The Lancet Commission set out to establish a roadmap for how high- burden countries could get on track to meet the goals established by the UN High Level Meeting (UNHLM) in September 2018. Commissioners met regularly over a period of 18 months to answer the question: “How should TB high-burden countries and their development partners target their future investments to ensure that ending TB is achieved?” The Lancet Report provides, comprehensive analysis and specific action items to address this question and, ultimately, remove the barriers to building a TB-free World.
The Report calls upon high-burden countries and the global community to:
Implement and Expand on Proven, Evidence-Based Strategies
- Provide person-centered diagnosis and treatment
- Reach all populations at high risk for TB
- Strengthen and deliver prevention strategies in tandem with active case finding -interventions.
- In Kenya, where rates of HIV/TB co-infection are high, scaling up access to both antiretroviral therapy and TB preventive therapy can help save an additional three million lives over the next generation.
- Prioritize private-sector engagement. To defeat TB, we must recognize that the public sector cannot do it all.
- Modeling demonstrates that optimizing private sector engagement in India could avert eight million deaths from TB between now and 2045
- Provide universal access to drug susceptibility testing (DST) and ensure access to second-line DST for all persons with drug resistant TB.
- In Moldova, where more than 25 percent of all TB is drug-resistant, improving access to DST and second-line drugs would reduce DR TB mortality by 73% in the coming generation.
Invest to Accelerate Development of New Tools
- Invest in and accelerate the pace of TB science, innovation, and development — transformative new tools are necessary to ensure we meet End TB targets by 2030
- Ensuring that 90% of persons with TB are found, diagnosed and treated, and ensuring 90% treatment success can avert 2.2 million deaths/year from TB. To avert the remaining unavertable deaths (0.85 million/year) requires new tools
- Invest in implementation, operational, and programmatic research to rapidly translate research findings into TB control policies and programs to address public health needs.
- Implement and scale up the use of existing biomedical and prevention tools
- Deliver strong advocacy to science ministries and research-oriented pharmaceutical companies to ensure global commitment to TB R&D.
- This investment must be weighed against the cost of inaction: In India, even with optimal implementation of all existing tools, unavoidable TB deaths will cost the economy at least US$32 billion each year over the next 30 years.
Make the Case Why TB is the “Best Buy” in Global Health
- Improved domestic financing for TB is one of the biggest success stories in global health over the past two decades.
- Economic analysis commissioned for this report shows that the benefit of saving a life from TB is at least five times the cost of saving it — and may be much greater in many settings.
- By 2017, 84% of funding for TB came from domestic sources. However, high- burden countries can do more to address their epidemic. Greater domestic resource mobilization can be achieved by increasing the distribution of public resources to health, pooling financing, and allocating tax revenues to health, especially in middle-income countries.
- Countries like Bangladesh, Zambia, China, and Indonesia can increase their annual TB expenditures more than five-fold over the next five years, through increased revenue generation and allocation of greater budgetary resources to health.
- Benefits from preventing TB will exceed costs by a factor of at least three, but likely much more
- Expand on efforts to enact new models of donor financing that focus on results, encourage innovation and strengthen government accountability
Create a New Era of Shared Responsibility
- Fortify the leadership and engagement of civil society
- Establish a country-specific Report Cards to measure progress and where more resources are needed
- Establish a Lancet Observatory to independently evaluate progress
Overall, the Commission states that the roadmap to Building a TB-free World is not a straight path, but rather a winding road that requires countries to be flexible as they respond to changing demographics, patient preferences and available data. While donor countries, funders and others share in the responsibility in breaking down the barriers to end TB, it is the country leaders who ultimately hold the keys to success.
The Commission concludes that the prospect of a TB-free world is a realistic objective that can be achieved with the right commitment of leadership and resources.
The Lancet Commission
Time to bring tuberculosis out of the shadows
(E Zuccala, R Horton)
India’s leadership to end tuberculosis
(J P Nadda)