Better diagnostics and new drugs essential for fighting tuberculosis

WHO and the STOP TB partnerships are advocating a new approach to eliminating tuberculosis through improved, quicker diagnosis, more effective drugs and vaccines and stronger health systems. This approach has been set out in ”The Global Plan to Stop TB 2011-2015: Transforming the Fight”, launched today in Berlin, Germany. The goal is to reach the UN Millennium Development Goal (MDG) of halting and reversing the TB epidemic by 2015, and halving the number of deaths due to the disease compared to 1990 levels. The ultimate aim is to eliminate TB as a public health problem by 2050.

To extend universal access for all those affected by TB, the plan emphasizes early case detection and treatment to cut transmission. The need to rapidly deploy quicker and more accurate diagnostic tools now available to more easily detect all cases of TB, including multidrug resistant TB, has been highlighted. Although TB is curable, the shortest treatment regimen currently available is for six months. With more funding for research into more effective drugs, a much shorter treatment period could become a reality.

One in every three patients with TB lives in South-East Asia Region, where half a million deaths due to the disease occur every year. Bangladesh, India, Indonesia, Myanmar and Thailand are among the 22 countries with the highest burden of TB, accounting for 80% of all TB cases globally. TB spreads in poor, crowded and poorly ventilated settings. Over 25% of TB is attributable to poor nutrition; 25% to HIV infection. TB is also linked to smoking, alcohol use, and diabetes.

“In spite of being curable, tuberculosis remains one of the biggest killers both globally and in the Region,” said Dr Samlee Plianbangchang, WHO Regional Director, for South-East Asia. “We need to enhance services to reach all TB patients, strengthen primary health systems, and address the social and other determinants of TB. Addressing TB is crucial for meeting the MDGs on poverty, HIV as well as maternal and child health.”

Recent breakthroughs have produced new tools to tackle TB over the next five years. In the area of diagnostics, recently introduced molecular techniques can detect MDR-TB in a few days instead of weeks. There are 38 new TB drugs in preclinical and clinical development, including nine in late-phase clinical trials, which hold the key for shorter treatment regimens for TB. Shorter treatments for drug-resistant TB using novel combinations of new chemical compounds combined with existing drugs will also soon be available. Nine TB candidate vaccines are currently undergoing clinical trials, and by 2020 it is expected that a new generation of TB vaccines will make it possible to achieve the ultimate goal of eliminating TB.
There has been substantial progress in the battle against TB. Over 15 million TB patients have been treated during the past ten years, nearly ten million of these using DOTS (directly observed treatment, short course), thereby averting nearly half a million deaths.

There has been a slow but gradual decline in TB prevalence, incidence and mortality over the years in the South-East Asia Region. However, the rate of decline needs to be greater in order to meet the MDG, and multidrug resistant TB continues to pose a special threat.