By Obaid Khan, Humanitas Global
In this two part piece on the development gaps in tuberculosis (TB) diagnostics and treatment, I intend to highlight the need for a rejuvenated focus on TB and identify the key challenges in improving the global public health response.
Despite an estimated two billion people living with TB infection, the disease has yet to receive the attention it deserves. Key statistics from The World Health Organization’s 2014 Global Report on TB further substantiate the sense of urgency needed in international policy circles. Early diagnosis and treatment of TB can have positive spillover effects on reducing HIV incidence, as those living with HIV are at higher risk of developing TB. Bi-directional screening and integrated case diagnosis and management can help tackle the looming epidemic of TB-HIV co-infection. In 2013, 9 million TB cases were detected, including 1.1 million HIV positive cases. In 2013, TB caused 1.5 million deaths, including 360,000 who were HIV-positive. Disaggregating by gender, women make up a significant portion of those dying from TB. In 2013, 510,000 women died from TB, including 180,000 who were HIV-positive. Out of the cumulative TB deaths among HIV-positive people, 50% were among women. TB is one of the leading causes of death for women of reproductive age. In 2013, approximately 550,000 TB cases were children and 80,000 HIV-negative children died of TB in 2013. Over time, TB has become more of a bitter reality for the less developed nations with over 95% of TB deaths occurring in low- and middle-income countries. These statistics call for dynamic policies to curb the threatening epidemic of tuberculosis.
The rationale behind citing these statistics is to establish the consequent public health and economic impact of TB on developing nations. The Global TB Report reveals funding gaps of US$ 1.4 billion for implementation of existing interventions in 2015 and an annual funding gap for research and development of about US$ 1.3 billion. With that in mind, the overarching goal of the global community must focus on investing heavily in TB diagnostics and treatment research and development. However, the response, especially by high-TB burden countries, to this looming epidemic has been below par. Peter Small of Gates Foundation aptly highlights the fundamental gap when he says: “The remarkable fact is that global control of tuberculosis, a disease that kills someone every 20 seconds, predominantly depends upon a 125-year-old test, an 85-year-old vaccine and drugs that take six months to cure and haven’t changed in four decades.”
The situation gets worse as the infection develops resistance against these drugs and vaccines. As obsolete TB diagnostic and treatment techniques fail to treat the infection, sustained transmission of the disease continues in high burden areas. In 2013, there were approximately 480,000 multidrug-resistant TB (MDR-TB) cases and about 210,000 deaths from MDR-TB. The drug resistant cases are increasing at an alarming rate, with MDR-TB diagnosed cases tripling between 2009 and 2013, and reaching a total of 136,000 cases worldwide. Yet, a high proportion of drug resistant cases go undiagnosed with only 45% of the estimated MDR-TB cases being diagnosed and notified in 2013. The growing number of undiagnosed drug resistant cases is a major impediment in the fight against TB. A concerted effort is required from investors and developers to come up with feasible solutions in TB diagnostic and treatment to lower TB incidence and transmission.
Better diffusion and implementation of novel methods and techniques is essential to reinvigorate the innovations cycle for TB. Manufacturers and developers must be incentivized for increased investment in TB R&D and development of diagnostic and treatment tools to match the current context. Global and local health policies need to ensure that the existing successful diagnostic and treatment tools and incoming innovations are accessible for all segments of the society. Adaptive health policies and systems are required for technological breakthroughs to take full effect in high-TB burden countries. Strengthening institutional structure, including health systems, policies, TB control programs and the health sector, is the key for sustainable health service delivery to facilitate the successful implementation of developments in TB diagnostic and treatment. To optimize the public health impacts through updated and innovative technologies, operational challenges must be overcome by effective service delivery models. The impact achieved by these models can be instrumental in creating a positive multiplier effect in terms of increased accessibility, diagnosis and treatment.
This airborne infectious disease afflicts many lives in developing countries today. TB can have debilitating effects throughout a community because of the insidious transmission dynamics. The fight against TB requires pro-active initiatives by developers and innovators. The pressing need for innovations in TB diagnostics and treatment, coupled with effective institutions for the rapid uptake, is undeniable.
