4% annual decrease too slow to end TB by 2030 – call for Europe’s commitment to increase investment to end TB
A new report published today by the European Centre for Disease Prevention and Control (ECDC) and the WHO Regional Office for Europe indicates that the number of new tuberculosis (TB) patients has been decreasing at an average rate of 4.3% per year in the WHO European Region over the last decade. Yet, despite being the fastest decline in the world, this trend is insufficient to end the TB epidemic by 2030, as envisioned in the End TB Strategy and the Sustainable Development Goals. The report is being released ahead of World Tuberculosis Day, which this year calls on global leaders to accelerate efforts to end TB once and for all.
“It is not enough to ‘walk’ towards ending TB, as this way we would arrive too late for too many people. We need to ‘leap forward’ and invest now for individual benefits and societal returns. The Tuberculosis action plan for the WHO European Region 2016–2020 shows that bold actions will save over three-million lives and USD 48 billion in five years in the Region,” says Dr Zsuzsanna Jakab, WHO Regional Director for Europe. “We need to revamp political commitment at all levels to achieve tangible and immediate results that change and save the lives of all those people suffering from TB today and ensure a TB-free world for our children tomorrow.”
Recalling the 2030 Agenda for Sustainable Development, Dr Vytenis Andriukaitis, European Commissioner for Health and Food Safety, adds:
“The European Commission is fully committed to helping Member States reach the goal of ending TB by 2030. I urge leaders in Europe and beyond to take a multisectoral approach to TB, mobilising the necessary funds for research, ensuring access to preventive and curative health care for all, and addressing the social conditions that encourage its spread.”
According to Dr Andrea Ammon, ECDC Director:
“Remaining vigilant about TB, even in low-incidence settings, is important due to the potential resurgence of this airborne disease, especially in the light of increased population mobility and of multidrug-resistant TB.” She adds: “New technologies to aid investigation of cross-border outbreaks of multidrug-resistant TB, such as whole genome sequencing, are key in curbing transmission in the European Union/European Economic Area.”
Low detection and inadequate treatment of multidrug-resistant TB (MDR-TB) are major drivers of the epidemic in Europe
Despite progress, TB - especially in its drug-resistant forms - remains a major public health concern in the WHO European Region. The latest data from the TB surveillance and monitoring report indicate that one in four MDR TB cases are not detected in the WHO European Region. While diagnosis of MDR TB patients increased from 33% in 2011 to 73% in 2016, it remains below the regional target of 85% defined in the European TB action plan.
Treating cases with drug resistance is another challenge: the observed increase in treatment success from 46% in 2013 to 55% in 2016 is still insufficient for European countries to achieve the 75% target for 2020 that they committed to in the action plan.
The spread of extensively drug-resistant TB (XDR TB) is an additional threat to ending TB in the WHO European Region. With the rapid rollout of drug-susceptibility testing and improved surveillance, countries detected 5000 XDR TB cases in the WHO European Region in 2016, however on average only one in three patients with XDR-TB is cured.
MDR-TB in the EU/EEA
In the European Union/European Economic Area (EU/EEA), the rate of notified MDR-TB cases has remained unchanged since 2012, at 0.3 per 100 000 population. However, the proportion of XDR-TB cases among MDR-TB cases increased from 13.9% to 20.6% during the same period. Treatment success rates for both MDR-TB and XDR-TB remain low.
To address this threat, ECDC launched a pilot project in 2017 on the use of whole genome sequencing (WGS) technology to improve the detection and investigation of Mycobacterium tuberculosis in the EU/EEA. The project will establish common standards for WGS in investigating MDR-TB bacteria strains and tracing outbreaks. It will also enable all EU/EEA countries without WGS capacity to utilise the technology by linking them to institutes with robust experience in WGS.
Commitment to end TB by 2030
With 2018 marking the 10th anniversary of the Berlin Declaration ‘All Against Tuberculosis’, and as the world prepares for the first-ever United Nations General Assembly High-Level meeting on tuberculosis in September this year, there is a dire need for further commitment to accelerate the pace of TB elimination.
This entails using existing modern and rapid diagnostic technologies; enhancing research for new tools; developing and implementing regulations to scale up access to new medicines and shorter treatment regimens; and working together with all sectors, including civil society, patients and communities, in a whole-of-society approach.
Increased collaboration and intensified allocation of resources are crucial to ensure that every TB-affected person has access to quality health services for early detection, successful treatment and people-centred care.
Notes to the editor
World Tuberculosis Day is observed on 24 March each year around the world. Its overall goal is to raise awareness about the burden of TB worldwide and the status of TB prevention and control efforts.
TB elimination is defined as less than one case of TB disease per 1 million population per year.
The WHO European Region comprises 53 countries with a population of nearly 900 million people, of which around 508 million live in the EU/EEA (28 EU Member States plus Iceland, Liechtenstein and Norway).
In 2016, 297 132 TB cases were reported from 52 countries in the WHO European Region, equivalent to 28.0 cases per 100 000 population. Of these cases, 58 994 were in the 30 EU/EEA countries, equivalent to 11.4 per 100 000 population.
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