The World Health Organization (WHO) has once again highlighted the ongoing battle against Tuberculosis (TB) in its annual Global Tuberculosis Report for 2019. Since 1997, WHO has been documenting the global response to this epidemic, as well as delivering a detailed analysis of TB trends. This year’s report specifically highlights the state of TB in India, amongst other high burden regions.
The Grim Reality: TB as a Leading Infectious Killer
According to the report, TB is the leading infectious killer worldwide, taking over 4,000 lives daily. The majority of positive TB cases in 2018 were found in regions such as South-East Asia (44%), Africa (24%) and the Western Pacific (18%).
High TB Burden Countries
India, China, and Indonesia together account for a significant proportion of the global TB burden – India with 27%, China with 9%, and Indonesia with 8%. These three countries, among others, are part of WHO’s list of 30 countries with high TB burdens, responsible for 87% of the world’s cases in 2018.
Understanding Multi-Drug Resistant TB
In 2018, approximately half a million new cases of rifampicin-resistant TB were reported, with 78% of these being multi-drug resistant TB. Once again, India (27%), China (14%) and the Russian Federation (9%) shouldered the bulk of the global burden.
The Challenge of TB Diagnosis
Globally, 7.0 million new TB cases were reported in 2018, up from 6.4 million in 2017. The surge in global notifications since 2013 can largely be attributed to changes in India and Indonesia. In India, notifications increased from 1.2 million in 2013 to 2.0 million in 2018 – a significant rise of 60%.
| Year | Number of TB Notifications in India |
|---|---|
| 2013 | 1.2 million |
| 2018 | 2.0 million |
The Troubling Gap in TB Reporting
Despite the rise in TB notifications, there remains a wide gap between the reported 7.0 million new cases and the estimated 10.0 million new incidences in 2018. This shortfall is attributed to underreporting and underdiagnosis issues. In fact, ten countries, including India (25%), Nigeria (12%), Indonesia (10%), and the Philippines (8%) accounted for approximately 80% of this gap.
TB Treatment Outcomes: A Glimmer of Hope
Data on treatment outcomes for new TB cases in 2017 showed a global treatment success rate of 85%, up from 81% in 2016. This improvement can largely be attributed to progress made in India.
Funding for TB Prevention
Funding directed towards TB prevention, diagnostics, and treatment has seen a two-fold increase since 2006. Specifically in India, domestic funding quadrupled from 2016 to 2019.
Recommendations for Future Efforts
The report suggests a need to double annual financing for TB prevention, care, and research. It emphasizes the importance of ensuring access to TB care and preventive treatment, mitigating the costs burdened by patients and their families, and intensifying multisectoral action. To meet the targets set for 2030 by the Sustainable Development Goals (SDGs) and the End TB Strategy, the report emphasizes the need for intensified research and development, and a commitment to Universal Health Coverage.
WHO’s End TB Strategy
The WHO’s End TB Strategy aims to terminate the global TB epidemic by reducing TB deaths by 95% and new cases by 90% between 2015 and 2035. This strategy also focuses on ensuring that no family faces ruinous expenses due to TB and has set interim milestones for 2020, 2025, and 2030.