The Sustainable Development Goals have prioritized ending the epidemic of tuberculosis by 2030. The world is, therefore, at a critical juncture in implementing efforts to control and eliminate tuberculosis. Current efforts have averted 56 million deaths since 2000. We also have better diagnostic tools and the promise of a few new, potent agents in the pipeline.
Yet tuberculosis remains the leading cause of infectious disease deaths globally, responsible for 1.7 million deaths in 2016. The UN’s high-level meeting on TB on September 26th, 2018 represents a unique opportunity to secure a commitment from heads of state and governments for a coordinated global response to end the epidemic.
This Lancet Commission aims to identify decisive global and country-specific actions necessary to ensure the success of that response. The report is due for release in the near future. The full report as well as the modeling and fiscal analyses included will be available here. The report will seek to provide a framework for how ending TB as a global health priority is possible. Below is a summary of the core domains that the report will address:
Scaling up proven strategies
We are not starting from scratch when it comes to the prevention and treatment of tuberculosis. Although new tools and innovations are urgently needed, increasing access to what already works, such as molecular diagnostics for all patients and preventive therapy for those at highest risk for TB, needs to be prioritized. However, we can no longer rely on one-size-fits-all approaches to ending tuberculosis; current efforts are missing millions of people with tuberculosis every year. This Commission highlights how countries can improve outcomes and optimize use of available resources by realigning them to ensure that all tuberculosis care is people-centered and by prioritizing interventions that increase efficiencies in the delivery of tuberculosis services.
Without urgent action, drug-resistant tuberculosis will be the single largest cause of mortality by 2050, responsible for a quarter of the projected 10 million annual antimicrobial resistance (AMR)-related deaths. The Commission will highlight how scaling up evidence-based strategies to address drug-resistant tuberculosis must be a high priority if we are serious about addressing this global health security threat.
Invest to accelerate development of new tools
Investing in research and development must be a global priority. To date, global tuberculosis control efforts have been hindered by the lack of effective and acceptable diagnostic, therapeutic and preventive tools. Furthermore, health-system frailties constrain proper uptake and delivery of existing tools, especially in areas where they are needed most.
An intensification of tuberculosis research across the full continuum—from fundamental to operational research and addressing the formidable challenges of drug-resistant tuberculosis—is urgently needed to address these challenges. The Commission outlines research priorities at global and national levels to help address knowledge and implementation gaps.
Generate sustainable financing
All countries need to dedicate substantial resources to implement strategies to end tuberculosis. Evidence on the cost-effectiveness and benefits of expanded financing for tuberculosis control suggests that such investments will yield a high return. Nevertheless, funding for tuberculosis programmes and research has stagnated in recent years. This Commission reviews and extends the evidence base to provide up-to-date guidance for health and finance ministers.
Create an enabling environment
Creating an enabling environment is essential to successfully ending tuberculosis. In most high-burden countries, tuberculosis efforts are undermined by social, financial and clinical barriers to care. Tuberculosis is a disease of poverty and often has the worst outcomes among the most vulnerable—children, homeless people, prisoners, HIV-infected persons and other marginalized populations.
Tackling tuberculosis must occur in concert with a commitment to securing financial risk protection, access to quality essential health-care services, and use of safe, effective and affordable necessary diagnostics and medicines.
If health advocates are to create an enabling environment to reduce burdens of tuberculosis within countries, they must engage civil society and patient groups, acknowledging that they are a crucial constituency that should be involved in all aspects of tuberculosis programming. In addition, new multisectoral accountability mechanisms must be put in place to ensure progress at global, national and local levels is achieved.
Implementing the Lancet Commission’s concrete solutions could accelerate reductions in TB