The year 2015 is a watershed moment in the battle against tuberculosis (TB). It marks the deadline for global TB targets set in the context of the Millennium Development Goals (MDGs), and is a year of transitions: from the MDGs to a new era of Sustainable Development Goals (SDGs), and from the Stop TB Strategy to the End TB Strategy. It is also two decades since WHO established a global TB monitoring system; since that time, 20 annual rounds of data collection have been completed. Using data from 205 countries and territories, which account for more than 99% of the world’s population, this global TB report documents advances in prevention, diagnosis and treatment of the disease. It also identifies areas where ef forts can be strengthened.
Main findings and messages
The advances are major: TB mortality has fallen 47% since 1990, with nearly all of that improvement taking place since 2000, when the MDGs were set. In all, ef fective diagnosis and treatment of TB saved an estimated 43 million lives between 2000 and 2014.
The MDG target to halt and reverse TB incidence has been achieved on a worldwide basis, in each of the six WHO regions and in 16 of the 22 high-burden countries that collectively account for 80% of TB cases. Globally, TB incidence has fallen by an average of 1.5% per year since 2000 and is now 18% lower than the level of 2000.
This year’s report describes higher global totals for new TB cases than in previous years, but these reflect increased and improved national data rather than any increase in the spread of the disease. Despite these advances and despite the fact that nearly all cases can be cured, TB remains one of the world’s biggest threats. In 2014, TB killed 1.5 million people (1.1 million HIV-negative and 0.4 million HIV-positive).
The toll comprised 890 000 men, 480 000 women and 140 000 children. TB now ranks alongside HIV as a leading cause of death worldwide. HIV’s death toll in 2014 was estimated at 1.2 million, which included the 0.4 million TB deaths among HIVpositive people.1 Worldwide, 9.6 million people are estimated to have fallen ill with TB in 2014: 5.4 million men, 3.2 million women and 1.0 million children. Globally, 12% of the 9.6 million new TB cases in 2014 were HIV-positive. To reduce this burden, detection and treatment gaps must be addressed, funding gaps closed and new tools developed. In 2014, 6 million new cases of TB were reported to WHO, fewer than two-thirds (63%) of the 9.6 million people estimated to have fallen sick with the disease.
This means that worldwide, 37% of new cases went undiagnosed or were not reported. The quality of care for people in the latter category is unknown. Of the 480 000 cases of MDR-TB estimated to have occurred in 2014, only about a quarter of these – 123 000 – were detected and reported. Although the number of HIV-positive TB patients on antiretroviral therapy (ART) improved in 2014 to 392 000 people (equivalent to 77% of notified TB patients known to be co-infected with HIV), this number was only one third of the estimated 1.2 million people living with HIV who developed TB in 2014. All HIV-positive TB cases are eligible for ART. Funding gaps amounted to US$ 1.4 billion for implementation of existing interventions in 2015.
The most recent estimate of the annual funding gap for research and development is similar, at about US$ 1.3 billion. From 2016, the goal is to end the global TB epidemic by implementing the End TB Strategy. Adopted by the World Health Assembly in May 2014 and with targets linked to the newly adopted SDGs, the strategy serves as a blueprint for countries to reduce the number of TB deaths by 90% by 2030 (compared with 2015 levels), cut new cases by 80% and ensure that no family is burdened with catastrophic costs due to TB.