, if the test is positive, receive anti-retroviral drugs and other appropriate HIV care.
In HIV treatment settings, all patients will be screened for TB and receive appropriate preventive therapy or treatment as needed.
On financing, the Global Plan calls for US$ 37 billion (about R251 billion) for implementation of TB care between 2011 and 2015. A funding gap of about US$ 14 billion (about R95 billion)- approximately $US 2.8 billion (about R17 billion)per year - will remain and needs to be filled by international donors.
The plan includes a separate calculation of the funding required to meet targets for research and development: a total of US$ 10 billion (about R 68 billion), or $US 2 billion (about R13.6 billion) per year. High-income countries and those with growing economies will need to increase their investment in research and development to fill an estimated gap of about US$ 7 billion (about R47.6 billion), or $1.4 billion per year(about R 9.52 billion).
In 2006 the Stop Partnership launched the Global Plan to Stop TB 2006-2015. The new roadmap for 2011-2015 follows on that earlier plan while setting new and more ambitious targets for the next five years.
(WHO and Stop TB, press release, October 2010)