1.1 Background

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Tuberculosis (TB) continues to be a global public health problem, particularly in the developing countries. Nearly one-third of the global population (i.e., two billion people) is infected with Mycobacterium tuberculosis (MTB) and is at risk of developing the disease. The United Nations High-Level Meeting on (UNHLM) TB on 26 September 2018, with attendance of heads of the state and other eminent people, provided a platform to reinforce the commitments and actions needed to end the global TB epidemic in line with the World Health Organization’s (WHO) End TB Strategy, and by the Sustainable Development Goals (SDGs) deadline of 2030.

According to the Global TB Report 20201, TB causes ill health among millions of people each year and is a leading cause of death from a single infectious agent (ranking above HIV/AIDS). WHO recently released an updated report2 on leading causes of death and disability worldwide between 2000-2019. According to that report, although TB is now the 13th leading cases of deaths worldwide with 30% reduction in global TB deaths between 2000 and 2019, it still remains among the top 10 causes of deaths in the African and South-East Asian regions, where it is the 8th and 5th leading cause respectively.

Globally, an estimated nearly 10 million (range 8.9– 11.0 million) population developed TB in 2019 and TB caused an estimated 1.2 million (range, 1.1–1.3 million) deaths among HIV-negative people in the same year (a reduction from 1.7 million in 2000). Further, it is estimated that an additional 208,000 HIV positive people died from TB (a reduction from 678,000 in 2000) in 2019. Overall, adult (aged > 15 years) men and women accounted for 56% and 32% of cases respectively while children (<15 years) made up the remaining 12% of cases globally. Among all affected, 8.2% were people living with HIV (PLHIV). South East Asia Region (SEAR) alone accounted for nearly 44 % of global TB cases in 2019.

Drug-resistant TB remains a public health crisis and a global health security threat. Globally in 2019, nearly half a million (465,000) people developed rifampicin-resistant TB (RR-TB), of which 78% had multidrug-resistant TB (MDR-TB). Furthermore, 3.3% of new TB cases and 17.7% of previously treated cases had MDR/RR-TB.

The Global targets and milestones for reductions in the burden of TB disease have been set as part of the SDGs, the WHO’s End TB Strategy and the 2018 UNHLM with a target to end the global TB epidemic by 2030.

1 WHO 2020. Global TB Report 2020. Accessed on 24 May 2020 from https://www.who.int/publications/i/item/9789240013131

2 WHO 2020. Accessed on 30th Dec 2020 from: https://www.who.int/news/item/09-12-2020-who-reveals-leading-causes-of-death-and-disability-worldwide-2000-2019

The SDG Target

End the epidemics of AIDS, TB, malaria and neglected tropical diseases, and combat hepatitis, water-borne diseases and other communicable diseases by 2030.

WHO End TB Strategy

WHO End TB Strategy3:

3 Accessed on 30th Dec 2020 from: https://www.who.int/tb/post2015_strategy/en/#:~:text=The%20strategy%20aims%20to%20end,2020%2C%202025%2C%20and%202030

UNHM 2018 Targets

UNHM 2018 Targets4:

  1. 40 million people treated for TB from 2018 to 2022, including:
    1. 3.5 million children
    2. 1.5 million people with drug-resistant TB, including 115 000 children
  2. At least 30 million people provided with TB preventive treatment from 2018 to 2022, including:
    1. 6 million people living with HIV
    2. 4 million children (< 5 years)
    3. 20 million household contacts from other age groups
  3. Funding of at least US$ 13 billion per year for universal access to TB prevention, diagnosis, treatment and care and at least US$ 2 billion per year for TB research from 2018 to 2022

Globally, the TB incidence rate is declining with a cumulative reduction of 9% (from 142 to 130 new cases per 100 000 population) from 2015 to 2019. However, this rate is not fast enough to reach the End TB goal of 80% reduction by 2030. However, the good news is that seven high TB burden countries, including Bangladesh, have already achieved the 2020 milestone and a total of 46 countries are well on track to reach the same.

Timely diagnosis and successful treatment of people with TB avert millions of deaths each year, but there are still persistent gaps in detection and treatment. Gaps between the estimated number of new cases and the number reported are due to a mixture of underreporting of detected cases and underdiagnoses which is still a major programmatic gap of TB program.

In 2014, the Copenhagen Consensus project5 , with a team of 60 leading economists and experts identified 19 out of 169 targets in the SDGs that provided the highest economic returns. TB was identified as one of the highest priority public health investment options where every single dollar invested in diagnosis and treatment yielded a return of USD 43. Hence, it is crucial to encourage investment in Ending TB efforts at global, national as well as local levels.

4 Accessed on 30th Dec 2020 from: https://www.who.int/tb/features_archive/UNGA_HLM_ending_TB/en/
5 Accessed on 30th Dec 2020 from: http://www.stoptb.org/assets/documents/news/factsheet_05.pdf