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Access to TB Services remains a challenge confirmed by WHO report

There has been steady progress in tackling TB with 9% decrease in incidence seen between 2015 and 2019 and 14% drop in deaths in same duration. High-level political commitments at global and national levels were delivering results before pandemic. A new report from WHO shows that access to TB services remains a challenge, and global targets for prevention and treatment are likely to be missed without urgent action and investment.

Approximately, 14 million people died of TB-related illness in 2019. Of the estimated 10 million people who developed TB that year, 3 million were not diagnosed with the disease or were not officially reported to national authorities.

The situation is even more acute for people with drug-resistant TB. About 465000 people that were newly diagnosed with drug-resistant TB in 2019 and less than 40% were able to access treatment. There has been limited progress in scaling up access to treatment to prevent TB.

Dr. Tedros Adhanom Ghebreyesus, Director-General of WHO said, “Equitable access to quality and timely diagnosis, prevention, treatment and care remains a challenge. Accelerated action is urgently required world-wide if we are to meet our targets by 2022.”

For the period 2018-2019, 14 million people were treated for TB, just one-third of the way towards the 5-year target (2018-2022) of 40 million according to report. Some 6.3 million people started TB preventive treatment in 2018-2019, about one-fifth of the way towards the 5-year target of 30 million.

In 2020, the funding for TB prevention, diagnosis, treatment and care reached US$ 6.5 billion, representing only half of the US $ 13 billion target agreed by the world leaders in the UN Political Declaration on TB. Due to COVID-19 pandemic have led to disruption in services in many countries, human, financial and other resources have been re-allocated from TB to COVID-19 response. Data collection and reporting system have also been negatively impacted.

According to new report, data collected from over 200 countries has shown reduction in TB notifications, with 25-30% drops reported in 3 high burden countries – India, Indonesia, the Philippines – between January and June 2020 compared to same 6 month period in 2019. According to WHO modelling, the reduction in case notifications could lead to a dramatic increase in additional TB deaths.

In line with WHO guidance, countries have taken measures to COVID-19 on essential TB services by strengthening infection control. A total of 108 countries including 21 countries with high TB burden – have expanded digital technologies to provide remote advice and support.

Dr Tereza Kaseva, Director of WHO Global TB Program said, “In the face of pandemic, countries, civil society and other partners have joined forces to ensure that essential services to both TB and COVID-19 are maintained for those in need. These efforts are vital to strengthen health systems, ensure health for all, and save lives.”

In 2014 and 2015, all member states of WHO and UN Sustainable Development Goals (SDG) and WHO’s End TB Strategy. They include targets and milestone for large reduction of TB incidence, TB deaths and cost faced by TB patients and their households.

TB is included in the Goal 3 Target 3.3 of the SDG which aims to “end the epidemics of AIDS, TB, malaria and neglected tropical diseases” by the 2030. The WHO End TB strategy aims for 90 percent reduction in the TB deaths and 80 % reduction in the TB incidence rate by 2030, compared to the 2015 baseline. Milestones for 2020 include a 20 % reduction in the TB incidence rate and a 35% reduction in TB deaths.

Efforts to step up political commitment in the fight against TB intensified in 2017 and 2018, in the firstever high-level meeting on TB at UN General Assembly in September 2018. The outcome was a political declaration in which commitments to the SDG and End TB Strategy were reaffirmed.

The UN Political Declaration on TB also included 4 new targets for the period 2018-2022: Treat 40 million people for TB disease; Reach at least 30 million people with TB preventive treatment for a latent TB infection; Mobilize at least US $13 billion annually for universal access to TB diagnosis, treatment and care; Mobilize at least US$13 billion annually for TB research.

According to WHO European Region is on the track to achieve key 2020 targets of the WHO End TB Strategy, with reductions in the incidence and deaths of 19% and 31% respectively over the last 5-year period. The African Region has also made impressive gains, with corresponding reduction of 16% and 19% in the same time frame. On a global scale, the pace of progress has lagged, and critical 2020 milestone of the End TB Strategy would be missed.
As in the previous years, most available TB funding (85%) in 2020 came from domestic sources with Brazil, Russian Federation, India, China and South Africa providing 57% of the global total. International donor funding increased from US $ 900,000 in 2019 to US$ 1 billion in 2020. The Global fund to fight AIDS, TB and Malaria was single largest source of international TB financing in 2020, while US remains the biggest bilateral funder of the efforts to end TB.

Technological breakthrough by 2025 are required to reach 2030 global TB targets. The world needs affordable and accessible rapid point-of-care test, as well as new, safer and more effective treatments and vaccines. Member States called on WHO in 2018 to develop Global strategy for TB research and innovation that lays out key steps that government and non-state actors can undertake to meet 2030 global TB targets. The strategy was adopted by the World Health Assembly in August 2020.

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