TB situation

and response
Dr Mario RAVIGLIONE
Director

National Press Foundation Tuberculosis Training

1 December 2015
Cape Town, South Africa

Overview
TB basics

TB situation, progress and response

The commitment to end TB

Tuberculosis: basics
Tuberculosis (TB) is one of the oldest
diseases of humans
TB ranks alongside HIV/AIDS as the
top infectious killer world-wide and a
major killer of women
TB is caused by the bacterium
Mycobacterium tuberculosis
TB usually affects the lungs, although
other organs are involved in 15-30% of
cases
If properly treated, TB caused by drugsusceptible strains is curable in
virtually all cases
If untreated, TB may be fatal within 5
years in 2/3 of cases
MDR-TB is a form of TB that needs
longer, more toxic and more expensive
regimens. Cure rate is 50%

TB is airborne

Text

TB is transmitted via aerosolized

particles from an infectious patient
to those sharing the same air

Of those exposed, some (e.g., 10-15 in 1 year)

will get infected (1/3 of humanity!) and of those
Infected up to 10% will develop TB

Who carries the burden of tuberculosis?

mostly, the most vulnerable

TB spreads in poor, crowded

& poorly ventilated settings

Half a million
women and 140,000
children died of TB
in 2014; 10 million
TB orphans

TB linked to HIV infection,

malnutrition, alcohol, drug
and tobacco use, diabetes

Migrants, prisoners,
minorities, refugees face
risks, discrimination &
barriers to care

Tremendous
progress
in the
Tremendous
fight
against
TB
progress
in the
fight against TB

MDG6 TB target achieved

Rate per 100,000 population

TB
REVERSED
EPIDEMIC
Incidence
Falling
1.5% per
year (20002014).
18% drop since
2000

1990
2014

2000

47% drop in TB mortality

SINCE 1990
Most of the improvement

Rate per 100,000 population

is since 2000

Targ
et

47% decline since 1990

1990
2015

2000

43 million lives saved

BETWEEN 2000 AND
2014

TB = 43m

HIV =
7.8m
Malaria =
7m
Ref: Global TB Control Report

Huge burden of
deaths
and
Huge burden of
suffering
deaths
and
remains
suffering
remains

TB ranks alongside HIV

as a leading cause of death
2012, WHO Global Health Observatory

2014, WHO and UNAIDS

TB
HIV/AIDS
TB

In grey: TB/HIV deaths

HIV/AID
S

Millions

The Global Burden of TB,

2014
Estimated number
of cases
All forms of TB

9.6 million
133 per 100,000
1 million children
3.2 million women
5.4 million men

HIV-associated
TB
Multidrugresistant TB
Source: WHO Global TB Report 2015

1.2 million
(12.5%)
480,000

Estimated number
of deaths

1.5 million*
140,000 in
children
480,000 in
women
390,000in men
890,000
190,000

* Including deaths attributed to HIV/TB

TB incidence: countries and regions

Americas
Europe
3%
3%

E.
Mediterranean
8%

Africa
28%

23% in India
10% each: Indonesia
& China
5% each: Nigeria &
Pakistan

South-East
Asia
41%

TB/HIV: 1.2 million cases in 2014

12.5% of all new cases
Estimated HIV prevalence in new TB cases, 2014

Other
emerging in other regions

Ref: Global TB Control Report 2015

74% of TB/HIV cases

co-morbidities in Africa

MDR-TB: 480,000 cases in 2014

3% of new TB cases globally

Highest % in the former USSR

countries
India, China, Russia, Pakistan and
Ukraine
have 62% of all MDR-TB cases

Ref: Global TB Control Report 2015

Percentage of new TB cases with MDR-TB

M/XDR-TB generates great media

interest

Global
commitment
Global to
END TB to
commitment
END TB

Global commitment to End

TB
Moving from halting TB to ending TB by 2030

67th World Health Assembly, Geneva, May

2014

Vision, goal, targets,

milestones

Vision:
A world free
of TB
Zero TB
deaths,
Zero TB
disease, and
Zero TB
suffering

The End TB Strategy: 3 pillars and 4

Principles

Looking beyond 2015:

Priorities for action
6 PRIORITIES FOR ACTION
Ensure diagnosis and quality
care for the missed cases (3.6
million)

Address MDR-TB as a crisis

Accelerate response to TB/HIV

Increase financing to close resource gaps

Address TB within universal health coverage, social

protection and poverty agendas

Intensify research and ensure rapid uptake of

innovations

Reaching the "missed" cases early is

crucial
(~3.6 million not diagnosed or reported)

9.6 million
estimated

Share of total missed

cases

6 million
notified

10 countries account for

75%
(2.7 million) of the
estimated missed
cases globally

Estimated incidence
Global notifications

Ref: Global TB Control

Indonesia + India:
1.2 million missed

Addressing the MDR-TB public health

crisis
480 000
cases of MDR-TB estimated in 2014

123 000

111 000
50%
50%
Three out of the 27 high MDR-TB countries
achieved a treatment success rate of 75%

WHD 2011 slogan

Closing TB/HIV gaps

ART coverage needs to be
expanded

Critical funding gaps can

compromise efforts to save
MPLEMENTATION

lives

S$8 billion needed in 2015

$1.4 billion
funding gap

RESEARCH
at least US$ 2 billion
per year needed

$ 6.6 billion available

in 2015

$677
available
in 2013
$1.32 billion
funding gap

$8 billion funding required in 2015 for

TAG TB R&D report 2014

TB prevention, diagnosis and

treatment

Trends in international donor

funding for
HIV, malaria and TB, 2005-2013
9

HIV/AIDS

8
7

US$ billions

$1.4 billion
6
funding gap
5
4
3

MALARIA

$1.32 billion
funding gap

1
0
2005

2006

2007
HIV/AIDS

2008

2009

Malaria

2010

2011

2012

TB
2013

TB

Source: Creditor reporting system. Paris: Organisation of Economic Co-operation and Development
Note: HIV funding is recorded as STD control including HIV/AIDS.

Millio
ns

Full financing critical

to drive down deaths like HIV

Looking beyond 2015 - Ending TB

is one of the Best Returns on
Investment

Development - The economics of optimism , Jan 24th 2015 - The debate heats up about what goals the world should set
itself for 2030

TB has no borders

TB needs a stronger voice:

Media are powerful
influencers
Accountability of governments in implementing the new End TB
Strategy and reaching its targets
Advocacy for adequate resources to End TB in the national and
international agendas of your country. Emerging economies need
to step up and become global players!
Promotion of success stories
Highlighting roadblocks
Influence on the research industry

Join us in
the fight to

END TB
Thank you.