The latest annual report on global tuberculosis control from the World Health Organisation celebrates the progress made so far - but warns that all could be lost if drug-resistant strains are not kept in check and money for new tools is not forthcoming
Twenty million lives have been saved from tuberculosis over the past 17 years, but the battle against one of the deadliest scourges of mankind is now on a knife's edge, as drug-resistant strains spread, according to the World Health Organisation.
Its annual report shows that a race is on between the spread of deadlier TB strains and the development of new technologies that have the potential to stamp out the disease. This was Dr Mario Raviglione, director of the WHO Stop TB Department:
The momentum to break this disease is in real danger. We are now at a crossroads between TB elimination within our lifetime, and millions more TB deaths.
Huge efforts have been made to defeat TB, which was once thought to have been eradicated in more affluent nations but is now a re-invigorated threat to the whole world. Some 51 million people have been treated since 1995 according to WHO recommendations, which involve six months of antibiotics taken under observation, because of the importance of finishing the course.
"Without that treatment, 20 million people would have died," said Raviglione. "This milestone reflects the commitment of governments to transform the fight against TB."
The numbers of people falling ill have continued to drop, by 2.2% last year and the mortality rate has gone down by 41% since 1995. But there were still 8.7 million new cases last year and an estimated 1.4 million deaths.
But the real fear is that the steady progress against TB will not be enough to defeat the resistant strains that have emerged and are now spreading. The report talks of a "persistently slow response" to multi-drug resistant TB. Only one in five cases that are thought to exist are being diagnosed world-wide, and unless they are detected and treated, drug-resistant virus will be passed on. A paper published by the Lancet medical journal in August found an alarming rate of increase in drug resistant cases.
On the positive side, the WHO report says a diagnostic test that can be used in the field and new drugs on the way, the first of which is expected to become available next year. There are a number of new potential vaccines. The executive summary says:
New or re-purposed TB drugs and novel TB regimens to treat drug-sensitive or drug-resistant TB are advancing in clinical trials and regulatory review. Eleven vaccines to prevent TB are moving through development stages.
But there is not enough money to pay for the new tools that are needed. The report talks of "critical funding gaps for research and development". $2 billion a year is needed, but in 2010, the funding gap was $1.4 billion.
A strongly-worded editorial in the Lancet emphasises the danger:
Overall, the approach to tuberculosis control is not returning the kind of impact the world should expect to see. Insufficient attention and funding over several decades have allowed the global epidemic to remain a deep scar on the reputation of global health. And looking ahead, the report warns the situation could worsen and the gains be reversed if the substantial funding gap is not filled. The existing control approach has taken a short-term view with heavy reliance on treatment and cure. But the health systems of many countries have simply been ill-equipped to deal with the complexities of managing tuberculosis, a fact proven by the escalating rates of MDR and XDR disease.
It calls on UN secretary general Ban Ki-moon to break the gridlock, by setting up a Global Commission on Tuberculosis Elimination, which should recommend a fresh strategic approach by September next year.