On 19 May, the World Health Assembly approved the World Health Organisation’s new strategy for addressing the global TB epidemic after 2015. The strategy provides ambitious new direction for eliminating tuberculosis as a global epidemic by 2035, with important milestones to achieve by 2025.
The strategy includes three pillars:
1) Integrated, patient-centred care and prevention, which includes a call for early diagnosis and treatment and for systematic screening of people who come in contact with those who have TB—strategies that have been in place for some time in developed countries but have not yet become the norm in developing countries.
2) Bold policies and supportive systems, which call on countries to contribute resources and implement policies necessary to deliver the interventions laid out in the first pillar.
3) Intensified research and innovation, which recognises that the technologies and medicines we have now are good enough to make some continued progress, but are ultimately inadequate for eliminating TB as a global epidemic. Notably, the research pillar includes operational research, which is important for learning how to best apply knowledge in local, real-world settings, and an area where The Union is a pioneer.
When the three pillars are implemented effectively, the strategy aims to reduce the number of annual TB deaths by 90 percent, the number of people who develop the disease each year by 95 percent, and to eliminate the catastrophic financial loss that families affected by TB often suffer.
WHO’s Global TB Department should be commended for putting together an ambitious strategy that is both comprehensive and easy to understand. The strategy’s clarity and vision should aid advocates who will do the heavy lifting to ensure that governments and actors in the private sector now do their parts to allocate the human and financial resources necessary to execute it.
The Union will be a strong partner in the implementation of this strategy, working with governments around the world to provide technical assistance, scientific leadership and training.
As I laid out in a recent op-ed, it is important that the global approach to TB elimination adapts in order to make faster progress against the epidemic. Namely, we need to start addressing TB’s linkages with non-communicable diseases like diabetes and tobacco use, which will cause increasing numbers of people to develop TB, especially in middle-income countries.
As The Union’s Senior Advisor Tony Harries recently said, "In areas where TB prevalence is high, both diabetes and smoking independently increase the risk of getting TB, the risk of relapse even after successfully completing treatment and the risk of dying while on anti-TB treatment." An integrated approach to TB and diabetes, and TB and tobacco use, will be important pieces of the strategy’s first pillar.
And as my colleagues explained in a recent paper in the medical journal The Lancet Global Health, operational research, which I mentioned above, is an important but currently under-funded piece of the research agenda. They write, “A crucial gap remains between the development of efficacious health interventions and their optimum delivery in real-life settings. This gap is particularly true in many low-income and middle-income countries (LMICs).” Finding resources to conduct more operational research—especially in low-income countries—and to shape policy and practice based on the findings, will be critical to achieving the new strategy.
See here for a fact-sheet on the new WHO post-2015 TB strategy and targets.
José Luis Castro
Executive Director
The Union