The Global Tuberculosis Report 2013, published today by the World Health Organization (WHO), confirms that the world is on track to meet the Millennium Development Goals (MDGs) target of reversing TB incidence, along with the target of a 50 per cent reduction in the mortality rate by 2015 (compared to 1990).

The report also underlines the need for a “quantum leap” in TB care and control which can only be achieved if two major challenges are addressed, WHO stated in a news release.

First, there are around three million people – equal to one in three people falling ill with TB – who are currently being ‘missed’ by health systems. WHO estimates that 75 per cent of the three million are in 12 countries.

Also, the response to test and treat all those affected by multidrug-resistant TB (MDR-TB) is inadequate. Not only are the links in the MDR-TB chain weak, the links are simply not there yet, according to the report. WHO estimates that 450,000 people fell ill with MDR-TB in 2012 alone. China, India and Russia have the highest burden of MDR-TB followed by 24 other countries.

At the heart of both challenges, said WHO, is insufficient resources for TB.“Quality TB care for millions worldwide has driven down TB deaths,” said Mario Raviglione, WHO Director of the Global TB Programme. “But far too many people are still missing out on such care and are suffering as a result. They are not diagnosed, or not treated, or information on the quality of care they receive is unknown.”

While the number of people detected worldwide with rapid diagnostic tests increased by more than 40 per cent to 94,000 in 2012, three out of four MDR-TB cases still remain without a diagnosis.

Even more worrying, WHO pointed out, is that around 16,000 MDR-TB cases reported to the agency in 2012 were not put on treatment, with long waiting lists increasingly becoming a problem. Also, many countries are not achieving high cure rates due to a lack of service capacity and human resource shortages.

“The unmet demand for a full-scale and quality response to multidrug-resistant tuberculosis is a real public health crisis,” Dr. Raviglione stated. “It is unacceptable that increased access to diagnosis is not being matched by increased access to MDR-TB care.

“We have patients diagnosed but not enough drug supplies or trained people to treat them. The alert on antimicrobial resistance has been sounded; now is the time to act to halt drug-resistant TB.”

Another challenge, according to the report, relates to the TB and HIV ‘co-epidemic’. While there has been significant progress in the last decade in scaling-up antiretroviral treatment for TB patients living with HIV, less than 60 per cent were receiving antiretroviral drugs in 2012.

The report recommends five priority actions that could make a rapid difference between now and 2015. These include reaching the three million TB cases missed in national notification systems by expanding access to quality testing and care services across all relevant public, private or community based providers, including hospitals and non-governmental organizations which serve large proportions of populations at risk.

Other priorities include addressing with urgency the MDR-TB crisis; intensifying and building on TB-HIV successes to get as close as possible to full antiretroviral therapy (ART) coverage for people co-infected with TB and HIV; increasing domestic and international financing to close the resource gaps – now estimated at about $2 billion per year – for an effective response to TB in low- and middle-income countries; and accelerating rapid uptake of new tools.

“The WHO Global TB report highlights the very big gains the global community has made in the fight against tuberculosis,” said Osamu Kunii, Head of the Strategy, Investment and Impact Division of the Global Fund to Fight AIDS, Tuberculosis and Malaria.

“We are now at a crucial moment where we cannot afford to let these gains go into reverse. We need the commitment of the international community to address the significant funding gap to fight this disease.”

In a joint news release, the Director-General of the World Health Organizations (WHO), Margaret Chan, and the Executive Director of the Global Fund, Mark Dybul, said significant funds need to be mobilized to prevent the spread of multi-drug resistant TB, also known as MDR-TB.

“We are treading water at a time when we desperately need to scale up our response to MDR-TB,” said Dr. Chan. “We have gained a lot of ground in TB control through international collaboration, but it can easily be lost if we do not act now.”

In 2011, 1.4 million people died due to TB, with the greatest per capita death rate in Africa. MDR-TB presents a major threat, with an estimated 630,000 people ill worldwide with this form of TB today.

WHO and the Global Fund said the $1.6 billion is needed to fill the funding gap in 118 low- and middle-income countries, the majority of which are located in Africa. These funds could enable full treatment for 17 million TB and MDR-TB patients, and save some 6 million lives in the next three years.

“It is critical that we raise the funding that is urgently needed to control this disease,” said Dr. Dybul. “If we don’t act now, our costs could skyrocket. It is invest now or pay forever.”

The call for an increase in funds for TB comes ahead of World TB Day on 24 March, which commemorates the day when Robert Koch discovered the mycobacterium that causes tuberculosis in 1882. The Day seeks to raise awareness about the global epidemic and efforts to eliminate the disease.

In addition to the $1.6 billion annual gap in international financing, WHO and partners estimate that there is a $1.3 billion annual gap for TB research and development for the 2014-2016 period, including clinical trials for new TB drugs, diagnostics and vaccines.

“The momentum to break this disease is in real danger,” said the Director of the Stop TB Department of the UN World Health Organization (WHO), Dr. Mario Raviglione. “We are now at a crossroads between TB elimination within our lifetime, and millions more TB deaths.”

The UN official’s comments came as the health agency released the WHO Tuberculosis Report 2012, which finds that an estimated 20 million people are alive today as a direct result of TB care and control. The report features data from 204 countries and territories, and covers all aspects of TB, including multi-drug-resistant tuberculosis (MDR-TB), TB’s links to HIV, research and development and financing.

“In the space of 17 years, 51 million people have been successfully treated and cared for according to WHO recommendations,” Dr. Raviglione said. “Without that treatment, 20 million people would have died.”

Despite the progress, TB remains a major infectious killer, according to the report. Among its findings, the report notes there is continued decline in the number of people falling ill from TB, but still an enormous global burden, with 8.7 million new cases in 2011.

As well, it notes an estimated 1.4 million deaths from TB, including half a million women, underlining the disease as one of the world’s top killers of women; and persistently slow progress in the response to MDR-TB, with diagnosis of only one in five presumed cases worldwide.

However, the report also notes that there is a $1.4 billion funding gap per year for research and development into new ways to combat TB – in addition to a $3 billion per year shortfall over 2013-2015, which could have severe consequences for TB control.

“This gap threatens to hold back delivery of TB care to patients and weaken measures that prevent and control the spread of TB, with low income countries at most risk,” said Dr Katherine Floyd, who coordinated the team which produced the WHO Tuberculosis Report 2012.

To address this, WHO is calling for targeted international donor funding and continued investments by countries themselves to safeguard recent gains and ensure continued progress. Currently, 90 per cent of external donor financing for TB is provided by the UN-backed Global Fund to Fight AIDS, Tuberculosis and Malaria.

But while decrying the funding gap, the report also offers reason for hope. It praises the worldwide roll-out of a new diagnostic device capable of testing patients for TB, including drug-resistant TB, in just 100 minutes. The fully automated nucleic acid amplification test (NAAT), which can diagnose TB and rifampicin-resistant disease, is now available in 67 low- and middle-income countries.

Adoption of the ‘while you wait’ test is expected to further accelerate following a recent 41 per cent fall in the price of the test, WHO said in a news release.

The report also points to the promise of medical breakthroughs from new TB drugs – the first in over 40 years – which could be on the market as early as 2013.

“Indeed, tools to prevent, detect and treat all forms of TB are steadily advancing through the R&D pipeline,” WHO said, adding, “Progress means that a new TB vaccine and a ‘point-of-care’ diagnostic could be available within the next decade.”