Towards ending tuberculosis: what gets measured gets done
The fight against tuberculosis (TB) was in crisis in 2007. Co-infection with HIV and the emergence of drug resistance strains made it more deadly. WHO and its partners have pursued a culture of innovation, leading to a more effective and affordable diagnostic tool and the approval of two new anti-TB drugs. In May 2014, WHO launched an ambitious strategy to end TB by 2035, and is elevating the TB fight from the technical to the highest political levels.
During the first five decades of its history, WHO gave TB control widely varying degrees of priority, first swinging up, then down, then dramatically up again in line with the evolving epidemiology of this disease. In 1948, the newly established agency singled out malaria, TB and sexually transmitted diseases, especially syphilis, as epidemics requiring urgent international attention. The discovery of streptomycin in 1944, shown to have striking therapeutic efficacy, meant that it was widely available by 1948. The availability of two new TB drugs, isoniazid and pyrazinamide, in the early 1950s, followed by the discovery of rifampicin some 20 years later, transformed TB from a major killer to a disease that could be easily and cheaply cured, at least in affluent nations.
In the developing world, a series of research studies, supported by WHO and the governments of India and the United Kingdom, laid the foundation for a radical integration of TB control into general health services. Patients were treated in homes instead of segregated in specialized hospital wards. Doctors diagnosed cases based on respiratory symptoms alone. The mobile radiography units – long the symbol of TB control in poor countries – were dismantled. As treatment courses were long, TB control borrowed from the success of the leprosy programme and recommended that patients be directly observed as they took their daily medicines, thus improving adherence.
"By the 1980s, tuberculosis had lost its status as a top international priority at WHO and elsewhere."
Dr Chan, WHO Director-General
The tuberculosis epidemic was held at bay, but just barely. The incidence of new cases declined in middle-income countries, but at half the rate seen in wealthy nations.
By the 1980s, tuberculosis had lost its status as a top international priority at WHO and elsewhere. Research dwindled. Medical journals that had been exclusively devoted to tuberculosis were rebranded as journals covering respiratory diseases. International conferences on tuberculosis diminished in frequency and then stopped altogether. At WHO, only two TB experts were kept on its headquarters staff. TB dropped to the status of a largely forgotten disease. In reality, though, its power to resurge was merely waiting in the wings. That neglect changed dramatically in 1993, when WHO took the unprecedented step of declaring the epidemic a global emergency. The agency had good reasons to do so.