The WHO End TB Strategy lays out several milestones to help the world stay on track to End TB by 2030. By the end of 2020 the world must achieve a 35% reduction in the number of TB deaths and a 20% reduction in TB incidence as compared with 2015. Not a single TB-affected family should incur catastrophic costs. Despite significant progress, the world will struggle to reach these milestones. Among other challenges, gaps in case notifications persist, access to preventive treatment is insufficient, and funding shortfalls continue. Drug-resistant TB remains a serious global threat.
Countries in the WHO South-East Asia Region have made important progress. Myanmar is on track to achieve the milestones for mortality and incidence. Bangladesh and Thailand are on track to reach the milestone for mortality. In 2018 the Region notified at least 750 000 more cases than in 2015, indicating a 20% increase in treatment coverage. The Region detected more than double the number of RR/MDR-TB cases. In 2019 the total budget for TB programmes in the Region was double what it was in 2016. Domestic allocations in some countries have trebled. All countries must accelerate efforts to end TB – one of the Region’s eight Flagship Priorities.
New diagnostics, tools and therapeutics will be crucial. WHO continues to review evidence and update guidelines to ensure national programmes can act on the best available science. In 2019 WHO updated its guidelines on the treatment of drug-resistant TB and on infection prevention and control. WHO also issued a Rapid Communication on expected updates to guidelines on TB preventive treatment, as well as on molecular diagnostic tests. The Seventy-second session of the Regional Committee endorsed a Regional Action Plan for preventive TB treatment, which all countries are now rolling out. If fully implemented, the Action Plan will help reduce TB incidence by an additional 12-15% annually, equating to around 270 000 fewer cases each year.
Political commitment is at an all-time high. In 2018 the UN held a high-level meeting (UNHLM) for TB, at which leaders issued a political declaration and committed to accelerate progress towards ending TB. WHO is supporting all Member States in the Region, as across the world, to integrate the UNHLM commitments into national strategic plans. The South-East Asia Region has the world’s highest TB burden, meaning the Region’s progress will have a significant impact on whether the world delivers on the targets that it must. All national plans must be ambitious, fully-costed and fully-funded. All countries must continue to scale up domestic financing.
TB-affected families continue to struggle with catastrophic costs. We must redouble our efforts on this crucial milestone, especially as we strive to achieve another of our Flagship Priorities – universal health coverage. To target the socio-economic dimensions of TB, countries must make diagnosis and care more accessible while addressing the broader determinants of TB, such as undernutrition, poverty, smoking and diabetes. WHO has developed a multi-sectoral accountability framework that will help Member States coordinate action and track partner follow-through. It’s time for accountability.
The global outbreak of COVID-19 is an immense challenge to the Region’s health systems. It is yet another reminder that health security and health for all really are two sides of the same coin. As we battle both respiratory diseases, we must synergize our efforts. Among other priorities, to prevent resistance or negative health outcomes, TB programmes must continue to provide anti-tuberculosis medications to those already started on care. To free-up health workers for the COVID-19 response, while also reducing TB transmission, TB programmes should prioritize continued community or household TB treatment delivery, instead of facility-based treatment.
Most critically, Member States must better engage affected communities. All last-mile efforts start with community engagement, be it reaching out with preventive treatment, identifying symptomatics or supporting patients through and after treatment. To help do this, in 2019 WHO published a series of modules based on community consultations, which Member States are now implementing. They must make full use of these valuable tools.
There are reasons for hope. The Region has in recent years catalyzed unprecedented momentum to tackle TB, which is reflected in progress in all 11 Member States. On World TB Day, WHO reiterates its commitment to supporting countries as they struggle to overcome a problem that has persisted for far too long. It’s time for action. It’s time for progress. It’s time for change. It’s time to End TB.