The World Health Organization (WHO) today, together with the European Respiratory Society (ERS), launched a new framework to eliminate tuberculosis (TB) in countries with low levels of the disease at the European Respiratory Society’s International Congress in Munich. This framework has been developed by representatives and experts from over 30 countries and territories with a low burden of TB at a meeting in Rome this July, co-hosted by WHO and ERS in collaboration with the Italian Ministry of Health.
The framework outlines an initial “pre-elimination” phase, aiming to have fewer than 10 new TB cases per million people per year by 2035 in these countries. The goal is to then achieve full elimination of TB by 2050, defined as less than 1 case per million people per year. Although TB is preventable and curable, in these low-incidence settings 155 000 people still fall ill each year and 10 000 die. Millions are infected and at risk of falling ill.
The framework builds on approaches that are already proving successful. It was developed with experts from low-burden countries and adapted from the new WHO global TB strategy, “EndTB”, for 2016-35, approved by the World Health Assembly in May 2014.
“These countries recognize the common need to reenergize efforts to eliminate TB as a public health problem and prevent its resurgence. They already have the means to drive down TB cases significantly by 2035 and can serve as global trailblazers,” says Dr Mario Raviglione, Director of WHO’s Global TB Programme.” As TB rates have fallen in many of these countries, attention to this public health threat has waned and capacity to respond could be weakened. The key is to target smart TB interventions towards the people who need them most.”
The new WHO framework highlights the effectiveness of eight key interventions, in a coherent package for impact in the target countries:
- Ensure political commitment, funding and stewardship for planning and essential services of high quality;
- Address the most vulnerable and hard-to-reach groups;
- Address special needs of migrants and cross-border issues;
- Undertake screening for active TB and latent TB infection in TB contacts and selected high-risk groups, and provide appropriate treatment;
- Optimize the prevention and care of drug-resistant TB;
- Ensure continued surveillance, programme monitoring and evaluation, and case-based data management;
- Invest in research and new tools;
- Support global TB prevention, care and control.
Among the most vulnerable groups are people who are poor or homeless, migrants, and members of ethnic minorities. In addition, people who use drugs or are incarcerated, and people with compromised immune systems (e.g. people living with HIV, malnutrition, diabetes, smokers and heavy drinkers) all have a much greater risk of falling ill with TB. Many of these vulnerable groups face barriers in accessing health services.
Addressing tuberculosis in the context of cross-border migration can also pose a significant challenge to health service providers. Many undergoing a course of TB treatment may have no option but to relocate for work, even if they have not completed their TB treatment.
Globalization and increased population movements enable TB - an airborne infectious disease - to continue to spread across communities and countries. To eliminate the disease in low-burden countries it will be vital to dramatically scale up TB prevention and care in high-incidence countries. This interdependency calls for concerted action, tight collaboration between countries with high and low burden of TB, and mobilisation of international resources.
Professor GB Migliori, Secretary General of the ERS, said: “The ultimate goal of international and national public health authorities is the elimination of TB. Although the disease has declined substantially in high-income countries, we must not become complacent. Recently, new strains of the disease have emerged that are resistant to the commonly used drugs and we must reinforce our commitment to ending the global tuberculosis epidemic.”