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.”

The framework, entitled Treatment 2015, offers countries and partners practical and innovative ways to increase the number of people accessing antiretroviral medicines that will enable those living with HIV to live longer and healthier lives, as well as help prevent new infections.

“Reaching the 2015 target will be a critical milestone,” said Michel Sidibé, the Executive Director of the Joint UN Programme on HIV/AIDS (UNAIDS). “Countries and partners need to urgently and strategically invest resources and efforts to ensure that everyone has access to HIV prevention and treatment services.”

Treatment 2015 takes into account the new consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection released last month by the World Health Organization (WHO), which recommend that people living with HIV start antiretroviral therapy (ART) much earlier.

“The scale up of ART is an unprecedented global success story for public health,” said WHO Director-General Margaret Chan. “Maintaining this momentum will require earlier treatment and innovative ways for enabling more people to take the medicine such as the one-pill daily regimen recommended by the new WHO guidelines.”

According to UNAIDS, nearly 10 million people living with HIV were accessing antiretroviral treatment last year, and the target to reach 15 million is a push to achieve the Millennium Development Goal (MDG) that seeks to have halted and begun the spread of HIV/AIDS by the 2015 deadline.

However, the report notes that 30 countries account for 9 out of 10 people who are eligible for antiretroviral therapy but who do not have access.

The new strategy emphasizes the importance of HIV testing and counselling as a gateway to expand access to antiretroviral therapy in these 30 countries, and outlines three pillars essential to reaching the 2015 target which consist of: increasing demand for HIV testing and treatment services; mobilizing resources and improving the efficiency and effectiveness of spending, and ensuring more people have access to antiretroviral therapy.

In addition, the framework highlights that community testing campaigns have proven to be particularly effective in countries like Kenya, Malawi, South Africa, Uganda, Tanzania and Zambia.

“Community health workers have the capacity to provide almost 40 per cent of HIV service-related tasks,” UNAIDS said in a news release, adding that HIV testing and treatment services need to be decentralized to promote easier access, and underserved populations need to be targeted to receive access to this life-saving treatment.

“Cancer should not be a death sentence anywhere in the world as there are proven ways to prevent and cure many cancers,” Oleg Chestnov, Assistant Director-General for Noncommunicable Diseases and Mental Health at the World Health Organization (WHO), said in a statement about the global capacity survey.

“In order to reduce exposure to risk factors leading to cancer and ensure that every person living with cancer gets access to appropriate care and treatment, comprehensive cancer control programmes need to be set up in every country.”

A functional cancer control plan includes prevention, early detection, treatment and care, according to WHO. The agency’s recent survey of 185 countries and their national capacity for noncommunicable diseases revealed major gaps in cancer control planning and services.

Even if countries developed cancer plans or policies, many of them are struggling to move from commitment to action, the survey showed.

Seventeen per cent of African countries and 27 per cent of low-income countries have cancer control plans with a budget to support implementation, according to the survey.

In contrast, South-east Asia generally has the greatest percentage of countries with policies, plans or strategies related to cancer, and all of them have some type of policy for diabetes, unhealthy diet, physical inactivity and tobacco use, which are known risk factors for some cancers.

Overall, fewer than half of the countries have population-based cancer registries critical to capture high-quality information on the numbers and types of cancer cases. The data helps to develop, implement and evaluate effective national policies for cancer control.

To support Member States’ capacity to collect reliable data, WHO’s International Agency for Research on Cancer (IARC) and partners introduced the Global Initiative for Cancer Registry Development in Low- and Middle-Income Countries (GICR).

“This initiative is supporting mainly those countries that lack the resources to efficiently fight the rapidly growing cancer burden,” said Christopher Wild, Director of IARC.

“Better data on cancer occurrence will help governments to make the most of their limited resources and direct funds and activities to the areas where they are needed most.”

The first regional hub was launched in Mumbai, India, last year, with the regional hub in Izmir, Turkey, to become operational this year.

Political commitments from world leaders to address cancer have gained steam recently, WHO said. Secretary-General Ban Ki-moon last month called on participants at the World Economic Forum in Davos, Switzerland, to strengthen efforts to achieve global targets related to health, stressing the imperative of building a better future for all.

This year’s World Cancer Day, marked on 4 February, focuses on improving general knowledge around cancer.

“Drug dependence is a disorder that can be treated effectively but, unfortunately, the large majority of persons who need it do not have access to treatment,” the Director of the World Health Organization’s (WHO) Department for Mental Health and Substance Abuse, Dr. Shekhar Saxena, said in a news release announcing the launch of the information system.

“The data presented in the new system illustrate the huge gaps that still exist in the area of drug dependence treatment. But more and more countries realize the benefits of treatment for drug and alcohol dependence, not only for the individuals themselves, but also for the society and the economy,” he added.

According to WHO, until now, drug dependence has not been recognized as a health problem in many countries and stigma and discrimination associated with drug dependence have been major barriers to appropriate treatment. For the health agency, drug dependence is a disorder that can be treated effectively with low-cost medicines and standardized psychological therapies.

With its launch coinciding with the International Day against Drug Abuse and Illicit Trafficking, the WHO Global Health Observatory Database – Resources for the Prevention and Treatment of Substance Use Disorders estimates that, worldwide, about 230 million adults aged 15-64 – or five per cent of the world’s adult population – used an illicit drug at least once in 2010, including about 27 million people with severe drug problems.

The global information system provides data for each of the assessed countries, such as funding, staff and services, and thereby complements already available information on the scope and associated harms of substance use disorders. The country profiles included in the new system cover 88 per cent of the world’s population.

“The availability of drug dependence treatment lags well behind treatment and care offered for other diseases according to our data,” said the Coordinator of WHO’s Management of Substance Use team, Dr. Vladimir Poznyak.

As an example, he said that only 45 per cent of the assessed countries are able to provide essential medicines to treat the dependence on heroin and other opiates, and in almost half of the countries where treatment is available, not more than one in five people with drug use disorders benefits from the services.

“A quarter of the countries which identify opiates as the main drug problem do not offer the range of medications recommended by WHO,” he added.

WHO has been working closely with the UN Office on Drugs and Crime (UNODC) since 2009 to increase the access to treatment for people with drug use disorders. The health agency notes that the understanding that drug abuse, at its core, is a public health issue has increased in recent years – however, only 82 countries offer special health services to people with drug use disorders.