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Changing minds about tuberculosis
Editorial
The eradication of tuberculosis will require a fundamental overhaul of the way the disease is viewed, identified, and treated—this was the conclusion of two major recent publications about tackling the epidemic. Between 2000 and 2015, progress was made in reducing the global tuberculosis burden and improving surveillance. WHO’s 2015 Global Tuberculosis Report, published on October 28, outlines some of the key achievements: tuberculosis mortality has fallen by 47% since 1990; the Millennium Development Goal to halt and reverse tuberculosis incidence has been achieved at the global level; and tuberculosis incidence has fallen by 1·5% per year since 2000. But, as emphasised by both the Stop TB Partnership’s report The Global Plan to End TB and a recent Lancet Series titled How to Eliminate Tuberculosis, this rate of change is too slow, especially for a disease that can be treated with antibiotics. The End TB Strategy, which provides a framework for tackling the disease in the post-Millennium Development Goal era, aims for a 90% reduction in incidence by 2035. As such, the 1·5% annual reductions seen in the past 15 years seem underwhelming; at that rate, it would take more than 150 years to achieve the End TB targets. According to The Global Plan to End TB, which provides a 5-year roadmap to achieving the End TB targets, tuberculosis incidence must decline by 10% per year. To make this happen, the Stop TB Partnership proposes that stakeholders must aggressively scale up efforts to combat the disease. The report outlines an accelerated funding scenario with a peak investment of US$ 12·8 billion in 2018. This is roughly double what is currently spent. The partnership argues that while this figure might seem high, it should progressively decrease as fewer people require treatment, and that the future human and economic costs of inaction would be greater. Attitudes must also change if the End TB goals are to be met. “All countries must be bold and ambitious, declaring that TB has no place in their future societies”, according to the Global Plan to End TB. This sentiment is echoed in a Comment in
www.thelancet.com/respiratory Vol 3 December 2015
How to Eliminate Tuberculosis, which states “Business as usual can no longer be an option in the fight against tuberculosis”. This is a key point—historically, tuberculosis has simply not been viewed in the same way as other infectious diseases such as HIV or malaria, despite anti-tubercular drugs being available since the 1950s. All too often, it is considered to be too complex to control, or the onus is placed on waiting for better diagnostic and treatment options rather than scaling up the use of those already available. When compared with the remarkable advances that have been made in the prevention and treatment of HIV in the past 40 years, little progress has been made in the prevention, diagnosis and treatment of tuberculosis. In fact, as Furin and colleagues argue in their Comment, researchers and clinicians working to tackle tuberculosis need to emulate their colleagues working in HIV, implementing community-based care, treatment as prevention, and a human rights-based approach to management and prevention. Most importantly, health-care organisations involved in the fight against tuberculosis must ensure integrated approaches are developed and used across the board. This will include filling gaps in surveillance networks so that all cases are identified; treating patients in the latent and active phases of the disease and working at the level of cities, towns, and smaller populations to eradicate the disease in specific areas. The development of better tools, including a vaccine against tuberculosis; rapid and sensitive point-of-care diagnostic tests; and effective, fast-acting drug regimens will also play an important part. Although investment in research and development is important, eradication efforts must begin now with the resources and tools that are currently available. The complete eradication of tuberculosis is ambitious but if integrated control strategies are applied consistently and stringently across the board and extra funding is made available as a priority, the End TB goals can be achieved. The first step is not only to change attitudes but also to support and encourage stakeholders in their efforts to meet this goal. ■ The Lancet Respiratory Medicine
Harvinder Singh/Science Photo Library
Changing minds about tuberculosis
For the Global Tuberculosis Report see http://www.who.int/ tb/publications/global_report/ en/ For The Global Plan to End TB see http://www.stoptb.org/ global/plan/plan2/ For the How to Eliminate Tuberculosis Series see http:// www.thelancet.com/series/howto-eliminate-tuberculosis For the Comment on The Lancet Series see Comment Lancet 2015; published online Oct 26. http://dx.doi.org/10.1016/ S0140-6736(15)00401-8 For the Comment by Furin and colleagues see Comment Lancet 2015; published online Oct 26. http://dx.doi.org/10.1016/ S0140-6736(15)00319-0 For more on vaccines for tuberculosis see Comment page 906 and Articles page 953
901
The eradication of tuberculosis will require a fundamental overhaul of the way the disease is viewed, identified, and treated—this was the conclusion of two major recent publications about tackling the epidemic. Between 2000 and 2015, progress was made in reducing the global tuberculosis burden and improving surveillance. WHO’s 2015 Global Tuberculosis Report, published on October 28, outlines some of the key achievements: tuberculosis mortality has fallen by 47% since 1990; the Millennium Development Goal to halt and reverse tuberculosis incidence has been achieved at the global level; and tuberculosis incidence has fallen by 1·5% per year since 2000. But, as emphasised by both the Stop TB Partnership’s report The Global Plan to End TB and a recent Lancet Series titled How to Eliminate Tuberculosis, this rate of change is too slow, especially for a disease that can be treated with antibiotics. The End TB Strategy, which provides a framework for tackling the disease in the post-Millennium Development Goal era, aims for a 90% reduction in incidence by 2035. As such, the 1·5% annual reductions seen in the past 15 years seem underwhelming; at that rate, it would take more than 150 years to achieve the End TB targets. According to The Global Plan to End TB, which provides a 5-year roadmap to achieving the End TB targets, tuberculosis incidence must decline by 10% per year. To make this happen, the Stop TB Partnership proposes that stakeholders must aggressively scale up efforts to combat the disease. The report outlines an accelerated funding scenario with a peak investment of US$ 12·8 billion in 2018. This is roughly double what is currently spent. The partnership argues that while this figure might seem high, it should progressively decrease as fewer people require treatment, and that the future human and economic costs of inaction would be greater. Attitudes must also change if the End TB goals are to be met. “All countries must be bold and ambitious, declaring that TB has no place in their future societies”, according to the Global Plan to End TB. This sentiment is echoed in a Comment in
www.thelancet.com/respiratory Vol 3 December 2015
How to Eliminate Tuberculosis, which states “Business as usual can no longer be an option in the fight against tuberculosis”. This is a key point—historically, tuberculosis has simply not been viewed in the same way as other infectious diseases such as HIV or malaria, despite anti-tubercular drugs being available since the 1950s. All too often, it is considered to be too complex to control, or the onus is placed on waiting for better diagnostic and treatment options rather than scaling up the use of those already available. When compared with the remarkable advances that have been made in the prevention and treatment of HIV in the past 40 years, little progress has been made in the prevention, diagnosis and treatment of tuberculosis. In fact, as Furin and colleagues argue in their Comment, researchers and clinicians working to tackle tuberculosis need to emulate their colleagues working in HIV, implementing community-based care, treatment as prevention, and a human rights-based approach to management and prevention. Most importantly, health-care organisations involved in the fight against tuberculosis must ensure integrated approaches are developed and used across the board. This will include filling gaps in surveillance networks so that all cases are identified; treating patients in the latent and active phases of the disease and working at the level of cities, towns, and smaller populations to eradicate the disease in specific areas. The development of better tools, including a vaccine against tuberculosis; rapid and sensitive point-of-care diagnostic tests; and effective, fast-acting drug regimens will also play an important part. Although investment in research and development is important, eradication efforts must begin now with the resources and tools that are currently available. The complete eradication of tuberculosis is ambitious but if integrated control strategies are applied consistently and stringently across the board and extra funding is made available as a priority, the End TB goals can be achieved. The first step is not only to change attitudes but also to support and encourage stakeholders in their efforts to meet this goal. ■ The Lancet Respiratory Medicine
Harvinder Singh/Science Photo Library
Changing minds about tuberculosis
For the Global Tuberculosis Report see http://www.who.int/ tb/publications/global_report/ en/ For The Global Plan to End TB see http://www.stoptb.org/ global/plan/plan2/ For the How to Eliminate Tuberculosis Series see http:// www.thelancet.com/series/howto-eliminate-tuberculosis For the Comment on The Lancet Series see Comment Lancet 2015; published online Oct 26. http://dx.doi.org/10.1016/ S0140-6736(15)00401-8 For the Comment by Furin and colleagues see Comment Lancet 2015; published online Oct 26. http://dx.doi.org/10.1016/ S0140-6736(15)00319-0 For more on vaccines for tuberculosis see Comment page 906 and Articles page 953
901